 Thank you for that brief intro. Again, today we are joined by our few chapters in the series of Hubli, Mysore, and Mangalore. And Dr. Nagraj Naik, who is from the Department of Nephrology, SDM Darwat, a dear friend, a fellow young Indian member from Hubli era, a very passionate advocate for the cause of organ donation is going to moderate the panel today. So I'll let Dr. Nagraj take it from here. And I really welcome all the doctors for taking your time out through a busy schedule today, and we really look forward to this amazing important session from all of you. Dr. Nagraj, on yours. Thank you, Nilesh. First of all, a warm welcome to each and every one of you. Now it's like my two mothers. One is Manipal, where I passed out. They are all my teachers. Second is young Indians now, where we do a lot of work. So thank you, Nilesh, for asking me to moderate the session. So young Indians and today's topic, youth in organ donation. So probably they should match together. And that is how we have to go forward today. So young Indians has three pillars. One is youth leadership, thought leadership, and nation building. So one of the pillars, youth leadership, should probably take the organ donation forward today. So without wasting much time, we will go to the business. So we'll start with the first panelist. So he is Dr. Ravi Shankar B. He is a nephrologist and head at Manipal Whitefield Hospitals. So he's finished his MBBS, MD, and DM nephrology. He has both national and international experiences. He is a fellowship, and he has fellowship and membership from Indian as well as foreign societies. He's a fellow of Indian society of nephrology, fellow of American society of nephrology, and fellow of Royal College of Physicians. His field of expertise is general nephrology, dialysis, kidney transplant, and interventions in nephrology. He speaks a lot many languages, and he has a lot of publications to his name. So Dr. Ravi Shankar sir will be speaking on organ donation as such. What do you, Ravi Shankar sir? Oh, thank you Dr. Nagaraj. That's a huge introduction about me. I'm not that great. So but anyhow, we are one of our best students, and then I'm happy that you are doing extremely well in Darwad. So I'll start basically, this is basically a kind of opportunity for us on this World Organ Donation Day. So I just briefly touch on what exactly organ donation, what are the types of organ donation, and then what is the need, and then what is the criteria briefly. So I'll start with what exactly organ donation means. So it means that a person who can donate an organ from his body to another person who is suffering with an organ failure, which is permanent. It could be a liver, kidney, heart, or lung. So and then without receiving an organ, he will not be able to survive a normal life. Of course, they'll be on kind of life supportive treatment, but the organ donation and then receiving an organ gives a kind of life to them. That is what is organ donation is meant for. And then why it is important to have an organ donation. So because when you have a permanent organ dysfunction and then you are living on life supportive measures, obviously receiving an organ will lead to a normal life of that particular individual. And then if you look at in India now, majority of the transplant organ donations are living donations. I would say that about 60 to 70%. Reminding 30%, 30, 35% would be cadaver donations, what we call diseased organ donation. And then there is a huge demand for this diseased organ transplant because there will be not everyone will have a living organ donor. So they will depend on a diseased organ or cadaver organ for to have a normal life. So there is a huge gap between the demand and the need and we are still not able to fulfill the donation that can happen because if you look at there is 80,000 deaths because of accidents and 50,000 people can donate organs, but it doesn't happen all the time. Only a small percentage of things only happening and then they do donating the organ. So we need to have more awareness about the organ donation both living as well as the cadaver organ donation. That is the importance of organ donation. So let us come to know like now what are the types of organ donation we have right now. So privately in India, it is a living organ donation which happens about 60 to 70% as I said earlier which means that a person like you and me who are alive who just donate an organ to another person but this is not possible with every organ. So it's only limited to some organs especially like those who have like two kidneys we have so we can donate one kidney from two kidneys and then portion of the liver portion of the pancreas can be done. Whereas heart transplant, lung transplants are not possible because without them though nobody will survive. So this is not possible with the living transplant. So what about the diseased organ donations or cadaver what we call it is? So this means that a person who is dead declared brain dead due to some medical reasons and most of these people are admitted in hospitals and then they are on life supportive measures just for living for some time. But as per the law, Indian law a person who is declared as a brain dead is dead. So that time the physicians in that hospital or the medical team or the transplant coordinators who work for organ donations they just motivate the family that if they are willing to donate their like person organs to other people. So if this motivation process happens effectively and many times these people will the family will agree that okay we would like our person to donate the organs and then they give a written consent and after that the process will continue and there is a retrieval team which will be in the hospital or they go from some other hospital they retrieve the organ and then they transport to different hospitals where the allocation has been given to particularly liver has to go to money pile kidney has to go to Apollo hospital but the patient is in some other hospital. So this is what actually the cadaver organ donation the entire process takes place and this is purely a kind of regulated by Karnataka government what we call this Jeeva Sartakate. So that means this body is the regulatory body which has all the registrations of the people who want to have the cadaver organ and they keep the list based on the blood groups and then they will allocate according to the listing list one to 10 something like that and they will inform the transplant coordinators of the various hospitals and say that okay you are likely to get a kidney or patient in your hospital likely to get a kidney or the heart or liver so that we activate the patients to come to the hospital wait for the organ once we are declared that okay you are going to get the kidney that particular kidney heart liver will go to the respective hospital and the surgery takes place. This is what exactly the cadaver donation and cadaver transplantation process and then but what about natural death people who die of DC not because of this brain death but they die of cardiac arrest due to some reason some disease the heart is stopped but all the vital organs also here dead. So whereas the cadaver donor where the brain is dead but all other organs will be functioning so that we get the all other organs but people have died by naturally they cannot donate vital organs because they're all dead so they can only donate cornea and then skin and then bones sometimes larger blood vessels also being taken and then given to other people or banks they just go to the saving banks. So this is what is basically a types of organ living donor and cadaver donor and then we have donations after a natural death. Okay, so then everyone should know what exactly the brain did. Everybody I said that brain did what does it mean brain did? That means a person who sustained an injury to the brain because of an accident or because of a kind of big bleed in the brain or a tumor or it could be a big clot. So this can cause entire brain becomes non-functional because of this disease and then those people are declared as brain dead because the brain is not working they assess the medical team will assess the brain function by various means and then say that, okay this person brain is not working it is dead. That particular point of time the medical team will say that, okay this person is likely could be a donor to a kind of donate is vital organs which are functioning and then after that the process will go on. So this is what exactly the brain dead or brain death is. So then what is the age criteria? Everybody will ask that, okay if I have a living donor so which donor can donate a kind of organ it could be liver, it could be kidney. So these are the two organs in living donors will happen but usually the age criteria for living kidney or liver is more than 18 years of age but the upper limit of age is not like very fixed and there are donors up to 70 years also even 75 years if they are physically healthy medically healthy they can still donate the organ. So it is not that exactly age is the number but 18 years since as per the law is the cut off they should cross 18 years of age then they can be a voluntary donor either for the kidney or the liver. And what about are there anything contraindications? That