More donors, fewer transplants: Why TN govt hospitals trail private ones

First, the good news. For the first time since the organ transplantation programme in Tamil Nadu began in 2008, government hospitals in the state received more organ donors (146) than private hospitals (122) in a year (2024), says the statistics released by the Transplant Authority of Tamil Nadu.

Now the bad news. Only 473 transplants were performed in government hospitals compared to 973 in private hospitals, suggesting that despite the rise in the number of donors, patients still benefit more from organ donations in private hospitals than their government counterparts.

A complex issue

Experts blame this imbalance on fewer approved facilities for transplants, lack of skilled healthcare workers, and limited human resources in government hospitals.

Even though the announcement of state honours for organ donors has boosted organ donation in Tamil Nadu, government hospitals require advanced infrastructure and human resources to improve the number of organ transplants in government facilities.

Vascular surgeon Dr Amalorpavanathan Joseph, who was instrumental in starting the Cadaver Organ Donation Programme in the state, told The Federal that despite the rise in the number of donations, several other factors are at play. The issue is quite complex.

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An imbalance

Incidentally, Tamil Nadu records the largest number of road accident fatalities and head injury cases in the country.

“Since most of these accidents involve two-wheelers, we can guess that they are middle-class people. Their organs are utilised for patients registered in private hospitals for transplant,” said Dr Joseph.

He added that most of these accident victims are young — a common phenomenon in many third-world countries. “But public hospitals are not geared to use all the organs, as they have a work overload of providing treatment to regular chronic ailments.”

Hospitals need more resources

While hospitals need to be equipped to perform certain types of transplants, such as those of the heart and lungs, doctors, too, need to be provided special training for carrying out such skilled procedures, pointed out Dr Joseph.

Even if doctors are trained to perform transplants, many of them move to private hospitals. Since even tier 2 and tier 3 private hospitals have transplant services now, skilled doctors keep migrating.

In all, 1,446 organ transplants were performed in the state in 2024, with cadaver donations from 268 deceased. While 177 kidney, 194 cornea, and 87 bone transplants were performed in government hospitals, only five skin transplants, three of heart, and seven of liver were done. No transplants of lungs, hand, heart valve, pancreas, intestine, or combined organs were recorded in government hospitals. Yet, the total number of organ transplants in the state since 2008 was the highest in 2024.

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Not many to perform transplants

Dr N Gopalakrishnan, member secretary of TRANSTAN, the transplant authority of the Tamil Nadu government, said only a limited number of government institutions perform transplants. While only three of them perform liver transplants and two, heart transplants, 12 government institutions perform kidney transplants.

“The government is keen to expand the transplant facilities in the state. We also have private hospitals empanelled to perform transplants for free under the Chief Minister’s Comprehensive Health Insurance Scheme,” he added.

Need for public-private partnership

While kidney transplantation has a high success rate, the donor-matching parameters are very complex in the case of liver, heart, and lung transplant. The complexity of the procedure and low success rate after a year for other transplants, such as bowel and pancreas, are other reasons why their numbers are low in government hospitals.

“If skilled doctors are provided with incentives for performing transplants, they would be able to serve at government hospitals also. Alternatively, the government should also ensure that public-private partnership is increased, and the expertise of top doctors from private hospitals should be drawn to train the government sector hospital doctors,” added a former member secretary of TRANSTAN, requesting anonymity.

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Too many braindead cases?

There is another alarming concern. The growing number of donors in government hospitals is arousing suspicion on the braindead certification being issued in large numbers, despite hospitals having skeletal human resources.

On the other hand, common people are unhappy with the fewer transplants being carried out in government hospitals despite them getting more organs — it essentially shows the organs are not being used effectively by them.

Need for public awareness

Emphasizing the need for building public awareness on the system of allocation of organs, Dr S Ashokan, founder of AP Hithendran Memorial Trust and father of Hithendran, the first cadaver organ donor in the state, narrated the case of a 36-year-old patient who had a kidney disorder.

He was called for a transplant but could not be given the organ eventually because he arrived late at the government hospital. While he got delayed travelling from Chengalpattu to Chennai for the transplant, the organ had to be allocated to the next person in the waiting list because of that. “Such practical challenges need to be addressed and the communication gap should be bridged to ensure transparency,” he observed.

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Question of inequity

Another factor to think about is that although the largest number of transplants in Tamil Nadu government hospitals are those of the kidney, only 12 of the 116 hospitals approved for kidney transplantation are run by the government. Therefore, the government must prioritise increasing the number of facilities approved for transplants.

Dr Sunil Shroff, kidney transplant surgeon and managing trustee of a non-government and non-profit organisation called MOHAN Foundation, which works in the field of deceased donor transplantation in India, said government hospitals receiving more donors is a good move but there is an inequity.

“When the deceased from lower-middle or middle classes of society donate organs, infrastructure and facilities should also be available for them in government hospitals; they should not have to rely on private hospitals for a transplant,” he added.

A lot waits to be done

To establish public trust in organ donation and transplantation in the state, there is a need to equip hospitals, improve infrastructure, and train healthcare workers.

“Skill training should also be conducted for doctors and nurses so that human resources can be made available in public hospitals to benefit more patients. Transplants are already being covered under the Chief Minister’s Comprehensive Health Insurance Scheme in private hospitals. The same funds can be utilised to perform transplants in government hospitals under the expertise of skilled doctors,” added Dr Shroff.

While state honours for organ donors is indeed a well-intended move, experts say it is more important to evaluate the post-recovery survival rate and the success of the transplants based on follow-ups. The efficiency of a transplant, follow-up, risk of infections, and overall health after the transplant also need to be considered.