Heart transplantation in India—looking back as we celebrate 25 years of the transplant law

A CORRESPONDENCE to this article was published on 18 September 2020


India’s heart transplantation programme is the number one programme in South Asia with an average heart transplantation rate of 0.2 per million population (pmp) versus the global average of 1.06 pmp (2016-2018). The deceased donation rate was 0.67 pmp in India in 2018. The law which made it possible has completed 25 years. In the first 5 years, after the law was passed, less than 50 hearts had been transplanted. The foundation for the deceased donation programme was laid through the creation of an ‘Organ Sharing Network’ in the year 2000 by Multi Organ Harvesting Aid Network (MOHAN) Foundation, a non-governmental organisation in Chennai. The role of the Health Department of Tamil Nadu in streamlining the deceased donation process in 2008–2009 changed the course of the programme. The heart transplantation programme evolved due to a handful of committed hospitals from the private sector. The challenge was in the identification and certification of brain death, and this continues to be the main reason for the low donation rate. The referral government hospitals, which usually receive traumatic head injuries that result in brain death, seldom possess the infrastructure or financial autonomy to start a transplant programme. Hence, expensive transplants like heart and liver have catered to the needs of the economically affordable class mostly. To improve the donation rate will require innovative thinking by taking steps such as strengthening the national programme and creating cross-subsidy formulas in organ sharing so that the less affordable too have access to such surgeries. To showcase the success of the programme, it is also imperative to start a heart transplant outcome registry to study the short- and long-term outcomes.

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  1. 1.

    Mehta N, Singh K. Remembering India’s first heart transplant surgery. Livemint. 2016. https://www.livemint.com/Science/ER42epr7fhSfpB06bpgYPI/Remembering-Indias-first-heart-transplant-surgery.html. Accessed 04.01.2020.

  2. 2.

    Kalra A, Seth S, Hote MP, Airan B. The story of heart transplantation: from cape town to cape comorin. J Pract Cardiovasc Sci. 2016;2:120–5.

    Article  Google Scholar 

  3. 3.

    Ad Hoc Committee of Harvard Medical School to examine the definition of brain death: a definition of irreversible coma. JAMA. 1968.205:337–340. https://doi.org/10.1001/jama.1968.03140320031009

  4. 4.

    International Registry on Organ Donation and Transplantation – IRODaT. www.irodat.org. Accessed 07.01.2020.

  5. 5.

    http://archive.nmji.in/archives/Volume-15/issue-5/letter-from-chennai.pdf. Accessed 07.01.2020.

  6. 6.

    Shroff S, Navin S, Abraham G, et al. Cadaver organ donation and transplantation – an Indian perspective. Transplant Proc. 2003;35:15–17.

    CAS  Article  Google Scholar 

  7. 7.

    Srivastava A, Mani A. Deceased organ donation and transplantation in India: promises and challenges. Neurol India. 2018;66:316–22.

    Article  Google Scholar 

  8. 8.

    Organ donation. https://en.wikipedia.org/wiki/Organ_donation. Accessed 13.03.2020.

  9. 9.

    MOHAN Foundation. Cadaveric organ donation figures in Tamil Nadu. https://www.mohanfoundation.org/cadaveric-organ-donation-figures.asp?state=Tamil%20Nadu. Accessed 07.01.2020.

  10. 10.

    First heart transplant a success. THE TIMES OF INDIA. 2004.https://timesofindia.indiatimes.com/city/hyderabad/First-heart-transplant-a-success/articleshow/483265.cms. Accessed 04.01.2020.

  11. 11.

    Annadurai K, Mani G, Danasekaran R. Road map to organ donation in Tamil Nadu: an excellent model for India. Int J Prev Med. 2015;6:21.

    Article  Google Scholar 

  12. 12.

    Menon J. In Tsunami land, women sell kidneys to payoff debts. The Indian Express. 2007.http://archive.indianexpress.com/news/in-tsunami-land-women-sell-kidneys-to-pay-off-debts/20802/ Accessed 13.03.2020.

  13. 13.

    Gopalan TN. Tsunami victims ‘selling kidneys’. BBC. 2007. Accessed 01.02.2020.

  14. 14.

    Carney S. Black-market scandal shakes India’s ban on organ sales. WIRED. 2007.https://www.wired.com/2007/05/india-transplants-main/.Accessed 07.01.2020.

  15. 15.

    Menon J. TN hospitals: won’t take responsibility. The Indian Express. 2007 http://archive.indianexpress.com/news/tn-hospitals-won-t-take-responsibility/27029/ Accessed 13.03.2020.

  16. 16.

    Abraham G, Shroff S, Shivanand Nayak K, et al. Deceased-donor renal transplantation program in India. Kidney Int. 2010;77:378–80.

    Article  Google Scholar 

  17. 17.

    Tamil Nadu government to promote cadaver transplant programme. Indian Journal of Medical Ethics. 2008;5.

  18. 18.

    Transplant authority of TamilNadu, Government of Tamil Nadu: Tamil Nadu Network for Organ Sharing. https://www.tnos.org. Accessed 01.02.2020.

  19. 19.

    National Organ & Tissue Transplantation, Government of India. https://notto.gov.in. Accessed 01.01.2020.

  20. 20.

    Shroff S. Twenty-five years of transplantation law in India – progress and the way forward. Indian J Transplant. 2019;13:151–3.

    Article  Google Scholar 

  21. 21.

    Lakshmana KV, Babu R. Kerala air ambulance carries for organ transplant in Chennai. Hindustan times. 2015. https://www.hindustantimes.com/india/kerala-air-ambulance-carries-organs-for-transplant-in-chennai/story-Q9aqqSfdbDLGBiA72q2W2N.html Accessed 13.03.2020.

  22. 22.

