India does not have a favourable environment for organ transplant. Shortage of dedicated transplant surgeons, lack of clarity in the existing Organ Transplantation Act of 1994 and convincing relatives of brain dead patients are posing a serious challenge to conduct organ transplants in India.

In India, transplants are carried out for kidney, pancreas, liver, heart and bone marrow. But the country records the highest organ transplants in kidney. However, India is way behind in organ transplants compared to the developed world. There are only 2,500 transplants carried out of the three lakh kidney failure cases reported annually compared to the US which has one fourth of India's population and performs 15,000 kidney transplants a year.

According to Dr Ajit K Huilgol, consultant, kidney transplant surgeon at Columbia Asia and Mallya Hospital and chairman and vice president, Indian Society of Organ Transplantation, there are no young surgeons willing to take on organ transplants as a specialization with the result India has only around 4 or 5 dedicated transplant surgeons. Today, transplants are performed at hospitals by urologists or general surgeons for kidney, vascular, cardiac and neuro surgeons for other organs. There are only a handful of centres in India at Chandigarh, Noida, Global Hospital and Krishna Institute of Medical Sciences at Hyderabad which have the infrastructure to perform organ transplants.

Another serious impediment for progress is the Organ Transplantation Act of 1994 which permits only parents, spouse and siblings for organ donation. There is a need to enlarge the scope of the definition of the close relative, stated Dr Huilgol and bring in uncles, aunts, grand parents and cousins. "We need to pressurize the government to alter this Act only to increase the number of cases and allow patients to survive, he added.

The cadaver transplants have also not taken off in India as expected despite the increasing number of brain dead victims. It is difficult to convince the relatives of a brain dead case because of his continuing heart beat, ECG tracing and urine flow into the catheter. With the result, there is always a feeling for the relatives that there could be some remote chance for the patient to survive.

There is also the issue of 'who' is in charge of the body for the doctors to carry out a transplant for the brain dead case, whether it is the parents, children or the spouse.

The Act which allows payment for the donor does not specify the amount and this makes it difficult for hospitals to provide a compensation to the donor who has taken time off from work and needs a period of rest to recuperate. Therefore the Act needs to specify the sum for the donor, informed Dr Huilgol.

With the kidney scams on the rise, resulting out of deceptive patients and donors, nephrology surgeons are finding it difficult to handle cases. "The hospitals should not be put into problems when patient and donor hoodwink the Authorization Committee with submission of false claims to perform a transplant," he added.