Women more proactive to kidney donation in Bihar

In a male dominated society, the trend of women sacrificing one of their two kidneys for their loved ones, and the number of males benefiting out of the donations have only increased over the years

PATNA: What Rohini Acharya, sister of Bihar’s deputy chief minister Tejashwi Yadav, did by donating kidney for her father Lalu Prasad, 123 other women, as compared to only 50 men, have done the same for their immediate family members out of the total 173 renal transplants reported in the state since 2016, as per data sourced from Bihar’s State Organ Tissue and Transplant Organisation (SOTTO) at Patna’s Gandhi Institute of Medical Sciences (IGIMS), as the country celebrated Indian Organ Donation Day on Thursday.

Of the total 15 renal transplant donors in 2016, as many as 12 were women (Shutterstock)

The ratio of women kidney donor to recipient in Bihar, however, is lopsided. Barely 17% women have benefited as recipients from the 71% of the total kidney donations done by women. Over 83% beneficiaries of the total renal transplants have been men.

In a male dominated society, the trend of women sacrificing one of their two kidneys for their loved ones, and the number of males benefiting out of the donations have only increased over the years, especially till 2019. The coronavirus pandemic affected live organ donations. The number of renal transplants reduced post Covid-19, only to gradually gain momentum now.

Of the total 15 renal transplant donors in 2016, as many as 12 were women. Thirteen among the 15 beneficiaries from these donations were male. In 2019, there were as many as 23 females among a total 34 kidney donor of which 29 recipients were male, as per data available with the SOTTO.

Interestingly, all beneficiaries of the 22 renal transplants in 2022 were men, when women accounted for 15 kidney donations. Similarly, 13 males have benefited from 10 kidney donations by women and four by men, out of the 14 renal transplants done so far this year till July.

“It is the emotion of women, which prevails in two-third cases of organ donation, whereas in one-third cases, men force the women to donate their organs,” said Dr Manish Mandal, chairman of SOTTO and also the deputy director and medical superintendent of IGIMS.

Males, however, outnumber females when it comes to donating eyes after death. Of the 553 cornea donors registered since 2014, male accounted for 248 and female 196. Likewise, male beneficiaries were higher (537) as compared to 339 females, as per SOTTO data.

Bihar, which is the second most populous state of India, with close to 125 million people, and accounts for 9.10% of the total country population (137,05,08,600 - source: Unique Identification Authority of India, 2020), is at the lower rung when it comes to cadaveric donations.

Bihar has reported only two cadaveric (brain stem death) donations — one in 2018 and another in 2020. Southern and western Indian states, including Kerala, Tamil Nadu, Rajasthan, Gujarat, Andhra Pradesh, Maharashtra, Haryana and Punjab are far ahead in such donations, thereby facilitating retrieval and transplant of organs and tissues.

In the first instance of cadaveric donation in Bihar, the heart and liver of the deceased were flown to New Delhi through a green corridor, while the cornea and kidneys were utilised at the IGIMS. In the second case, the heart was taken to Kolkata while the liver, cornea and kidneys were utilised at the IGIMS.

Infrastructure for heart transplant is now in place at the IGIMS, and Bihar government last year gave its nod for the procedure. The institute, however, does not have a decent recipient pool for undertaking the transplant, said Dr Sheil Avneesh, additional professor and head, department of cardiothoracic and vascular surgery (CTVS) at IGIMS.

“We have got all the wherewithal and permissions for doing a cardiac transplant, but we need a rich patient pool. Due to lack of awareness, barely 2-3 patients have registered with us as recipients for the heart transplant,” said Dr Avneesh.

Ekta Rani, SOTTO’s information, education and communication consultant, said knowledge and public awareness about organ and body donation was low in Bihar and there was lack of willingness to donate organs.

“Many people do not understand what a brain dead means and in spite of several rounds of counselling, they refuse to donate their organs. Family members of patients who are brain dead often get confused with coma and harbour hope of the patient reviving, but the fact is that brain death is irreversible,” said Rani.

“A living donor can donate one kidney, a portion of liver, while from a cadaveric or brain stem death organs like heart, kidneys, lungs, pancreas and liver; and tissues like cornea, heart valves, nerves, bones and skin can be donated. From one donor, at least eight lives can be saved, while many lives can be improved with tissue donation,” she added.

However, such is the psyche of women in the state that they dissuade their husbands and other male members in their family even from pledging to donate their organs after death, ruedRani.

Not surprisingly, only 700 people, of which 458 are men and 242 women, have so far pledged for organ donation and registered with SOTTO, as per available data till March 31 this year.

“The higher enrolment of men is because of their comparatively higher footfall at our organ donation awareness camps, where we hand out forms to the people willing to pledge their organs,” said Rani.

“We even noticed at such camps that rural populace are more inclined towards organ and body donation as compared to the urban people,” she added.

There have been few body donations as well in Bihar.

IGIMS, which is the state’s leading medical colleges in terms of body donations, has received 13 bodies since 2014, said Dr Avanish Kumar, professor and head, department of anatomy, IGIMS.

“More persuasion is required to convince people to donate their bodies after death. The Dadhichi Deh Dan Samiti (DDS) has done a commendable work to spread public awareness in this regard. It has facilitated in nine of the total 13 bodies we have received through donation so far,” said Dr Kumar.

“The awareness about body donation is increasing. We have received six bodies so far till July this year, as compared to one last year and two each in 2019 and 2021,” he added.

The demand for organs is much higher than their availability, as per the national registry. India requires 2 lakh kidneys whereas only 10,000 transplants are being done annually because of their low availability. Similarly, it requires 30,000 liver whereas only 2,000 transplants are being done annually. It requires 50,000 hearts and 1 lakh eyes, whereas only 250 cardiac transplants and 50,000 corneal transplants are being done annually due to their low availability.

There are 529 establishments registered as transplant or retrieval centres in India with the National Organ and Tissue Transplant Organisation (NOTTO), as per government data of 2019. Of them, only 10 of the 19 government-approved centres are registered with SOTTO in Bihar.

With the total number of transplants having gone up from 4,990 in 2013 to 12,666 in 2019 (source: NOTTO Guidelines, 2021), India is the third country after US and China to do transplants in the world.

India’s organ donation rate, which is the number of deceased donors per million population, also increased from 0.27 in 2013 to 0.65 in 2018.

The demand and supply gap of organs, however, still remains high.