Dr H Sudarshan Ballal, Chairman, MHEPL, talks about the current situation of renal transplantation in the country and how the COVID-19 pandemic had an impact and the way forward
A majority of the renal transplants in India are live related (90 per cent live and 10 per cent cadaver or deceased donor) Though the number of cadaver donations is increasing they are far less than the demand at present. This leads to patients waiting on the cadaver list for more than four to five years to receive a deceased donor kidney if there are no related donor available. Some even may not survive waiting for the kidney (cadaver). In India, the average number of transplants done is 6000 to 7000 per year.
For many reasons the southern states have always been the leaders in cadaver transplant and also have had a more robust healthcare system. The northern, eastern and central states have had a less robust healthcare system and lesser number of transplant centres and have not developed strong cadaver transplant programmes, hence the regional disparity. However, Delhi and NCR have a strong live transplant programme and the cadaver programme is slowly picking up.
During the lockdown, both live and deceased kidney transplants had come to a complete standstill world over including India. Though slowly live renal transplants were restarted, cadaver transplants are yet to pick up, though a few have happened during the last two to three months, but much lesser than pre-covid times. In pre-covid era from January to March, the monthly transplant all over India was more than 600. During the lockdown, transplants were almost nil, later came to an average of 100 to 200 per month from August 2020 onwards.
Finding a suitable donor within the family is becoming more difficult as the number of nuclear families is increasing. Family donors have become far and few leading to the patients waiting for cadaver donations which may take many years. To sustain till then with weekly thrice dialysis is a very expensive proposition and will drain the patient and the family financially, emotionally and may also lead to job loss and other problems.
Especially in India, most of the patients do not have any insurance and have to bear the expenses out of the pocket of a transplant which may cost an average of Rs 5-6 lakhs. This leads to a significant amount of hardship for the family and we have to work out a universal health coverage system for our citizens akin to the NHS of the UK or Medicare of the US.
There is an increasing number of patients undergoing SWAP transplants, ABO-incompatible transplants, steroidfree kidney transplants, second /third transplantation(kidney), dual organ transplants like liver-kidney, pancreas kidney etc. Many surgical advances also have taken place like laparoscopic donor nephrectomy, robotic kidney transplantations etc. Most of the centres have good results. Centres with higher volume have always better results.
More number of cadaver donations (similar to what is seen in Spain) is the need of the hour in our country. There are centres doing kidney transplantation including tier-II cities which is a welcome move for the patients. There is a need to educate the general public on the need for organ donation constantly.
