International Comparisons & Case
Studies in Organ Transplantation: Lessons for India
By Suryavanshi IAS
Introduction
While India’s NOTTO advisory on gender-based priority in
organ allocation is a progressive step, it is essential to examine global
best practices and case studies to refine our
policies. This section explores successful models from Spain, the USA,
and Iran, along with key ethical dilemmas and UPSC-relevant
insights.
1. Spain: World Leader in Deceased Organ
Donation
Key Features:
✅ Opt-Out
System (Presumed Consent) – Citizens are automatically donors unless
they explicitly opt out.
✅ High Public Awareness –
Strong government campaigns normalize organ donation.
✅ Trained Transplant
Coordinators – Every hospital has specialists to facilitate donations.
Results:
- Highest
deceased donor rate (49 per million population, vs. India’s <1).
- 80%
of transplants come from deceased donors (vs. India’s 15%).
Lesson for India:
- Adopt
a hybrid opt-in/opt-out system to boost cadaver
donations.
- Invest
in transplant coordinators at major hospitals.
2. USA: Transparent Allocation & Ethical
Challenges
Key Features:
✅ UNOS
(United Network for Organ Sharing) – A centralized, algorithm-based
allocation system.
✅ Medical Urgency +
Waiting Time – Prioritizes sickest patients first.
✅ Ethical Dilemma:
- Socioeconomic
Bias – Wealthier patients get faster access.
- Racial
Disparities – African Americans wait longer for
kidneys.
Results:
- Fair
but unequal – System is transparent but favors
those with better healthcare access.
Lesson for India:
- Algorithm-based
allocation (like UNOS) can reduce bias.
- Need
safeguards to prevent elite capture.
3. Iran: The Only Legal Kidney Market
(Controversial Model)
Key Features:
✅ Government-Regulated
Paid Donations – Poor donors receive compensation (~$4,500).
✅ No Waiting List for
Kidneys – Eliminates shortages but raises ethical concerns.
Results:
- No
kidney waiting list (unique globally).
- Exploitation
Risks – Poor donors often regret selling organs.
Lesson for India:
- THOA
bans commercial trade, but Iran’s model shows a last-resort
option.
- Ethical
trade-off – Should India explore regulated
altruistic payments?
4. China: Reforms After Organ Trafficking
Scandals
Key Features:
✅ State-Controlled
Donation System – After 2015, only voluntary donations allowed.
✅ Facial Recognition
for Allocation – Prevents fraud.
Controversy:
- Past
use of prisoner organs led to global criticism.
Lesson for India:
- Strict
enforcement of THOA is needed to prevent black
markets.
5. UPSC Relevance: Previous Year Questions
Prelims Question (2023)
Q. Which country follows an "opt-out"
system for organ donation?
(a) India
(b) USA
(c) Spain
(d) Iran
Answer: (c) Spain
- Explanation: Spain’s
presumed consent law makes it the global leader in deceased donations.
Mains Question (GS Paper II – Governance)
Q. "The ethical challenges in organ
transplantation require a balance between equity and efficiency." Discuss
with examples from global practices.
- Approach:
- Compare Spain
(efficiency via opt-out) vs. USA (equity via UNOS).
- Discuss Iran’s
paid model (efficiency vs. exploitation).
- Suggest hybrid
reforms for India.
Conclusion
India’s NOTTO advisory is a step towards
equity, but global models show that transparency, public trust, and
strict regulation are key. UPSC aspirants must analyze:
1.
Ethical trade-offs (e.g.,
Iran’s paid donations).
2.
Policy innovations (Spain’s
opt-out system).
3.
Governance challenges (China’s
reforms).
For more UPSC insights, follow Suryavanshi IAS!
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