means somebody cannot donate a living donor or cadaver donor cannot donate. Yes, there are some some suppose some person want to donate but if I found that that patient has got active malignancy, active infection or some organ damage already is there usually they are not the candidates to donate an organ which could be liver or kidney. So similarly in deceased organ donation also there are some criteria like somebody who died of active malignancy, active infections which can cross infect the patient who received that organ or they have already damaged taken place during the process of cadaver in the hospital. So sometimes their heart is not good because of heart failure or the kidney is not good already kidney function is not good and then liver function is bad. So these patients also they cannot really donate that particular organ but they may still be able to donate other organ. Suppose the liver is not good. So probably we'll say that okay liver is we cannot take retrieve the liver but the kidney is good. We still retrieve the kidney and then we transport that particular organ to a different hospital where the allocation takes place. So this is what in general. So what is organ donation and then what is the kind of types of organ donation? What is the benefit of organ donation? And then what are the like the indications and contraindications of organ donation? But in general, so we are in India I would say that predominantly it's a living donor program. The cadaver or disease donor program is still not very active but if you compare to last 10 years we are definitely much above the previous the numbers like we are close to some hundreds in a month and all. So but this is what is growing but we need to have much more awareness of the organ donations, not only the living but mostly in on cadaver or disease organ donations because there is a lot more patients who doesn't have a living donor due to various reasons they will be just waiting for a cadaver or disease organ donor to have a life. So I certainly say that last week, two weeks back there was a patient 51 years of age and then he was waiting for the last two years for an organ he got a kidney all of a sudden and then now he got transplanted on 21st July and then he was discharged after seven days his creatinine, he was on dialysis but creatinine was 0.9 and then hemoglobin is 10 and then he's just totally independent and then he's sit at home and then doing outpatient consultations with me. Similarly we have some patients cadaver but there are good number of living transplants also but I'm happy that a lot of family member they come forward either parents or brothers, sisters including spouses, I have done many spouse transplants. So and they are doing well, the success rates are pretty good. So I'm sure that this program will activate and then inform the younger people to see that how to activate this program especially the disease transplant program in the city, in the state and in the country. So that's what the information is. So I hand over to my student. Hope this information is adequate. Yeah, thank you sir for this elaborate information. In fact, talking about those contraindications I still remember in Manipal we had a patient who was a dialysis patient and he had a stroke. Then the family volunteered to donate the liver. So I still remember my residency days in Manipal. So thank you sir for the elaborate explanation. We'll come back to you during the panel discussion. So a lot of questions are pending for you. Okay, thank you sir. So now we welcome our next panelist, Dr. Sanjay Rampuresar. Sanjay Rampuresar is a consultant nephrologist at Manipal Hospital Jainagar. So he's finished his MBBS MD and DNB nephrology from Minu. He has a fellowship of the Indian society of nephrology. His field of expertise are hemodialysis, then renal transplant and acute renal failure. He has also had a lot of publications. So I welcome you Sanjay sir, over to you. Sanjay sir will be speaking on basically how we transfer the organs from one place to another about Jiva Sarathakate, green corridor and the role of transplant coordinators in organ transplant. Thank you Nagraj for the introduction. Can you hear me? Yes sir, you are very clear and loud. Yeah, Dr. Ravishankar has covered most of the topics. Elevator has spoken, so he left me only a few points to talk. So I'll be talking about organ transfer. What is organ transfer? Organ transfer is nothing but transferring the kidney which is retrieved from one hospital to another hospital. So one person has two kidneys and the one kidney will be wherever the organ retrieved that hospital gets one kidney and the other kidney goes to another hospital. So the organ that is retrieved and the transplant same hospital is almost like a living donor transplant. So not much time is wasted and transplant is more successful there. And if you transfer one or one hospital to another hospital in the same city. So that will take some time. So it might take half an hour, one hour. So that my delay is okay. And if you transfer one CT to another hospital, CT that is also called transfer of organs maybe from one state to another state. So this is also organ transfers. So in Manipura hospital we have done kidney transfer from Mysore, Mangalore and other Pada Shumoga. So all these places have come to kidney from Manipura because the organ transplant program was not running well there. So in the initial period now they have their own transplant programs. So initially we used to get kidney from other places and used to transfer through a called green corridor. So where in the police used to create to clear the traffic and transfer but that is mainly used for heart transplant nowadays kidney transplant because the kidney can be stored in a ice pack for more than for up to 24 hours. So we have got transplant during Manipura hospital for up to 18 years, hours after Drikrival also we hadn't transferred the highest time period where we hadn't transferred for 18 hours. So this is a transfer of kidney from or any other organ from one hospital to another hospital. And green corridor is the one where the police with the help of police will create a signal-free trap road so that the ambulance can come fast and reach the hospital. And it is mainly used for in the heart transplant because heart cannot be kept in the outside body for more than few hours. So it is mainly kept for the heart but kidney can be sustained in the ice box for up to 24 hours for the kidney the green corridor is not required for kidney transplant. And coming to the Jeevan Sarthakate so wherever there is a as Ravishankar explained it is a government body created to distribute the organ and coordinate between different hospitals and distribute the organs among the different hospitals and they maintain a list of all the patient data and the way when they are in dialysis, how many P, what's the age of the patient, what's the basic kidney disease and how long they have been in dialysis and when they got registered for the kidney transplant kidney transplant. So over a year seniority will be allocated to the kidney and the decision of the Jeevan Sarthakate is finally allocated to the kidneys that not the individual hospital can decide which kidney to go to where. And also the kidney that is procured in the inside the hospital also the one kidney which go to the same hospital also the hospital cannot decide it has to be go through it has to go to the Jeevan Sarthakate and from there the allocation happens. And also we get a lot of calls from the patients for dialysis patient they say call up was until our relative died so in the yeast and the brain dead condition can we take the organ from him. So that is also not possible. Is everything is very transparent and it is very clear to everybody that everybody should go to the Jeevan Sarthakate and then they have distributed the organ they know hanky panky here and no jumping the queue, no influence on the minister somebody's and nothing works. It's very strict, very transparent and everybody can see their number going up or coming down how long they have been waiting what is waiting for everything they'll come to all information is provided in the Jeevan Sarthakate website. And coming to the transplant coordinators transplant coordinates are either nurses had some trained in the since graduate who have been trained to coordinate different hospitals or in the hospital between surgeons and patients to further donor and recipient transplant workup and also take necessary approvals from the government and also maintain the keep the record and to contact the patient donor. So all this is done by the coordinators who have been especially appointed by each hospital to smooth running of the transplant program. I'll hand it over to Nagraj to continue the other panelists and take up questions when we have the panel discussion. Thank you Sanjay sir for the very elaborate explanation of what is green corridor? What is Jeevan Sarthakate? Then who are transplant coordinators and all in fact, recently from the arward we have sent one liver through green corridor. So the surgeons were so meticulous in planning because they linked it with the commercial flight and they went one or two hours before the flight they got the liver out and