Feasibility of the Development and Implementation of an Organ Donor Registry in Mumbai, India

Abstract

<p><strong>Background:</strong> Organ donation in India is a complex issue due to the country’s large population, diverse religious beliefs and myths surrounding organ donation, varying literacy rates, nation-wide focus on disease control, and the commercialization of organs. India has only made marginal steps to address the significant obstacles in order to ensure adequate supplies of organs are available to meet the demand.</p> <p><strong>Purpose: </strong>The purpose of this study is to analyze the feasibility of implementing an organ donor registry in Mumbai, India. This is achieved by reviewing current organ donation policies and processes in Mumbai, exploring perceptions of key informants about Indian government health priorities, and identifying possible reasons why the Indian government has not made efforts to increase the deceased donor rate.</p> <p><strong>Methods:</strong> This qualitative policy analysis employs semi-structured interviews with physicians, transplant coordinators, and representatives of organ donation advocacy groups in Mumbai to explore key informants’ perceptions about the feasibility of developing and implementing an organ donor registry. The 3-I framework (ideas, interests, and institutions) is used to analyze the results and frame the discussion and their implications.</p> <p><strong>Results:</strong> Key informants cite various barriers to the implementation of an organ donor registry in Mumbai, including public misconceptions about organ donation, competing health priorities on the government agenda, and limited hospital infrastructure.</p> <p><strong>Conclusion: </strong>In the absence of a focusing event or a policy entrepreneur who is able to push the issue of organ donation onto the health policy agenda, both central and state governments may have little incentive to aggressively pursue the implementation of a donor registry in more than a superficial way. Moreover, even if the issue reached the government’s policy agenda, current barriers may be too overwhelming to overcome. This suggests that implementing an organ donor registry in Mumbai as a means of enhancing organ availability is not feasible in the current environment. Instead, efforts to enhance the transplant system should focus on alternate strategies, such as public education, until the policy environment becomes more amenable to change.</p>