Few would dispute that the COVID-19 pandemic is a time where feel-good stories are beneficial for the mind and soul. The story of Nikhit Nischhal is, in a number of respects, such a story. The teenage boy, at the top of his class in school, is to avail a kidney transplant courtesy of the Jharkhand state government.
Jharkhand’s Minister of Health Banna Gupta intervened in the case of the sixteen year-old Bermo, Bokaro native, who originates from an impoverished background. His family appealed to Anup Singh, leader of the Indian National Congress in Jharkhand, who in turn sought Gupta’s intervention. Following this, the state government will pay Nischhal’s medical bills, following his admission to Bhagwan Mahavir Medica Superspecialty Hospital.
“This government under the leadership of Chief Minister Hemant Soren is a people’s government and we will do all everything possible to make the lives of its citizens better,” Gupta said. “I am pained to see such a talented kid suffering from kidney ailment and have assured his parents that the state government will bear the treatment costs.” Nephrologist at the hospital Dr A. K. Baidya has said that “we will be conducting several tests on the patient and after a thorough diagnosis and tests, we will be in a position to conduct a transplant.”
The plight of Nischhal and his family points to a much broader crisis in India, where so many are unable to access life-saving treatments and procedures due to a lack of funds. Of the total spending on health in India, out-of-pocket spending accounts for the overwhelming majority. As reported by Health Issues India last year, “the country’s low expenditure on health…stands at 1.28 percent of gross domestic product (GDP), as of the 2017-18 period. Whilst an increase from the 2016-17 period, when expenditure stood at 1.02 percent of GDP, government spending is still insufficient to address India’s health needs.
“This fuels a high rate of out-of-pocket expenditure on health which data indicates accounts for around eighty percent of the total health spending in India. This drives millions into poverty: 55 million find themselves in this situation because of their medical bills.”
The rising rate of noncommunicable diseases – many of which are chronic and require lifelong treatment and management – in India means that families across the country are facing potentially ruinous expenditure on health. One could divide diseases into many categories, two of which are as follows: physical disease and social disease. The latter encompasses poverty, deprivation, lack of access to a healthcare provider in a time of need, and lack of access to health insurance. The COVID-19 pandemic has only emphasised how social diseases are so deeply ingrained that a healthy India is a long way off unless seismic changes are effected.
The case of Nischhal also points to the issue of organ transplantation. That he is positioned to avail a kidney transplant and fulfil his potential – one which he has said he hopes to apply in pursuit of a career as a doctor – is indisputably good news. However, organ donation in India is not where it needs to be to satiate demand. Life on the transplant list, for many, ends in death.
As I wrote on Organ Donation Day last year, “statistics on the situation are dire. According to Apollo Hospitals chairman Dr Prathap C. Reddy, just 3,500 organ transplants are conducted yearly despite there being an estimated one million people in India suffering from end-stage organ failure. As such, Dr Reddy asserts that fifteen people die each day waiting for an organ transplant whilst the transplant list itself grows at a rate of one name every ten seconds.”
It is important to note that estimates vary. As my report outlined, “the Union Ministry of Health and Family Welfare has said that the figure is in the region of 5,000. Nonetheless, the numbers in both cases are inadequate. 1.6 lakh Indians are in need of an organ transplant whilst just 12,000 organ donors are available. Regardless, data concurs on one major point: there is a major crisis when it comes to organ donation in India.”
In the cases of those in need of a kidney transplant, the figures are not good. As reported by Narayana Health
“[The] Ministry of Health’s calculation says that the annual requirement for kidneys could range between two to three lakh with a mere 6,000 transplants occurring in reality. The variance between the demand and supply of kidneys has to lead the government to push deceased donor or cadaver donations.
“The old statistics from the Indian Transplant Registry (a non-governmental initiative by the Indian Society of Organ Transplantation) says that out of the 21,395 kidneys transplanted in India between 1971 and 2015, only 783 were from a cadaver or deceased donors. This is also due to the lack of awareness and hesitation from the family members.”
That Nikhit Nischaal is to avail a kidney transplant that will not worsen his family’s economic situation is wonderful. However, as is the case with many feel-good stories (especially when it comes to health), it masks deeper issues. No family should be impoverished for vital medical treatment – and no person should languish on a waiting list for a life-saving procedure such as an organ transplant. Proper funding and awareness-raising are key. We must act on these so the current case does not remain so.