they were reached the airport from STM hospital in just around eight minutes. And then from there it went to Bangalore and from Bangalore to the Bangalore hospital. Thank you, sir. Now coming to our next panelist, Dr. Deepak Dubey. Dr. Deepak Dubey sir is HOD and consultant urology, robotic surgery and renal transplant at Manipal Hospital's Bangalore. So he has finished his MS general surgery from Zipmar and his MCH urology from SGPGI Lucknow. He has experience of around 32 years and has performed 750 robotic urological procedures. He is the leading transplant surgeon in Manipal Hospital, Old Airport Road, Bangalore. One of the finest surgeons, urologist of the country. Or to you Deepak sir. Deepak sir will be speaking on renal transplant surgeon. Thank you, Dr. Nagraj. So basically what happens is transplantation kidney, liver or any other organ is a combined effort between physicians and the surgeons. So for every specialty, there's a medical aspect and a surgical aspect. So as far as kidney transplant is concerned, the nephrology on nephrology colleagues will take care of the transplant patient and we get involved from the surgical aspects of kidney transplantation. So it's a combined team effort that is done to carry out the organ transplant. How is the organ transplanted? Obviously it's a surgical procedure and there are a variety of surgical procedures available for the transplantation. Traditionally it was done using an open surgery. Open surgery means involving a cut in the lower part of the abdomen and the donor kidney is then taken and transplanted into the blood vessels into the recipient's body. So that was the traditional way and it is still practiced in most places. However, surgical technology has been advancing over a period of time and the purpose of this improvement in technology is to provide better care to the patient, make the procedure less painful, allow them to get discharged early from the hospital and then also to carry out their activities, normal activities as quickly as possible after the surgery. So the entire endeavor in the surgical aspect is to minimize the pain and discomfort associated with surgery and improve outcomes. So most recently we have started using robotic surgery for doing kidney transplantation. This is a relatively new technique wherein it is largely done using keyhole surgery wherein you don't have to make a big cut in the abdomen and the kidney is inserted through a very tiny incision inside the recipient and the entire procedure is done by the surgeon using the facility of the robot. So that is a procedure which is evolving. We at Manipal Hospital in Bangalore have taken the initiative and we were the first people to conduct the robotic kidney transplant in Karnataka and since then we have made steady progress in this technique. So it is definitely beneficial in some patients to undergo a robotic transplant compared to the open transplants. So that is about how the transplant is done. Is it a major surgery? Yes, it is a major surgery and it is done in places where there is good teamwork available, good ICU facilities available and a well-coordinated team. So well-coordinated teams will obviously not be available in smaller hospitals. You need a larger setup. You need ICU, blood bank and you need a well-oiled team with good coordination between the urologists and the nephrologists. And in that regard, Manipal Hospital again has been a pioneer in providing the best outcomes for kidney transplantation over a period of time. Talking about surgery, it's also important to talk about the surgery for the donor, the live donor. Now the live donor is a very peculiar situation where this is a completely healthy, normal, active individual in society without any disease and they have decided to donate one organ or a part of their organ to their loved ones or near and dear ones in order to make them live a normal life. So this is an act of supreme sacrifice and a large amount of innovation in the donor surgery has been developed to minimize the pain, discomfort and problems associated with an open operation for kidney donation. In this regard, traditionally the surgery was done using open technique where there was a cut made into the body and then the ribs were cut and then the kidney was removed. But now for quite a number of years, this has been replaced by a laparoscopic surgery for the donor. So laparoscopic surgery is a keyhole surgery which we make small holes in the abdomen and then the entire procedure is conducted and towards the end the kidney is removed by a very small incision. Thereby minimizing the pain for the donor, allowing the donor to recover fast and to get back to their normal routine as quickly as possible. So again in this matter also we have taken a huge initiative for starting laparoscopic donor to affect me in the Manipal Hospital group and now it is catching on almost in many other places. So a lot of advances have been made as regards the technique and refinements in surgery. How much time does it take for the surgery? Well, typically the entire process that is the live donor surgery and the recipient surgery take about three to four hours. Both are done simultaneously, that is one team starts to remove the kidney in one of the operation theaters and on the other operation theater which is next to it, the recipient surgery is immense and as soon as the kidney is retrieved from the donor it is taken inside and transplanted to the recipient. So surgery approximately three to four hours, it's a big operation but when you have a well oiled team and good expertise available these surgeries are done very routinely and without much complication. So that way I would like to emphasize that teamwork is very critical in providing good outcomes for kidney transplantation. Are there any other things to be prepared before surgery? Well, good assessment is done for both the recipient and the donor. The critical assessment for the recipient is what is the right timing for the surgery? Are they well prepared in terms of adequate dialysis has been given if required and their other organ systems are in reasonably good shape like you need to have a good heart and lungs to undergo this kind of surgery. So very careful evaluation is done before the actual surgery is carried out. The evaluation is even more thorough for a live donor because this is again a normal person who is not suffering from any kind of disease or marginal disease like marginal hypertension or marginal diabetes. They have to be thoroughly evaluated with the intention that once they donate one kidney they are able to live completely normal lives after the donor surgery has been done. So careful evaluation is necessary before the surgery is performed. And last word, people need to be aware that kidney transplant recipients or like any other organ recipient can live completely normal lives. And they have many questions about whether they'll be able to return to travel, return to doing sporting activities and various things. For the information of people, they conduct a world transplant Olympic Games once in two years where they conduct an Olympics for people who have undergone various types of transplantation and there are transplant recipients who come and do marathon sprints and all other many activities that are conducted in the normal Olympics. So this is to show that once you have a transplant you can actually even resume good sporting activities indicating that you're back to completely normal. And with the newer techniques of transplantation where the surgery has become less painful and past recovery that also aids in all this. So thank you very much. This is in brief about the surgical aspects and I'll ask Nagraj to take this further. Thank you. Thank you Deepak sir for clearing all the doubts and confusion about surgery because for a common man kidney transplant they think it's a very big thing. And probably because of robotic surgery the morbidity has come down. In fact, I'm very proud to say that I was there when the first robotic transplant took place in Puneepal hospitals. Thank you sir. And I think we'll thank Deepak Dubeh sir. He has to leave early because of surgery. So on behalf of AI and Manipal team I would like to thank you for joining us and being one of the panel members. Thank you sir. Thank you very much. Thank you sir. Now going ahead with our next talk I would like to invite Dr. Srinivas R.P. Dr. Srinivas R.P. is a consultant urologist at Whitefield Manipal Hospital. So he finishes MBBS, MS general surgery and DNV urology from Manipal Hospital Bangalore. He has many fellowships and membership and he has also a lot of publications. His field of expertise is laparoscopic urology, transplant urology and reconstructive urology. He also speaks a lot of languages English, Canada and Hindi. Over to you Dr. Srinivas. Dr. Srinivas will speak on how do we transplant kidney? Then what are the precautions that the patient should take and what are the complications of renal transplant surgery? Over to you Dr. Srinivas. Thank you Dr. Nagaraj. On this occasion of organ donation day, I would like to reach out to the common of the country and the state that this is the time to think back and be an organ donor and promote the message among the common public. So since there's a overlap