Organ Donation Myths, Realities And The Future Of Kidney Transplants In India

The Silent Epidemic: Diabetes, Hypertension, and Chronic Kidney Disease in India

India is grappling with a silent epidemic of non-communicable diseases (NCDs), with diabetes mellitus (DM) and hypertension leading the charge. According to the Indian Council of Medical Research (ICMR), over 101 million Indians are currently living with diabetes, a 44% increase from 2019 figures. Additionally, around 136 million individuals, or approximately 15.3% of the population, are prediabetic and at high risk of developing diabetes The Times of India.

Hypertension is equally widespread, affecting roughly one in three adults, with 43% of those with diabetes also having high blood pressure, and over 25% of hypertensive individuals also living with diabetes. The Times of India.

Together, these are the foremost contributors to chronic kidney disease (CKD). Recent studies show that CKD prevalence in India has surged from 11.1% (2011–2017) to 16.4% (2018–2023) among individuals aged 15 and above Wiley Online Library. Additional reports estimate that one in three diabetics eventually develops CKD, underscoring the heavy burden of renal complications, The Times of India.


Insights from Dr. Tanmay Pandya, HOD & Director, Nephrology & Renal Transplantation, Sarvodaya Hospital, Faridabad

The CKD Spectrum and End-Stage Kidney Disease (ESKD)

CKD spans a continuum, but the most serious phase is End-Stage Kidney Disease (ESKD) - a stage where patients require kidney replacement therapy. India sees over 300,000 new ESKD diagnoses every year, all needing some form of treatment, either dialysis or transplantation. The LancetWiley Online Library.

Why Transplantation Stands Out

For quality of life, longevity, and cost-effectiveness, especially in resource-limited settings, kidney transplantation is the preferred modality.

The Source of Donor Kidneys

Most transplants in India rely on living-related donors, typically because of easier availability and cultural acceptance. This process is regulated under the Transplantation of Human Organs Act.

Safety of Living Kidney Donation

Humans can function well with just one kidney, making living donation feasible. Studies show that the increased risk of developing CKD post-donation is only 0.24% a minimal and acceptable figure when donors are thoroughly screened and managed.

Donor Selection & Recovery

Careful donor screening involving multi-specialty consultations ensures safety. Post-surgery, donors typically recover and return to routine activities within two weeks, with lifestyle guidance and periodic health check-ups to ensure long-term well-being.

Overcoming Donor Limitations: Kidney Swap Transplantation

Often, willing donors face blood group or tissue incompatibility. To mitigate this, India utilizes kidney swap (paired exchange) transplantation, where incompatible donor-recipient pairs are matched across swaps. Swap programs are legally supported, with organizations like ISOT and NOTTO actively promoting them. For instance, IKDRC in Ahmedabad performs 100–150 swap transplants annually, and ISOT has even developed software to match donors across pairs.


Summary

India’s rising tide of diabetes and hypertension is fueling a parallel rise in CKD and ESKD cases. Kidney transplantation, especially from living donors, is currently the most viable long-term treatment, offering improved patient outcomes in terms of quality of life and economic sustainability. Through well-regulated protocols and innovative solutions like kidney swap programs, India continues to expand transplant availability while safeguarding donor and recipient well-being.

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