• Foreign nationals have been found to be receiving disproportionately more cardiac transplants over locals in India despite dearth of donors.
• Recently, a controversy has erupted in this regard, opening up a debate that could help in correcting the faultiness in our transplantation policy.

What are the problems in the India’s current transplant policy?

• India’s organ allocation program currently lacks transparency.
• While Tamil Nadu has one of the best “deceased donor programs” in the country, there are some concerns regarding alleged preferential allocations.
• Recently, the controversy has heated up due to a leaked communication from the head of the “National Organ and Tissue Transplant Organisation”. 
• As public credibility is vital for the sustenance of any program, faith among the masses needs to be restored at the earliest.

Why are foreigners getting more transplants done?

• While there is a foreigner skew for recipients across organs (liver, kidneys etc...), the trend is pronounced in heart transplants.
• This is because, unlike others, heart transplant require a deceased donor, which is difficult to spot in countries that don’t have dedicated programs.
• So patients with advanced heart failure from countries that don’t have a deceased donor programme have no option but to try their luck in India.
• As most heart transplants are performed in corporate hospitals, the costs in India are well beyond a large majority of the local population.
• Hence, as affordability among foreign nationals is more, there is a clear skew that is visible among recipients.

What needs to be done?

• For ensuring credibility in the deceased organ donation program, mere calls for transparency in organ allocation won’t work.
• Rampant privatisation has led to a profit oriented approach to health and has thereby financially skewed organ transplants to the rich. 
• We will have to ensure that organs will go to those who need them the most rather than to those who can pay for them.
• Subsidising transplantation cost (in private) and quota based organ allocation to public hospitals are some options that can be considered to ensure fairness.
• This would mean, public hospitals should step up their capacity to integrate with ‘deceased donor programmes’ to catch up with their private counterparts.

What is the way ahead?

• One of the reasons behind Europe’s high donation rates is public trust in their respective nationalised health schemes.
• To ensure that such aspects are mimicked in India, we need imbibe among the mass, the feeling of inclusiveness.
• As India has comprehensively embraced liberal markets (even in health), innovative policies are needed to ensure equity in health access.
• Thus far, Tamil Nadu has led the way in deceased donation and also has a good record of public medical institutional infrastructure. 
• Hence, its model can become an all India template after some alterations.