slightly in a few of the topics with our fellow speakers, in case it's required, I'll try to speak a bit in Canada in case that is of use to the people. So when we talk about this cadaver that is people donating after the death of an individual. So initially the people are looked for suitability and matching and whether the organs are healthy and the organs are transported in a cold chain. That is called as preservatives. Suitable media, the preservative media, that is, and I don't want to say that the kidney is a serious disease. Any serious disease like infection or tumor or anything like that, the kidney is very huge, doesn't allow the donor kidney to be grafted. So if you don't have an organ, you just have to take the kidney. You don't have to take the kidney. Plus, if it's a disease, actually the organ is still uncool. The native kidney is uncool. So it doesn't have to be normal. If it's in a different place, it's not enough. You can put the kidney in a different place. And and you know the operation, there are a lot of people. Usually almost 100 people, almost 80-90 people, usually there won't be any problems. If there are any problems, it's not enough for bleeding. Or, you know, if you have an immunosuppression, it's enough for infection. Or if the immunosuppression is right, it's not enough for immunity. They don't have to reject it. If they don't have the drugs, if the immunity is less for infection, it's enough for the drug to be right. So it's enough for the kidney to be rejected. Or if the kidney is bleeding, it's enough for the kidney to be damaged. If it's not enough, it's not enough. But these chances are low. They are planning all this. But in that case, you know, you can't overcome that. But it's not enough. Plus, in general, when it comes to transplant, you have to take care of it. You know, how to take care of yourself after the kidney transplant. That's what the kidney has to say. But in that case, when it comes to COVID, there's a lot of awareness. Usually things, social distancing, you have to wear a mask. Kidney is the only one. Because if you don't suppress it, it's enough for infection. You have to wear a mask. You have to follow a basic hygiene. When it comes to COVID-19, we have to take care of it. These are our transplant patients. They are doing it because they are aware of it. Because that's what we have been advising our patients. And that's what they have been following. It's enough for them to take care of it. This is what they have to do for surgery. You know, the surgery site care. Wound care. You have to do that. And our nephrology doctors and transplant physicians have to take care of everything. They have to follow the same goal. You have to follow the same goal. You don't have to do extra things. And in our organ donation, the awareness is more recent. In our film, the famous actor, Sanchari Vijay, who has done a great act, there's a lot of awareness. But it's not enough to take care of it. We have to carry forward. That's all my talk for today. Dr. Nagraj, you can take on the procedure. Sir, thank you very much for speaking in Kannada. I think probably this is a highlight of today's program. Because you're talking in Kannada, we are all very, very happy, sir. Thank you. Thanks for bringing out the minute points also. In fact, our CM, Bhasavraj Bamae, sir has also pledged his organs today. And probably there are a lot of organ donation programs also from the government today. Thank you, sir. Thank you for explaining this in detail. Thanks, Dr. Prasad. Now, moving on to our next speaker, he is again my teacher, Dr. Jike Prakash sir, a senior consultant in nephrology at Manipal Hospital, Malaysia. After his MBBS and MD, he was trained in DNB nephrology at Apollo Hospital Chennai under Dr. Mani, who is the stalwart of nephrology in India. Currently, he's working with Manipal Hospital, Malaysia as chief of clinical services and consultant nephrologist. He is a consultant in Manipal Hospital from 2002 onwards. He has a lot of publications to his name and also honors and achievements. He was president of nephrology association of Karnataka 2011 to 13, recipient of the Rashtriya Chikitsa Karatna Award, Delhi and has more than 50 abstract and 10 publication. Over to you, Jike P. sir. He sir will be dealing about the most controversial part of today's talk that is myths about organ donation. In the society, it's very difficult to convince the people because they have their own belief, own myths. So sir is going to address about that. Over to you, Jike P. sir. Sir, Jike P. sir. Yeah, thank you, Ranganaj. Basically by now, I think most of us or most of you will know that kidney transplantation is not a procedure which can be done in a day's time. That is the biggest myth. And several years ago, people used to say, okay, kidneys can be stolen is what they would say. And it's not like blood transfusion wherein you can walk into the OPD and then give your blood and come. So it is not like that. It is a very, very laborious process wherein the donor is absolutely evaluated thoroughly to see that he or she is absolutely normal because we don't want the donor to be having any problems subsequently, so we do that. And then the recipient, we look at the recipient subsequently. That's the first myth. Probably the second myth would be that many of us or many in fact, including our own professional people would still think that, okay, there are so many of them who can donate kidneys or their blood, their kidneys is what they keep on thinking. If for your kind information, I should give you some figures, then you'll come to know how deficient we are in in trying to identify a organ donor. If you can understand that there are almost two and a half lakh kidney patients who are awaiting kidney annually. And we do several thousands of transplants in a year. Likewise, liver transplants, the people waiting for liver is almost to the tune of 80,000. The heart is 50,000. And if you look at the scenery worldwide, you can see that the best country, the best country which does maximum number of transplants or Spain, which has almost 43 or 44 donors per million population. And you compare with our country, the latest information tells us that it is just 0.9, this is 0.9 donors per million population. So this is the disparity we have in our country. So that is the gravity of problem. The next myth would be about people saying that my religion won't permit me to donate any kidney. So it is absolutely not true because most of the religions, be it Buddhism, be it Hinduism, Islam or Judaism, they all support wholeheartedly. And they feel that this act is a act of compassion and generosity. So there is absolutely no problem from any religion that they discourage the organ donation. That is the second, the third myth, what we can say. Third thing would be that, okay, I donate the kidney and then subsequently they feel that, okay, my family member would not be able to see my body as I was before. So actually that is not right. The truth is that it is like some surgical means, surgical procedure when we do for a normal living individual. So the organs are nicely treated in a sense that with honor and dignity, the donors are looked after and the body is absolutely kept in a good shape and decor and then the organist, the donor's body is handed over to the patient. So that with absolutely is not true. And then coming to the other myths, probably I'm too young or too old and I have a medical disease is what people tend to think. And this is absolutely not right. Anywhere from five years to almost 60 years and anyone can donate. And these days you're in anger once, anger once meaning even the age of two to three years we take as a prospective, get our donor and as aged as almost 60 to 70, like what our colleague mentioned about the upper limit of the age also can be taken as long as they are vertically fit. I think they can be taken. The other myth which has been doing a lot of rounds is about my organs will they take other organs when I pledge for a single organ? Absolutely no. Somebody has a pledge for kidneys. In fact, we have a scenery in, we've ever seen recently in the Manikal MHV that one of the patient categorically said that okay he wants to donate only kidney. No other organ. So that is absolutely not right. Whatever organ somebody pledges only those organs will be taken is what I would like to say. And the other thing is organ trading. Organ trading, according to the act of that human organs transcontact, which was framed as early as 1994, it says that nobody can really trade any organ and it is punishable under the law is what they say. And the last bit probably would be that people say that okay I have donated my organ this time will I be born with a deficient organ in my body subsequently, which I don't think so we can never accept this argument because nobody, we are not out of mercy of anybody. The almighty are the greater has his own way of doing things and creating things. So absolutely that's also not true what I could say. That's all about some of the myths. There are too many myths, but I would like to just concentrate these couple of ones and then end my talk on that. Thank you, Nagar. Thank you, sir. I think you have brought out clearly all the controversial points. So there should