Proposal Argument Essay about Organ Donation

Research Proposal

Background of the Problem

The shortage of organs is virtually a universal problem but Asia lags behind much of the rest of the world. India lags far behind other countries even in Asia. It is not that there aren't enough organs to transplant. Nearly every person who dies naturally, or in an accident, is a potential donor. Even then, innumerable patients cannot find a donor.

Over the years, the number of deceased donors has witnessed a threefold increase. While in 2013, there were only 313 donors across India, 2014 saw 411 donors and 2017 had 905 cadaver organ donors. But still given the demand and size of the population, India remains a country with one of the lowest organ donation rates in the world. Vasudevan S. (2018)enlists the top 5 reasons why organ donation lags in India were:

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• Lack of family consent
• Superstitions and misconceptions
• Lack of education and awareness
• Lack of brain-dead declaration and
• Lack of organ transplant and retrieval centers

The pressure on the Government saw the passing of the Transplantation of Human Organ Act (THO) legislation that made unrelated transplants illegal and deceased donation a legal option with the acceptance of brain death. Overcoming organ shortage by tapping into the pool of brain-dead patients was expected to curb the unrelated transplant activity. The last decade has seen the struggle of the deceased donation program evolve in India. Simultaneously, it has witnessed the living donation program being marred with constant kidney scandals. In most instances, the donor accused the recipient or the middleman of having not compensated them with the promised sum. It also saw liver, heart, and pancreas transplants from deceased donors.

Although the history of cadaver transplants in India is recent, the first attempts to use a cadaver donor’s kidney were undertaken in 1965 in Mumbai. They faced medical and social problems. The medical problems included technical difficulties in engrafting, immunological problems, and infection. However, it was the hostile reaction from some members of the medical profession and the general public that was a more daunting task to tackle. The whole process was described by some as neo-cannibalism.

This was a setback for the cadaver program all over the country. In India, despite the THO act, neither has commerce stopped nor the number of deceased donors increased to take care of organ shortage. The concept of brain death has never been promoted or widely publicized. Most unrelated transplants currently are being done under the cloak of legal authority from an authorization committee. The few deceased donations that are taking place are due to the efforts of a few Non-Government Organizations (NGOs) or hospitals that are highly committed to the cause. Recently, the government has come under much criticism from the public and media and has added a few legislations in the form of a Gazette to curb the illegal unrelated donation activities and has tried to plug the loopholes in the THO act. To a large extent, the failure of the THO Act has been because of the way it has been interpreted and implemented by authorities and hospitals. In Kerala, the deceased donor transplantation program started off well but ran into difficulties following which the Government issued fresh guidelines.

There are numerous obstacles creating the organ shortage. In third-world countries, there are concerns about superstitions, religious beliefs, outdated and inadequate medical technologies, underequipped transplant centers, improperly trained transplant coordinators, the lack of public education, and the black market that can greatly impair any progress that could be made in the field of transplantation (Daar, 1998a, 1998b; Pande, 1997; Patnaik, 1997; Singh, Srivastava, & Kumar, 1998). In addition, the cadaver candidate must be identified, a request must be made from the family, and the family must give consent to donate the organs (Kennedy & Rettig, 1996). These obstacles are dominant in all countries that perform transplants. For patients waiting for an organ, cadaver transplantation is accepted as an alternative to death in the United States.

Unfortunately, underdeveloped countries are still in a premature stage owing to certain religious beliefs and superstitions held by the public (Dash, 1999)—making cadaver organ donation in these countries is more difficult for the public to accept Because of the lack of medical technology available in certain countries, the ideal donor candidate is a patient who is brain dead and attached to ventilators to keep the circulation flowing. In the United States and other advanced countries, organs can be packed and transported across the country, whereas in underdeveloped countries organs can only be kept for the amount of time the brain-dead patient is on the ventilator. The problem in achieving donations from brain-dead patients exists within the patients’ families’ beliefs, superstitions, and culture, and denial of death. Families are inclined to believe that if the heart is still beating the patient may come back. Emotional feelings of giving up on the patient may overwhelm the family and prevent them from wanting to accept brain death

Organ transplantation is one of the greatest medical marvels of the twentieth century, which has prolonged and improved the lives of hundreds of thousands of patients, worldwide. Countless acts of generosity by organ donors and their families have made transplantation not only a life-saving treatment but also a shining symbol of human solidarity. The disparity between the huge demand for organs and their poor supply is the main issue of concern. Organ shortage is a global issue and deceased organ donation is the major sustainable solution.

