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India’s kidney transplant deficit

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India’s kidney transplant deficit

Why in the News?

India’s organ shortage has increased alarmingly, for which government’s recent reforms (February 2023) allow more flexibility in age and domicile requirements while registering to obtain an organ.

Kidney transplantation in India:

  1. There is a high prevalence of chronic kidney disease (CKD) in India, affecting about 17% of the population, due to
    1. the prevalence of diabetes, malnourishment
    2. overcrowding and poor sanitation
  2.  CKD often leads to end-stage renal disease (ESRD), for which kidney transplant is often the best treatment in terms of almost all dimensions that matter: 
    1. Quality of life, patient convenience, life expectancy, as well as cost-effectiveness
  3. In 2022, over two lakh patients needed a transplant, but there were only about 7,500 transplants (about 3.4%). 
  4. The United States and other developed countries carry out about 20% transplants compared to India.
  5. Stringent regulations in India is the main cause for the gap in transplants.
  6. Ways to obtain a Kidney by the Patient:
    1. Get a kidney from a deceased person.
      1. It is constrained due to a lack of donations, the particular conditions required on the nature of death, and the infrastructure needed to collect and store kidneys.
    2. To request a relative or friend to donate.
      1. However, compatibility in terms of blood type and tissue type, between the donor and recipient acts as a constraint.
    3. Kidney ‘swaps’
    4. Kidney ‘chains’

Need for change in regulations:

  1. Kidney exchange regulations, though required to encourage kidney exchange across family units, change is required to bolster two innovative kidney exchange methods: kidney ‘swaps’ and kidney ‘chains’.
  2. India has barely any kidney swaps and almost no chains due to legal roadblocks.
    1. Swap transplants are legally allowed in India with due permission, but only near-relatives are allowed as donor-recipient pairs. 
    2. If a recipient’s donor is not a near relative (such as spouse, parents), she and her donor cannot participate in a swap.
    3. Exceptions to this restriction are Kerala, Punjab and Haryana, where High Court judgments have recently allowed non-near-relative donor-recipient pairs after verification.
    4. But it is legal for a recipient’s non-near-relative to donate to him/her.
    5. Therefore, there are double standards across swaps and direct donations are questionable.
  3. Lack of national coordinating authority for swaps unlike that available for national, regional, and State lists for direct transplant from cadavers.
  4. There are no kidney chains in India, as it is illegal (except in Kerala) to donate a kidney out of altruism. 
    1. A chain cannot be started since one cannot donate without getting a kidney (for a family member) in return.
    2. Also, kidneys from the deceased or brain dead are only used for direct transplants, not for chains or cycles.
    3. Kidney chains involve significantly lower hospital resources and uncertainty for participants, as each patient first receives a kidney and only then does their relative donate.
    4. This is better than swaps where families demand nearly simultaneous operations of all donors and recipients since no one wants to lose a kidney without gaining one. 

 

 

  1. Stringent have led to a proliferation of black markets for kidneys.
    1. It majorly involves ‘Selling a kidney’ to relieve financial distress.
    2. black markets endanger participants as these operations are conducted without due legal and medical safeguards.
  2. The Transplantation of Human Organs and Tissues Act 1994:
    1. It recognises transplant possibility from brain-stem death.
    2. In the 2011 amendment, swap transplants were legalised.
    3. A national organ transplant programme was initiated. 

Way forward:

  1. Laws for swaps to make them on a par with direct donations is necessary.
  2. Inadequate kidney supply largely unaddressed.
  3. Sufficient precedents have been set globally can be adopted
    1. Australia, Canada, Israel, the Netherlands and the United States (among others) now allow altruistic donations. 
    2. Spain and the United Kingdom have national-level registries for kidney chains and swaps.
    3. Spain even has international collaborations for kidney exchange.

The digital world of cookies

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The digital world of cookies

 

 

What are cookies?

  1. These are bits of code, stored on a device when one visits websites online.
  2. Cookies help in personalisation and user convenience and therefore, play a pivotal role in shaping any online experience.

How do cookies work?

  1. Cookies remember a user’s login information on websites, which prevents the need to repeatedly enter the credentials every time revisiting the site, making it convenient for use.
  2. The cookies are used to provide recommendations and content based on personalised user experience.
  • For instance, Amazon’s cookies shall remember products browsed to purchases made by the user.
  • This knowledge helps it to give product recommendations and content, making the online shopping feel like a personalised boutique experience.
  1. Cookies are also employed to track online behaviour for extracting commercial benefits.
  • Platforms like Facebook and Google track online behaviour using cookies to align the ads encountered by the user with his/her preferences.

What are the types of cookies?