not be any controversy on the controversial points. In fact, about speaking about religion, Dr. Balal sir also took part in one of the programs in 2012 called Santasangama where there were a lot of Swamiji's Virendra Gadesar, everyone, where they propagated organ donation and so all religions should support organ donation, but it is individual choice. Thank you, sir. Thank you for the elaborate explanation. Now next, moving on to the next panelist today, Dr. Vishwanath sir. Dr. Vishwanath sir is the head of the department and consultant nephrologist and transplant physician at Manipal hospital, Bangalore, old airport road. He has over a decade of experience. He's a gold medalist in his DNB days and he has been associated with a lot of publications. Over to you, Vishwanath sir. Vishwanath sir will be dealing with role of youth in organ donation. So probably this is what we have all gathered here today. Probably the gist of today's topic probably he will be speaking. Over to you, Vishwanath sir. Thank you. Thank you, Nagraj. As Nagraj mentioned that today's main emphasis is on youth and I'd like to say a few words about what is the role of youth in promoting organ donation. As we all know, youth is our strength and youth is the strength of any country. If you can educate youth and make the youth aware of the importance of organ donation, nothing like that. It goes a long way in educating the whole society, especially if youth is educated, it will be continued to the next generation to come. And as we all know, India is said to be at prime because of younger population. The same thing if you take western population, most of the population is actually the aged population. So in general, most of them feel India is at its prime because of the younger generation. If we can educate the youth and make sure they have the right things in their mind, they are going to carry on for the next generation. So this is the importance of educating the youth who are the basically torch bearers of any society. So that's the reason youth should be strengthened, they should be educated and they should be made aware of the importance of organ donation, who are the people who are going to carry forward next. Coming to the next question, how can youth contribute to pledging and awareness? So as I mentioned earlier, youth is our strength and they are the guiding light. So youth is the guiding light for the older generation. And fortunately, they are also the hand holders for the next generation to come. That's the reason if youth is well educated, they will be able to guide the older generation and take along with them the next generation to come in a proper direction. That is very, very important. As Srinivas mentioned, Sanchari Vijay by donating his organs has created a huge awareness in the society. People have become more aware. Making aware is more important, especially in the crucial time of brain death of an individual in the family, when somebody has to take a decision, if the youth and their family members are educated, they can take right decisions at right appropriate time. If somebody has pledged their organs and if the youth in the family doesn't allow the organs to be donated, then it will go waste. So as you know, in our country, even if you pledge the organs, at the time of donation, the family also should give consent. That's where youth comes in the form of educating people, creating awareness and taking the society to the higher level. Coming to the next topic, what is the role of organizations like Youth India, Lions Club, Rotary Club? Definitely they are the ones who are going to create this awareness. So as you know, young Indians are creating this platform to educate people, spread awareness and make sure we educate people. So organizations are definitely doing wonderful job in creating awareness. And in fact, many of the societies like Lions Club, Rotary Club, they have their own dialysis units where they also serve the society. This is very important. Coming to the question of how is Manipal Hospital helping organ donation? Manipal Hospital, as we all know, is at the forefront of educating and educating the society, not only in education. Education of the society also is very important. So a part of it is definitely educating the youth. In fact, many educational programs are undertaken by Manipal Hospital. It is actually part of corporate social responsibility, including we go to various officers, I myself have gone to various software companies and given executive talks, how to, what is kidney? What do they do? How to take care of your health? What is the importance of hypertension management? How to recognize early? What is the lifestyle modification? So all these things we are educating, trying to educate more. In fact, we have tie ups with numerous schools in educating the young minds, which is very, very important. So if you saw the seed at the right time, they will be the future of our society. So that is very important. We have also done a lot of vaccination drives in schools to the teachers and other people. In fact, Manipal Hospital has been promoting a lot of organ donations. I don't know if Nagraj remembers, we had one Yatharth kid, this was just before Nagraj joined. He was a five year old kid who had unfortunate event of brain death and their family gave the organs as a cadaver donation. So they in fact saved eight lives. So in the honor of them, and this was a sacrifice which was ultimate, you cannot donate if you are not in the right frame of mind. Thanks to the parents, both of them in their grief, they donated the organs. We did transplant, all of them did well. In the honor of them, we have what is called as Yatharth Foundation and Manipal Foundation, where we are in fact doing free kidney transplants for the needy, especially pediatric kidney transplants which we have done numerous in the recent times after the Yathars. And fortunately, these parents had one more kid and when the mother came and delivered to the Manipal, it was like a festival to us. So this is where Manipal stands out, where we try to educate people, create awareness, especially in the youth. And we do have a lot of corporate social responsibility to take forward in educating society. Thank you, Nagraj. Thank you for the opportunity. Hope we were able to justify the questions. Thank you. Thank you, sir. In fact, I am very grateful to you for talking totally non-nephrological issue, which is probably a social issue and addressing it so nice. Thank you, sir. Probably we as young Indians and probably other organizations like Rotary and Lyons. And of course, all the youth have a bigger role to play. Probably Nilesh must have made a note of it and probably in our future programs, we will involve much. Now we all are youths, but probably we have to involve much more youths in our future programs. Thank you, sir. Thank you. Now, we will move on to the panel discussion. So I want, I request all the panelists to unmute themselves and to switch on their videos. So is Deepak Dubey, sir, there or he has left, sir? I saw him, he's not there. Okay, sir. I think all his questions, Shinima sir can take up. Yeah. Sure, sure. Yes, sir. So we have one question from Kearusha. Doctor just said, in spite of one's wish to donate, many a times, Kitha and Kim go against it and do not permit it when alive. How does the person make sure this doesn't happen? Is there no law? If not yet, is it in the making? In fact, many times I get a lot of queries from my friends also. No, I pledge. So I should take the decision about my donation. In case of eventuality or a brain dead, why should my parents address this? So can GKP sir take this question, sir? Yeah, absolutely. I think what is important here is to note in our country, it works like that. We need to definitely check with the family members before allowing somebody to take away men. It's always for retrieving, you know. So unfortunately, that is a normal rule in our countries. I don't think so that we can deliberate on this or have any second opinion on this. Some ruling has to come. Subsequently, I don't know whether it will ever happen. This is what I can say. In fact, sir, countries like Spain, I think there is opt-in and opt-out facilities. Yeah, it's there in Singapore. Singapore is an automatic opt-in. If you want opt-out, you have to say that I don't want to donate. Otherwise, automatically it is taken that organs can be donated. Yeah, and that's the reason in Spain, like I said, the number of transplants, cadaver transplants are the highest in the world, almost like 43 per million population. And like rightly what you said, they are opt-in or opt-out, they're opt-out. And we should be happy to note that the central government of India also is bringing in something like this. It is very good. And the second thing what they're doing now is that they're trying to have these cards imprinted on the driving licenses so that some good awareness is created. So these two things I think are really worth noting. Now, next question is to Dr. Vishwanath sir. Dialysis or kidney transplant? If I am a renal failure patient. So dialysis is better or a kidney transplant? Which is better, cost-wise, the quality of life-wise. I'm probably a 40-year-old guy now having renal failure. I'm uncomfortable on