The organ donation and transplantation system strives to honor the gift of donated organs by fully using those organs to save or improve the quality of the lives of transplant recipients. As a result of advances achieved through basic and clinical research over the past several decades, organ transplantation has become the optimal treatment for many end-stage organ-specific diseases. However, there are not enough donated organs to meet the demand. Furthermore, some organs may not be recovered, some recovered organs may not be transplanted, and some transplanted organs may not function adequately, all of which exacerbates the imbalance between the supply and the demand for organs.

The government of India promulgated the Transplantation of Human Organ and Tissues Act in 1994 and with the view to enlarge its scope and promote organ donation government has brought new amendments as of year 2014 and 2017. In the background of this journey, many new developmental milestones have been achieved in the country however organ donation which has assumed public health significance has been consistently lower than expectations. Healthcare workers need to be more knowledgeable and promote/ correct the misconceptions of the general public about organ donation and transplantation.

Statement of the Problem

A descriptive study to assess the Knowledge and attitude of Health providers on organ donation, employed in tertiary hospitals in Kerala

Objectives of the Proposed Research

• to assess the Knowledge & attitude of healthcare professionals working in tertiary care hospitals in Kerala
• to find the association between the knowledge & attitude of healthcare professionals working in tertiary care hospitals of Kerala with selected demographic variables.
• o develop an e-learning module on organ donation.

Operational Definition

• Health care workers- WHO defines health workers to be all the people engaged in actions whose primary intent is to enhance health
• Organ Donation- The act of a person giving permission for a part of their body to be taken, while they are alive or after they are dead, and put into someone else's body to replace an organ that is not working correctly- Cambridge Dictionary

Need of the Study

WHO (2015), there is a wide gap between patients who need transplants and the organs that are available in India. An estimated around 1.8 lakh persons suffer from renal failure every year, however, the number of renal transplants done is around 6000 only. An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant. Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed. Similarly about 50000 persons suffer from Heart failure annually but only about 10 to 15 heart transplants are performed every year in India. In the case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.

Brain Stem death is recognized as a legal death in India under the Transplantation of Human Organs Act, like many other countries, which has revolutionized the concept of organ donation after death. After natural cardiac death, only a few organs/tissues can be donated (like cornea, bone, skin, and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated including vital organs such as kidneys, heart, liver, and lungs. Mehta et al [2017]

Despite a facilitatory law, organ donation from deceased persons continues to be very poor. In India, there is a need to promote deceased organ donation as a donation from living persons cannot take care of the organ requirement of the country. Also, there is a risk to the living donor and proper follow-up of the donor is also required. There is also an element of commercial transaction associated with living organ donation, which is a violation of the Law. In such a situation of organ shortage, the rich can exploit the poor by indulging in organ trading.

Supposedly, healthcare providers constitute the group of professionals that should be most knowledgeable in the area of organ donation. Healthcare professionals are the most critical link in the organ procurement process because they are the first individuals to establish a relationship with the potential donor’s family and to have the opportunity to raise the option of organ donation. It has been suggested that a favorable attitude of health professionals toward organ donation can positively influence a potential donor family’s decision to consent .however as many as 61% of the professionals involved in the donation process rate themselves as uncomfortable in approaching donor families. Thus, improvements in the knowledge about and attitude toward organ donation may be an appropriate health policy strategy to increase the limited donor pool.

Nalluswamy et al (2018), identified the following challenges in the field of organ donation

• There is a lack of awareness among people with regard to deceased organ donation, the concept of brain death, and the process of organ transplantation
• More nongovernment organizations should take significant steps to create awareness
• There is a lack of clarity within the medical fraternity with regard to the rules and procedures related to organ transplantation
• The absence of a centralized agency to maintain a registry of donors as well as recipients and ensure maximum utilization of organs, as well as their fair and equitable allocation
• Strong need for developing a centralized organ-sharing network among hospitals for better coordination, timely utilization, and avoiding organ wastage.

More organ donation awareness should be done in the following ways:

1. Social media
2. Celebrity involvement
3. Organizing awareness camps
4. Involving the government and public hospitals.