Inspired by media reports and awareness campaigns on organ donation, a small tea kiosk owner from Pattamundai, a small town of Kendrapara district in Odisha, offered to donate the organs of his 14-year-old son, who had just died at the SCB Medical College and Hospital, Cuttack, on March 12, 2011.

However, there was no facility for cadaveric transplantation of organs in Odisha. The tea kiosk owner, Sourendra, could only donate the eyes of his dead son. Strangely, the facilities for organ donation are yet to be developed at a premier hospital like SCB till date.

The concept of organ donation and transplantation is not new to India. According to the Hindu mythology, Dadhichi, the great Rishi, donated his bones for the purpose of killing the demon king Brutrasur. Almost everybody is aware of implanting the head of an elephant over the shoulder of Lord Ganesh and that of a goat for Dakshya Prajapati.

The success of the concept of organ donation and transplantation depends on availability of simple and patient-friendly legal procedure and awareness, appreciation among the people as well as on suitable hospital facilities. It may be recalled that the first kidney transplantation of Odisha was successfully performed in June 1985 at the VSS Medical College and Hospital, Burla, much before the Transplantation of Human Organs Act, 1994, a central legislation, came into effect.

The Odisha Legislative Assembly adopted the act in August 1998 and the necessary rules were framed in May 2001. Kalinga Hospital, Bhubaneswar, started kidney transplantation in November 2002.The amendment to the law – Transplantation of human organs and tissues (Amendment) Act, 2011, – is yet to be adopted by the state assembly and hence, the benefits of the amendment is not available to the people of Odisha.

With almost 21,000 kidney transplantations so far, India stands second in the world. The cadaveric donation is a meagre 0.16 per million. Further, the rate of 0.16 per million will come down to 0.1 per million if we exclude Tamil Nadu, from the rest of India, where the rate is 1.3 per million — the highest among all states. Odisha can take a leaf out of the achievements of Tamil Nadu, which could reach this figure only with sincere efforts since 2008 by way of active participation of the state government in simplifying the procedure, arranging and funding awareness programmes to help create more transplant centres throughout the state.

Similarly, Odisha government can extend transplant facilities to the below poverty line (BPL) people without charging them any money and also provide all the medicines free of cost to them post-surgery until it is required.

Since the surgical cost of organ transplantation in any government hospital is almost half compared to any corporate hospital, social service organisations have been pressing the government of Odisha to create a transplant surgery unit in the government-run medical colleges and hospitals by raising the issue in various awareness programmes, through newspaper articles and having personal discussions with the chief minister, health and family welfare minister and secretaries of various departments and offices.

While delivering a judgment in August 2010 in case of a writ petition, Orissa High Court even issued a directive to the state government to start a transplant surgery unit in all the three state-run medical colleges and hospitals. Only in part compliance with the judgment, kidney transplantation has been started at SCB Medical College, Cuttack, since March 19, 2012, but not much progress has been made with respect to promoting organ donation activities.

Even though the transplantation started since last year, the facilities are incomplete. In order to ascertain the compatibility of the donor and the recipient, various specific tests are to be performed on the persons such as human leukocytes antigen and panel reactive antibody and leucocytes cross matching to know whether they will be compatible.

Interestingly, the three important tests are not available anywhere in Odisha. Hence all the transplant centres, including SCB Medical College and Hospital, are getting them done in metro cities.

The cost of these tests comes to nearly Rs 30,000 for the patient (recipient of the organ) and a time gap of nearly 10 days, apart from the inconvenience and expenditure on the boarding and lodging for both the patient and the attendant, who might have come from far off places to Cuttack.

It may not be out of place to mention that without the availability of the testing facilities in-house, deceased donor (cadaveric) transplantation, the ultimate way to reduce the gap between supply and demand of kidney for transplantation, will not be possible because a retrieved kidney can be preserved for maximum of two days.

It is encouraging to note that necessary steps have been taken to start bone marrow transplantation at SCB, but even in this case having the HLA test facilities is essential. At present, there are only two more centres outside SCB that perform kidney transplantation. Since November 2002, Kalinga Hospital has done more than 300 transplants while Apollo Hospital, Bhubaneswar, and SCB, Cuttack, have about 40 kidney transplants to their credit.

So to make organ transplantation a success in the state, the immediate requirement is to provide the necessary testing facilities at SCB and help patients save Rs 30,000. There should be a proper facility for post-operative care and medicine requirement and to facilitate the commencement of harvesting of kidneys from the deceased persons who had pledged their organs through the donation process.

The Odisha government should adopt the amended provisions of Organ Donation Act, 2011, and start transplant surgery units in the other two government-run medical colleges as directed by Orissa High Court.

Last but not the least, the Centre should legalise the retrieval of organs from the body of the persons being executed (as is the case of China), give incentives for deceased donation by announcing cash awards in advance, make a fixed number of railway journeys for the patients and their attendants free.

This concept of providing incentives by the Centre will generally be treated as welfare measure, and not commercial transaction, which the act intends to prevent.

(The author is an organ donation activist)