dialysis. Why should I not continue with dialysis? Why all the programs about organ donation, why transplant? I am very comfortable on dialysis. Absolutely dialysis is good. It is one of the good form of renal replacement therapy. But again, dialysis is something which doesn't replace the kidney completely. So as we all know, even on dialysis, creatinine can be a little higher. It won't come back to normal. Transplantation is the only way where kidney functions will be completely normalized. And in fact, there is no need to come back for dialysis. Dialysis, it means every other day you have to come for the hospital, have dialysis and go back. The quality of life will be much lesser compared to the transplant. Coming to the first question of cost. Initially cost of dialysis may look a little lower. But if you look at recurring cost, monthly cost if you add to the year, overall cost will never come down in dialysis. Once you have transplant, initial cost may be higher. That's the reason many people think transplantation is costlier. But after the transplantation is over, overall cost will come down. Maintaining a transplant patient after about an year or so with medication will be very, very minimal. Compared to dialysis, it will be almost 10 to 20% of the dialysis cost. So upfront if somebody has a donor or has a caregiver donor and has a transplant, overall cost over a period of two years actually will come down significantly compared to the dialysis. And as you mentioned, why should I have a transplant if I'm good on dialysis? For somebody who is 40 years, definitely quality of life improves after transplantation. They can get back to work. They can do whatever they want. In fact, we have a lot of software or people who want to work outside India where they can have transplant and go back and work wherever they want. Dialysis is not like that. If you are on dialysis, you need to arrange dialysis and go every other day, you have to visit hospital. Quality of life will be much better in transplant. And most important thing for many of them would be fertility, whether they want to have children, whether they want to get pregnant. Transplantation is the only way where they can have children or get pregnant. In fact, my next question was the same to Ravi sir. So transplant any day better, cost wise, quality of life wise. So it doesn't mean that I'm comfortable on dialysis today. So tomorrow I might be fine. So always transplant is a better option. Okay, sir. Ravi Shankar, sir. Now, can I become pregnant while I'm undergoing dialysis or should I compulsorily undergo transplant to have a baby? From our so many female dialysis patients, they will be having query. Often when we go for rounds, they'll be telling no doctor, why I can become pregnant on dialysis, why organ transplant? Can you address this question, sir, Ravi Shankar sir? Yeah, certainly. It's a very important question for ladies especially. It's, yeah, there is a remote possibility that somebody on dialysis for long periods can conceive. But the percentage is very, very small. And then it is not like we can say that, yeah, you have a reasonable chance. So I would say that somebody is wanting to become a mother and then on dialysis, the chances are very remote. And then even if they conceive by chance during dialysis time, and then there are a lot many things we have to do during dialysis because they have to be on dialysis every other day, something like four to five days in a week, they have to be dialyzed. And then we have to take a lot of other important things during dialysis. They should not have a drop in blood pressures, other complications might cause abortions and all in these patients. And then again, pulling them for nine months on dialysis is really, really tough. And then it's a ridiculous procedure for physicians as well as for the patient also. So even though there is a remote chance of becoming pregnant on dialysis, but it's not really a kind of very good option because there will be complications during dialysis and then it's very difficult to pull on for nine months on dialysis. But there are reports in India also, we had a couple of people have become pregnant during on dialysis. And then we have many, some reports from abroad, especially the Canada I was there and there is something like a, they do a nocturnal dialysis, daily dialysis, they'll be on at least nine to 12 hours every day. So those people, the survival of the baby and then the complications will be very less. So if you want really, if somebody conceived by chance, they want to have a good outcome, we have to switch over the dialysis to some kind of nocturnal dialysis, daily dialysis and give a smoother form of dialysis for many hours so that we avoid drop in blood pressures, which is not good for the baby. So this is what has to be done in those patients who conceive by chance, but the chances are not very great. I had seen one patient in Canada that she conceived one, while luckily she conceived second and then in fact that lady was asking for third. So the physician told that, no, no, no more, this thing you undergo sterilization, something like that. But yes, it's possible, but the remote chances are very less. But yes, after transplant, yes, you have got a very good chance. I had my own patients like now who had become father and then we have patients, our own patients become pregnant after two years of transplantation. So dialysis, yes, but complications are a little more and then they have to go through really a kind of herculeous procedure, yeah. So you mean that a kidney failure patient, so he has a better chance to become pregnant, female patient, if they undergo a renal transplant rather than being on... Yeah, obviously, obviously the renal transplant, everything will reverse, their ovularity cycles will reverse and then menstrual pattern will change. So they gain the hormonal things to normal, so that they have a very high chance of becoming pregnant. After the transplantation, around two years time, one and a half, two years of time. But on dialysis, very remote chances, yeah. Thank you, sir. Now my next question would be to Dr. Srinivas sir. Which other organs can be transplanted with kidneys simultaneously? If so, which are the organs that can be transplanted? So we hear of lot of multi-organ transplants and all. So can any other organs be transplanted with kidneys? See, if the question is, can any other organs be transplanted? Yes, there are various organs that can be transplanted. You can transplant liver with the kidney, you can transplant pancreas with the kidney. But the common thing that actually, depending on the disease of the patient, depending on the pathology, that is the problem which has caused the kidney disease. That problem can also affect the liver or the pancreas and all that. So in that, the common combination would be kidney and the pancreas. There's the common organ that sometimes, it's involved. And slightly less common is kidney and the liver that can be transplanted. So both can be transplanted sometimes. It's better if it's transferred from the same donor, like the disease donor, that is after the death of the person. So most organs can be transplanted together. So thank you, sir. So it means that not only kidneys, with kidneys we can also transplant pancreas, we can also transplant liver with the kidneys. Thank you, sir. Now, my next question would be to Dr. Sanjay, sir. I'm a common man. I have attended your webinar today. So I am very much motivated to pledge my organs. Now, how should I go about it? Where should I pledge the organs? Sanjay, sir? Yeah, yeah, yeah. Hello, can you hear me? Yes, sir. The organ donation website, you can pledge the organs. Or you can talk to a doctor. You're treating patients. You can talk to a doctor or your organ donor's website. You can go and pledge your organs. The government of Karnataka operating outside, where you can pledge your organs there and take a sticker also. Come there. In fact, the many sites, Jeeva sir, the Karnataka government body where we can pledge. One more is Mohan Foundation, that is multi-organ, harvest gate network. In fact, our own young Indians, we gift an organ, we have our own link for pledging the organs. So probably there. So we have to contact our doctor or hospital, sir. That is what you mean by telling, we can pledge. Yeah, that's correct. Yes, sir. Okay, sir. Thank you, sir. Do we have time to go ahead with some more questions? Or should we take the recipients of the organs on board? Srinath, are you there? Yes, sir. Sir, the recipients are there. They're also seeing. So can we take the recipients on board? And then we will again go ahead with the panel discussion, if the time permits. Can we do that? Yes, yes. Okay. Now, our first recipient is Mr. Vinod Gowli. He's a 27-year-old gentleman who had renal transplant on May 7th, 2021. Wife has his donor. Can we have Mr. Vinod Gowli? Vinod is there. Or shall we go ahead with our next recipient? Subramaniam is there in the line. Okay, no problem. You just try to connect with Mr. Vinod Gowli. In the meanwhile, we will go ahead with Mr. Subramaniam. He's a cadaver transplant recipient done in 2021 at Manipal Hospital, Whitefield. He's a 51-year-old gentleman. So Mr. Subramaniam, are you there? Idhira, sir, Thau, Subramaniam, sir. Yeah, now he's there. Subramaniam, sir, namaste. Namaste, sir. Now Manipal Hospital, a young Indian, swathi, in the name of your welcome. Namaste, sir. Yes. Okay. