Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2016; 6(2): 331-335
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.331
State of deceased donor transplantation in India: A model for developing countries around the world
Georgi Abraham, Madhusudan Vijayan, Natarajan Gopalakrishnan, Sunil Shroff, Joseph Amalorpavanathan, Anand Yuvaraj, Sanjeev Nair, Saravanan Sundarrajan
Georgi Abraham, Sunil Shroff, Anand Yuvaraj, Sanjeev Nair, Saravanan Sundarrajan, Madras Medical Mission Hospital, Chennai 600037, India
Madhusudan Vijayan, Kilpauk Medical College, Chennai 600010, India
Natarajan Gopalakrishnan, Joseph Amalorpavanathan, Madras Medical College and Government General Hospital, Chennai 600003, India
Author contributions: Abraham G, Vijayan M, Yuvaraj A, Nair S and Shroff S wrote the manuscript; Gopalakrishnan N, Sundarrajan S and Amalorpavanathan J provided the data and reviewed the manuscript.
Conflict-of-interest statement: None declared by the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Georgi Abraham, MBBS, MD, FRCP (Glas), Madras Medical Mission Hospital, No. 4-A, Dr. J. Jayalalitha Nagar, Mogappair, Chennai 600037, India.
Telephone: +91-98-41420992 Fax: +91-44-26565510
Received: January 13, 2016
Peer-review started: January 15, 2016
First decision: February 29, 2016
Revised: May 11, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: June 24, 2016

Renal replacement therapy (RRT) resources are scarce in India, with wide urban-rural and interstate disparities. The burden of end-stage renal disease is expected to increase further due to increasing prevalence of risk factors like diabetes mellitus. Renal transplantation, the best RRT modality, is increasing in popularity, due to improvements made in public education, the deceased donor transplantation (DDT) programme and the availability of free and affordable transplant services in government hospitals and certain non-governmental philanthropic organizations. There are about 120000 haemodialysis patients and 10000 chronic peritoneal dialysis patients in India, the majority of them waiting for a donor kidney. Shortage of organs, lack of transplant facilities and high cost of transplant in private facilities are major barriers for renal transplantation in India. The DDT rate in India is now 0.34 per million population, among the lowest in the world. Infrastructural development in its infancy and road traffic rules not being strictly implemented by the authorities, have led to road traffic accidents being very common in urban and rural India. Many patients are declared brain dead on arrival and can serve as potential organ donors. The DDT programme in the state of Tamil Nadu has met with considerable success and has brought down the incidence of organ trade. Government hospitals in Tamil Nadu, with a population of 72 million, provide free transplantation facilities for the underprivileged. Public private partnership has played an important role in improving organ procurement rates, with the help of trained transplant coordinators in government hospitals. The DDT programmes in the southern states of India (Tamil Nadu, Kerala, Pondicherry) are advancing rapidly with mutual sharing due to public private partnership providing vital organs to needy patients. Various health insurance programmes rolled out by the governments in the southern states are effective in alleviating financial burden for the transplantation. Post-transplant immunological and pathological surveillance of recipients remains a challenge due to the scarcity of infrastructure and other facilities.

Keywords: Deceased donor transplantation, Kidney, India, Developing countries

Core tip: Deceased donor transplantation (DDT) has been increasing in India, especially in the southern states due to proactive policies of the state governments and public private partnership. With the goal of achieving maximum organ harvesting from potential organ donors and universal access to transplant services, small steps of improvement have been made. The DDT program in India has to keep progressively expanding to cater to the end-stage renal disease affected population of India.