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Organ Donation Program in Andhra Pradesh and Telangana

Organ Transplantation is one of the most remarkable advances in the history of medical sciences and provides a ray of hope to the thousands of patients suffering from organ failure with a new lease of life through a life-saving organ. Despite of the advancement in medicine and technology, the availability of organs remains a major impediment and the demand outweighs the supply of the organs.

Though the deceased organ donation existed in the late 1990’s, it was sporadic in about half-a-dozen hospitals and the organs that were unutilized were offered to other hospitals i.e. there was a minimal amount of sharing of organs among the hospitals (Deceased-donor renal transplantation program in India, Kidney International (2010) 77, 378–380. doi:10.1038/ki.2009.494 - Georgi Abraham, Sunil Shroff, Karopadi Shivanand Nayak, Jayakumar Matcha, Mohan Rajapurkar, Yuvaram N.V. Reddy, Varun Sundaram and Yogesh N.V. Reddy).

The first formal network of sharing of organs, INOS, was promulgated by a Non-Governmental Organization body called MOHAN in the year 1999 with six hospitals joining the network in Tamilnadu (http://www.mohanfoundation.org/inos-figures.asp)

The overall potential of organ donation from brain dead patients in India is extremely high. With increasing density of motor vehicles and poor implementation of traffic regulation, the number of fatal deaths due to road traffic accidents in recent years has increased and exceeds 160,000 deaths per year. It is estimated that in 70% of such deaths occur due to brain death (Evolution of deceased-donor transplantation in India with decline of commercial transplantation: a lesson for developing countries -, Kidney International Supplements (2013) 3, 190–194; doi:10.1038/kisup.2013.12, Georgi Abraham1, Yuvaram N V Reddy1, Yogesh N V Reddy1, Sunil Shroff1, Milly Mathew1 and Sundarajan Saravanan1)

Erstwhile Andhra Pradesh (now divided into Telangana & Andhra Pradesh) was the fifth largest state in India. It was the biggest and most populous state in South India with an estimated total population of Andhra Pradesh as per 2011 census is 84,580,777 of which male and female are 42,442,146 and 42,138,631 respectively with a literacy rate 67.66 (Census Report of India 2011). There are 508 hospitals, 1,634 primary health centers and 170 dispensaries in erstwhile combined state of Andhra Pradesh with 9,726 doctors (including contract doctors) with 45,509 beds ( Abstract of Government Medical facilities (Allopathic) as on 31/3/2012 www.ap.gov.in & www.telangana.gov.in).

Indian Parliament had enacted the Human Organs Transplantation Act, 1994 with the objective of promoting and regulating the transplantation of human organs like kidney, liver and heart - both live as well as cadaver. The Legislative Assembly of Andhra Pradesh adopted the aforesaid Central Act in the form of Andhra Pradesh Transplantation of Human Organs Act, 1995. In 2003, Indian Network of Organ Sharing (INOS) with its success in Tamilnadu was extended to erstwhile Andhra Pradesh by MOHAN and has also employed grief counselors to explore the possibilities of improving deceased organ donation and provide donor families with support in the time of bereavement among the 10 networked hospitals. The mission statement of INOS was “Let No Organ Be Wasted” and it successfully established the fact that organ sharing was the way forward for the deceased organ transplantation programme. There were a total of 1033 organs and tissues that were shared (as seen in table below) consisting of 449 kidneys, 86 livers, 29 hearts, one pancreas, 16 heart valves, and 452 corneas being distributed and transplanted in various hospitals among the INOS network in Tamilnadu and erstwhile Andhra Pradesh.

Despite passing of the act and rules by the legislature and government, there was no streamlined structure of sharing of organs or mechanism that was developed by the government. In 2009, the Government of Andhra Pradesh appointed a high level advisory committee called Cadaver Transplantation Advisory Committee that came out with recommendations for streamlining procedures for cadaver transplantation and evolve mechanisms for coordination of deceased organ donations and transplantations, create a registry of donors and potential recipients, design guidelines for allocation of organs, and make recommendations on creating an organizational structure for cadaver transplantation (www.aponline.gov.in/APPORTAL/AP%20Govt%20Information/cadaver%20transplantation%20report.pdf). The CTAC after studying the existing system, came up with a suggestion of starting organ sharing network under the government and also a new comprehensive scheme called "Jeevandan" connoting “donation of life” to give a boost to the organ transplantation and designated Nizam’s Institute of Medical Sciences as the nodal center for the AACT (Appropriate Authority for Cadaver Transplantation) as the legal entity with statutory powers under APTHOA 1995 (www.aponline.gov.in/APPORTAL/AP%20Govt%20Information/cadaver%20transplantation%20report.pdf)