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. Sir, there is a wide gap between organ requirement and organ donation. What do you think are the top reasons that resist people to stay away from organ donation? As GK Prakash sir mentioned, there is definitely a lot of people who are waiting for a transplant and then many of them don't survive to receive a transplant. So this wide gap is probably due to a couple of reasons. One is, as you mentioned, the awareness is much lesser. People don't come forward for donation. That is where we need to educate our youth. That's where young Indians will play a major role in educating people, creating awareness so that people come forward to donate. So the message should be, please donate the organs instead of burning or burying them. That is where we can bridge the gap. Unless we do that, people will be actually waiting for a transplant. In fact, in vital organs like heart and liver, you cannot wait for a long time to have a transplant. And unfortunately, these organs, cadaver, is the only way to do transplant. Heart, only cadaver is possible. At least kidney and liver part of it, you can try life, but few organs like lung and heart, you need to have cadaver. Unless you have cadaver organ, you cannot sustain. With the recent COVID, many of us, we have seen a lot of people having permanent damage to the lung and many of them need a lung transplant. People are going around with oxygen at home, going around with oxygen cylinders where people need a vital organ like lung. That is where we can bridge the gap by creating awareness, having more organs pledged and family honouring the decision of donating organs and giving the organs to the society whenever the time comes. That is where we can reduce this gap. If this gap reduces significantly, we can increase the survival of the people and people waiting for a vital organ. So probably you think, sir, with a lot of awareness programs, a lot of change in policies by the government, probably we can bridge this gap. Absolutely. Thank you, sir. Sanjay sir, I am taking you slightly into the controversial shows. Every few months, the newspaper report about organ trade. Is it because the doctors are greedy or is it something else? Why this newspaper report? There is a kidney racket, there is a organ racket. See, it is controversial in the sense. See, it is not so simple. So without doctors involvement, no transport can happen. Hospitals, doctors are involved in transport. See, some racket is happening means it is a combination of many things. Agents, hospital, doctors, society. Depend upon the doctor cannot say that I don't know about the donor. Once I see a donor, I know whether it is related or not. A transplant coordinator sees a donor, he knows whether it is related or not. So doctors are also intelligent. So they can identify which is the real donor, identify which is the fake donor. So there is a composite involvement of the doctors, hospitals, everybody in this fake kidney racket. And every now and then it erupts. Sometimes recently it has happened in Kolkata and Kochi. So many different places, one erupts and then it becomes a big issue and it will be suppressed. And some others it will happen. So it is a combination of factors. Doctors are also greedy. Doctors are not super humans. They are also normal humans and they are also greedy. They also want fame. Hospitals want their fame. So it depends upon the institution, what is their morality, what they stand for in the society. Whether they want to make money through greedy means or normal means. So it depends upon the hospital, hospital, society, doctors, everybody is involved. Okay, sir. I think then probably we have to have our policies right when we choose our donors and recipients. Probably we follow all our legal steps like how we follow in Manipal or STM probably then probably we might not... Yeah, Manipal we have not been doing an unrelated transplant for a long time. We are just doing related now because we have become quite well known in the society and our results are very good. So we don't have to do any other than illegal things to make fame or earn money. But there may be some individuals who are coming up, they want to run faster, become more famous and earn fast money. So they may get involved in all these things and they get trapped. So the police and everybody should be very tough and then through thorough investigation and punishment should be there. Otherwise this will keep on erupting here and there in different parts of India. Okay, sir. Thank you, sir. Probably we should get all our paperwork right and we should not do controversial things which are not there in the law. Probably then we can get saved from all these rackets, all these problems. Only way to prevent these rackets now that just a point to add is to have more Kedavar donations. So when you have adequate number of Kedavar donations, these things will never happen. If you have Kedavar which is fully legal one and it is fully regulated by the government where you cannot do any other hanky-panky things. So that's where you can cut down all these illegal transplants. Well said, sir. Probably if the Kedavar donation picks up in 90 I don't think the live donations will... You don't need a live transplant at all if you have adequate Kedavar. But also basically become very desperate for a transplant. See there are no other options. No Kedavar is happening and only the donor, no donor in the family. So they become desperate and people are going to Pakistan, Turkey, Singapore, Sri Lanka and they are selling out crores of rupees for transplant. Because in India it's become more and more tough. The legal system has become more and more tough. So they are not unable to find any legal transplant. They are going abroad with people who can afford. Unaffording people are continuing dialysis. So the Kedavar program picks up, they know that they have to wait 1 or 2 years. I don't have to do all these things. I mean in couple of years I will get a transplant. So they keep quiet and then wait for the time to come and save the money for transplant. Actually to compare the data in India Kedavar transplant. Being South Indian I am proud that we are doing much more Kedavar transplant in South. Especially Tamil Nadu is the pioneers in this and then they started the very aggressive program. And then after that the other southern states have picked up. Compared to Northern India we are much better but we are still not up to the mark. We have to really go up on the numbers and then definitely we have a scope. So because there are a large number of hospitals in Bangalore will get a lot of accident cases and all. But the motivation still has to be more and more and then retrieve the donation should happen more. As I mentioned that in India total 80,000 accidents will happen and they die. But 50,000 donations can happen but it doesn't happen. So many cases will keep going without donations. So we should have more and more awareness and motivation. Probably in one day we will hit a good number and then we will come across all these difficulties. Those are waiting on dialysis. Some people might die on dialysis also. We lose them because they don't have a donor. So it's really painful but some day definitely we have a hope that we will overcome these difficulties. So the next question is to you only, Ravishankar sir. So my family has one person who is suffering from kidney disease. Another relative of mine has just met with a road traffic accident and he has a brain death. So why should my family not get the priority of my relatives organs? Is there any system like that where if my relative in case of any eventuality to me, brain death to me, my relatives have a priority of getting organs because they want to donate the organs? This question is sometimes we come across in our practice and then we keep seeing here and there. Some families will kind of ask us like whether we have a patient waiting on dialysis, in some other hospital can we get a kidney to that particular patient? Unfortunately, I mean this is not there in our law and then the law has been made that whatever the donation takes place and then there's no directed donation. What we call the family cannot ask or cannot direct that whether one kidney or some one kidney or two kidneys, whatever it is the organ from that patient has to go to his relative, wherever he is undergoing dialysis and the law is very strict and the rules made by various governments all over India. This directed donation will not happen. I mean as of now the law is like that so it doesn't happen. So that's what I cannot say why, but yeah, there will be a lot. Many people will come and tell that okay, I have one patient in some other part of the state. So can you just do that? I have a directed donation so which the law doesn't allow as of now and then it has to be as to go to a pool and then it will be distributed to or allocated to whosoever on the top on the waiting list. It cannot be a prioritized donation towards any patient relative who is suffering from any organ failure, either liver, kidney, heart, whatever