  1. Session cookies
    1. They are temporary cookies like post-it notes for websites.
    2. It is stored in the user’s computer’s memory only during your browsing session and vanishes on closing them.
    3. It helps the websites remember actions as the user navigate, like items in the shopping cart.
  2. Persistent cookies
    1. They are the digital equivalent of bookmarks.
    2. Stays on the device even after the browsing session ends
    3. They remember login information, language preferences, and even the ads interacted with to provide a more personalised web experience.
  3. Secure cookies
    1. It is only sent over encrypted connections, making them safer.
    2. They are often used for sensitive data like login credentials.

What are the uses of cookies?

  1. They act as digital ID cards, aiding in user authentication by allowing websites to recognise and keep the user logged in during their visit.
  2. They foster a sense of personalisation, recalling users’ preferences such as language choice or website theme.
  3. They act as digital equivalent of a persistent shopping cart, ensuring that items added online remain there when the user return.
  4. It facilitates website owners to gather data about user interactions, enabling them to make enhancements and customise content.
  5. They play a pivotal role in targeted advertising, as advertisers use them to display ads that align with the users’ interests and browsing history, making online shopping more enticing. 

Challenges associated with cookies:

  1. It pitches privacy concerns as it tracks the user’s online behaviour, which can sometimes encroach upon the user’s digital privacy.
  2. When cookies are nor secure, it can raise security concerns as cybercriminals can pilfer user’s personal information. 
  3. Third-party cookies (cookies from a domain other than the one visited by the user) have sparked debates, prompting many web browsers to curb their usage to safeguard user privacy.
  4. The data deluge generated by the multitude of cookies can potentially clog the user’s browser, leading to a sluggish web experience.

The Digital Personal Data Protection Act, 2023 recently enacted necessitates websites to acquire explicit consent from users prior to collecting or processing their personal data via cookies.  This has rendered obsolete the concept of implied consent as satisfactory, highlighting the significance of transparent and well-informed consent.

Maldives Election and India

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Maldives Election and India

 

 

Why in the News?

Maldives is set to face the second round of Presidential election very soon, after no candidate secured more than 50% of the votes in the first round on September 9.

Maldives Election:

  1. Maldives’ electoral system is similar to France, where the winner has to secure more than 50% of votes.
  2. If no one crosses the mark in the first round, in the second round, the top two candidates go head-to-head.
  3. In the first round of polling, Maldives President Ibrahim Mohamed Solih secured 39% of the votes, while the Opposition alliance candidate Mohamed Muizzu got 46%.
  4. Maldives has a population of about 5.2 lakh people, among which 2.8 lakh are eligible voters, of which about 1.6 lakh are members of various political parties.
  5. The multi-party system was adopted after a new Constitution adopted in 2008, that mandated Presidential elections after every five years, contrary to earlier method of electing President through a referendum.
  6. The opposition party candidate is Muizzu, seen as a proxy of Yameen has threatened to terminate agreements with foreign countries and expel foreign companies if they are not beneficial to Maldives and its people (hinting at India).

Engagement between the two nations:

  1. India worked with Abdul Gayoom closely for three decades (1978-2008).
  2. After Nasheer was elected as the President, he soon began courting China and cancelled the GMR contract for the Maldives airport in 2012.
  3. In 2013, Maldives joined President Xi Jinping’s Belt and Road Initiative.
  4. In 2018 elections, Solih won which led to strengthening of relationship.
  5. India has reached out to Maldives on various occasions, say from providing vaccines to building infrastructure to helping with debt relief assistance.
    1. India’s swiftly dispatched 30,000 doses of measles vaccine in January 2020.
    2. Rapid and comprehensive assistance during the Covid pandemic has reinforced India’s credentials of being Maldives’ “first responder”.
    3. India was the first to assist Maldives during the 2004 tsunami as well as the water crisis in Malé in Dec 2014.
    4. Current Projects of India at Maldives include road and land reclamation under the Addu development project, water and sanitation in 34 islands, the Greater Male connectivity project with bridges, renovation of a mosque, building the national college for police, among others.
  6. Trade relations:
    1. Trade between the two countries was about Rs 50 crore last year, of which India exported commodities worth Rs 49.5 crore and imports primarily scrap metals, and is exploring seafood products.

Why Maldives in important for India:

  1. Maldives's location and its position at the hub of commercial sea-lanes running through the Indian Ocean makes it strategically important to India.
  2. Maldives’ proximity to the west coast of India led to enhanced defence ties between India and Maldives, especially since the 26/11 attacks, for coastal surveillance and maritime cooperation.
  3. India has trained over 1,500 Maldivian defence and security personnel in the last 10 years, meeting around 70% of their defence training requirements.

Though India is viewed as a development partner, a large section of Maldivians, particularly the youth, are getting attracted to the ‘India Out’ movement propagated by the opposition party of Maldives.