    Heart transplant in India: favourable for foreigners or few takers here? Business Standard. 2018. https://www.business-standard.com/article/current-affairs/heart-transplant-in-india-favourable-for-foreigners-or-few-takers-here-118120600139_1.html. Accessed 02.01.2020.

  23. 23.

    Amalorpavanathan J, Karunakaran C.E. Does India’s heart transplant setup really favour foreigners? THE WIRE. 2018. https://thewire.in/health/india-heart-transplant-foreigners. Accessed 02.01.2020.

  24. 24.

    Vijay KS. In Chennai, the hearts beat for foreigners. 2019. THE HINDU. https://www.thehindu.com/news/cities/chennai/organ-transplant-racket-surfaces-in-tamil-nadu/article24139506.ece. Accessed 02.01.2020.

  25. 25.

    Poor enforcement, training behind India’s high road traffic accident numbers. India Spend. 2019. https://www.indiaspend.com/poor-enforcement-lack-of-training-causing-more-deaths-on-indian-roads/. Accessed 07.01.2020.

  26. 26.

    Sadegh Beigee F, Mohsenzadeh M, Shahryari S, Mojtabaee M. Role of more active identifications of brain-dead cases in increasing organ donation. Exp Clin Transplant. 2017;15:60–2.

    PubMed  Google Scholar 

  27. 27.

    M. Smith, P. Murphy, A historic opportunity to improve organ donation rates in the UK. British Journal of Anaesthesia, June 2008;100: 735–737. Accessed 13.03.2020.

  28. 28.

    National Organ & Tissue Transplantation, Government of India. https://notto.gov.in/WriteReadData/Portal/images/THOA-amendment-2011.pdf. Accessed 13.03.2020.

  29. 29.

    Medical Council of India. https://www.mciindia.org/CMS/information-desk/college-and-course-search. Accessed 01.01.2020.

  30. 30.

    Yadav R. AIIMS Colleges 2019: list of AIIMS campuses, category-wise seat distribution and admission fees. EMBIBE BETA. 2018. https://www.embibe.com/exams/aiims-colleges/. Accessed 02.01.2020.

  31. 31.

    Ellman PI, Ronson RS, Kron IL. Modern concepts in heart transplantation. J Long-Term Eff Med Implants. 2003;13:465–83.

    Article  Google Scholar 

  32. 32.

    Donation after circulatory death. NHS blood and transplant. https://www.odt.nhs.uk/deceased-donation/best-practice-guidance/donation-after-circulatory-death/ Accessed 13.03.2020.

  33. 33.

    Manara AR, Murphy PG, O’Callaghan G. Donation after circulatory death. Br J Anaesth. 2012;108:i108–21.

    Article  Google Scholar 

  34. 34.

    Singh S, Kumar S, Dasgupta S, et al. A single-center experience of kidney transplantation from donation after circulatory death: Challenges and scope in India. Indian J Nephrol. 2017;27:205–209.

  35. 35.

    Shroff S, Navin S. “Brain death” and “circulatory death”: need for a uniform definition of death in India. Indian J Med Ethics. 2018;3:321–3.

    Article  Google Scholar 

  36. 36.

    Kerala Network for Organ Sharing. www.knos.org.in. Accessed 13.03.2020.

  37. 37.

    Patil V. Indian Air Force to create green corridor for rapid transport organs. Defense world.net. 2017. https://www.defenseworld.net/news/14801/Indian_Air_Force_To_Create_Green_Corridor_For_Rapid_Transport_Organs#.XmoFhKgzaUl. Accessed 13.03.2020.

  38. 38.

    Nayar A. Indian Air Force saves two lives by flying organs from Pune to Delhi. Huff Post. 2016. https://www.huffingtonpost.in/2015/07/31/indian-air-force-organ-de_n_7908872.html. Accessed 13.03.2020.

  39. 39.

    Wapner J. Medical transport drones could transform health care in overcrowded cities. Newsweek. 2016. https://www.newsweek.com/2016/02/05/india-organ-transplant-drones-419013.html. Accessed 13.03.2020.

  40. 40.

    Wakefield J. Lifesaving kidney delivered by drone. BBC. 2019. https://www.bbc.com/news/technology-48132595. Accessed 13.03.2020.

  41. 41.

    Ahanti’s Heart Transplant Was Done in the Nick of time, Thanks to Crowdfunding. Impact Guru. 2019. https://www.impactguru.com/success-stories/ahanti. Accessed 13.05.2020.

  42. 42.

    A transplant that won a Pakistani heart. The Hindu. 2013. https://www.thehindu.com/news/national/tamil-nadu/a-transplant-that-won-a-pakistani-heart/article4743444.ece. Accessed 08.01.2020.

  43. 43.

    Ayushman Bharath Pradhan Mantri Jan Arogya Yojana. National Health Authority. Government of India. https://www.pmjay.gov.in/. Accessed 13.03.2020.

  44. 44.

    Mars Orbiter Mission. https://en.wikipedia.org/wiki/Mars_Orbiter_Mission. Accessed 13.03.2020.

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We wish to thank our staff Sujatha Suriyamoorthi, Manager, Information Systems, and Juhija Rajendran, Biostatistician, for their editorial assistance and in compiling the data. We also wish to thank Global Observatory on Donation and Transplantation and the National Organ and Tissue Transplant Organization for some of the data that we have used in this article.

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Shroff, S., Mittal, K. & Navin, S. Heart transplantation in India—looking back as we celebrate 25 years of the transplant law. Indian J Thorac Cardiovasc Surg 36, 215–223 (2020). https://doi.org/10.1007/s12055-020-00957-6

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  • Heart transplantation India
  • Brain death
  • Transplantation law
  • THOA
  • MOHAN Foundation