it is, it doesn't happen that way. Okay, thank you sir. So probably, so if I have a relative who is on dialysis and I have another relative who has brain dead so there's no priority, so there's no directed donation. The next question is to Srinivas sir. Sir, kidney transplant transplanting the kidney, will it harm the other organs? That is the most common question which we come across. Yeah. It's very obvious. Many people think about this. See, in fact, by doing the transplantation of the kidney to a person who has no disease kidney, which is failed kidney, it actually augments all the other organs functions. It makes the heart better. It makes the liver better. It makes the nerve better. Understand. So overall, all the rest of the body organs will become significantly better functioning. But only thing is during the transplant, so intraoperative during surgery and immediately after surgery or because of the surgical difficulty, there is a small risk of adjacent organ injury and all that which is like part of any other surgery. So not unique to kidney transplant. But yes, because of the kidney transplant, adjacent organs can take a small injury, but nothing very specific that these organs will be injured. It's mostly all organs, functions will be augmented. Overall, the body's, the person's well-being significantly increases because of the transplant. No such is to be supported. So because of kidney transplant, there's no major complication to other organs. No, not at all. Not at all. Thank you, sir. Next question is to GK Prakash sir. Many times, patient tell, see my number is 10th or 15th or 20th in the cadaver released in a particular blood group. So some MLA wants to talk. So can you please make my number come up or so many things in clinical practice. So Rich and the famous people get moved to the top of the waiting list. While regular people have to wait a long time for transplant. Is it true, sir? Absolutely. It is a wrong notion if somebody has. In fact, what we had proposed several years ago is that not proposed. In fact, the criteria is a little different before you even joined the Karnataka, then it is to be called as forte. It means to have some fixed criteria, fixed criteria, many medical conditions, where we can override and then take them based on scoring. So then it was possible probably, but now the Jeevana Satkate, which has come into food from the Karnataka government, there's no way we can probably jump the queue. So that notion of trying to influence somebody doesn't exist. This is what we see. But like Sanjay, what Sanjay was trying to tell. I don't know. In our country, India is a country where it's a paradise, we say. India is the best country to live in because you can do so many things which you can't do in any other country. So if that system, if somebody works at that level, I don't know. We are not aware and we don't encourage at all. So that's how we can say. Okay, sir. Thank you, sir. One last question before we wind up to Vishwanath sir. Our KR Usha has asked Vishwanath sir, what has made people in Tamil Nadu more open to ideas? We say that so many times Tamil Nadu, Telangana is doing very good in Kedavar organ donation. What might be the reason Vishwanath sir? The only reason I can think is awareness. That's where the crux of our team today of young Indians where we need to educate people and also media. Media should give right education to the people. No point in continuously streaming COVID cases. People are dying, things like that. We should also show them positive things. That is where media, media people, young Indian associations, associations like Rotary, Lions Club come in a big way in educating the youth, the general public and everyone on Kedavar donation. Otherwise there is nothing new that Tamil Nadu people are doing, Telangana people are doing. In fact, now Gujarat is also leading in Kedavar donations. Few states there is no Kedavar donations at all. If you look at Delhi, very, very minimal, not even one happens. But Delhi is the most educated society but still why it is happening. So we need to set the frame of mind. We need to create awareness among people and tell them this is the way forward instead of unnecessarily wasting organ. Try to save lives. That is the only way we can educate people and create more and more awareness. Something similar to Spain, what GK Prakash has mentioned. So that is the only way to increase the Kedavar donation. So many times people may not be aware that something like this is there. So if they are aware, definitely the families will come forward. And if that person is already made a pledge of donating, the family should honor that. That is the only way to increase the donations similar to Tamil Nadu and other states. I am sure religion is same in all the states. I don't think there is any only one religion in one state. So it is nothing related to the religion. It is probably the frame of mind. Just to add to Dr. Vishwanath's comment which is very, very valid. It is purely the frame of mind. So there are thousands of people dying every day. I am saying in the world because of the waiting for the kidney transplant. Plus millions of people dying for other reasons. Organs are being wasted. It is only the frame of mind that most people cannot think of when I die, I should donate. They cannot think of their death. Therefore, they don't want to go discuss deliberate things. Okay, let me pledge my organs. Let me become an organ donor. People do not go into the frame of mind. So that's where the awareness will really help. These programs like this organ donation day will significantly help I feel. Definitely. The last thing would be it. I think probably at the grassroot level, we need to do something here. Grassroot level meaning you will have to go to schools, colleges, and then textbook should have a chapter on organ donation. And central state should do something like what the government has nicely done. We're in the availability of dialysis is offered to all the telecast distance and all such moves should come from the government side also. And like Vishwanath and others said, probably we need to have PPP like arrangement. And as you know, I don't think I would like to just tell you that the data group, your SBI bank, your own times of India and others doing wonderful job by trying to propagate this knowledge on organ donation. So I think we should go to that level. I think there's no point in trying to speak to the superiors or at a different level. Probably we need to go at the grassroot level and then communicate this. Yeah, probably education of the society from beginning, I mean younger generation would be useful. And then you look at now, if you go to any of the corporate big, big, you know, top education institute where there is nothing will be shown there. So probably not only in the hospitals, we project in the hospital saying that organ donation is the organ donation. But if you go to people non-medical, you don't see anything there. Anything there, we talk once in a while and all, but it has to be a constant process. So to show them that this is what is needed. So hospitals is fine, people come, disease and all they will say they're okay, okay, but it should be coming for the public. So there's more awareness, even the most educated people did not know. Today morning I put this program in our community, many people sent me a message saying how to pledge organs. So they did not know how to pledge organs. One person said that long time back I signed some paper and all. So I said that I did not know about the paper, but now it is online, it is available. Please go to just pledge organs. You get a website open, you register and you get a number also. So and then inform your family that you have pledged your organs. So that's what also is important because if you don't tell anyone and then I pledge my organs, you met with an accident. And then who will, you know, say know that okay is pledged his organs. Probably in my family, I told everyone that I pledge my organs. So they should know that okay he has pledged his organs and when the organ, it happens like that by bad luck, whatever it is, unfortunate thing. Then they say that yeah, he has pledged his organs. So that's what is needed in our community. So is a community level, we have to do a lot and then awareness and then unfortunately some of that, even our medical institutes themselves, they will see that why I should do. Many years back, one of the top institutes in our state, they said, why should we do for it? They feel that in the organs are going, you know, some other people is like a charm, which is very, very unfortunate. It's not charm. It is basically giving a life to somebody who's suffering and then you know, who's going to die if they're not going to get transplanted. And apparently people have to understand dialysis and expensive procedure for the people and then they spend a lot of money. And then if they don't have insurance coverage and all, it's really tough actually. And the quality of life doesn't change much on dialysis. I mean, they're still containing same restrictions, everything. And then apparently, yeah, transplant or either disease transplant or the living transplant, which makes definitely a difference. So we should educate.