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‘Men get priority’: Data shows Indian women get less access to heart, transplant surgeries

Data from several hospitals in country shows women biggest organ donors, but less likely to get lifesaving surgeries than men. Gender gap more pronounced in north India, doctors say.

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New Delhi: There are many things women in India are deprived of just because of their gender. One of them, it would appear, if data from some prominent hospitals is anything to go by, is equitable access to life-saving surgeries.

ThePrint accessed data of some of these hospitals for three major surgical specialities that come with significantly high costs for operation/rehabilitation — cardiothoracic, organ transplant, and orthopaedic surgery.

The data shows that there is a significant gender skew in favour of males in two specialities: cardiothoracic and transplant surgeries. This even when, doctors say, the likelihood of a man or a woman requiring these surgeries is comparable.

However, the numbers appear to be slightly less skewed as one moves southwards, with doctors claiming that the gender gap in surgeries is a reflection of social realities, which may vary in different parts of the country.

Overall, there is another trend — organ donors tend to overwhelmingly be women. For instance, a representative from Delhi’s Max Super Speciality Hospital Saket told ThePrint that seven out of 10 donors were women, while a spokesperson for BLK-Max Super Speciality Hospital pegged the female to male ratio at 90:10.

The third speciality — orthopaedic surgery — has a reverse skew as the incidence of osteoporosis in women is higher. The disease onset, too, usually happens earlier in women, therefore giving rise to the need for joint replacement surgeries.

On the gender disparity in the cardiothoracic and transplant surgeries, medical experts point to certain social factors.

“There is a skew, but we have to accept social and economic realities without being cynical about them. The hard truth is these surgeries cost money and not everybody has a health insurance. So, the breadwinner always gets priority,” said Dr Harsha Jauhari, advisor, organ transplantation, at the National Organ Transplantation and Tissue Organisation (NOTTO), and senior consultant, renal transplantation, at Delhi’s Sir Ganga Ram Hospital.

He further said that when it comes to donors too, it is usually the women of the family who come forward. “For various reasons it is usually the wife who is the donor. The number of husbands coming forward to donate used to be disgustingly low but now it has become slightly more respectable.”

There has also been an improvement over time in the ratio of women undergoing surgeries, according to Dr Jauhari, who credited the advent of the NGO sector willing to fund complex surgeries, easier access to aid under the Prime Minister’s National Relief Fund, and increasing health insurance coverage.

“Earlier, about 10 per cent of the organ recipients were women. That number is now up to about 20-25 per cent,” he said.


Also read: Dedicated teams, cost, facilities — why pvt hospitals do over 75% of organ transplants in India


Wide gender disparities in surgeries

According to a Max Saket spokesperson, 80 per cent of all organ transplants there are performed on males. However, in 70 per cent of such surgeries, the donor is a woman.

“Even the 20 per cent females undergoing transplant will have a female donor,” the hospital representative said, not wanting to be named. For cardiac surgeries, the ratio of surgeries in the hospital is 65:35 in favour of males, although there is no difference in the incidence of heart diseases.

The Max Saket representative said that for joint and hip replacement surgeries, the ratio is reversed, at 60:40 (female to male). “This is since females have more orthopaedic problems.”

A Max hospital in Delhi | Commons

At BLK Max Hospital, the statistics follow the same broad trends.

“Organ transplants are happening in a 70:30 ratio for male and females and the donation ratio is 10:90. In the 30 per cent cases where women are the recipients, in most cases the donor is also a woman. The joint and hip replacement surgery ratio is 65 (females):35 (males),” said a hospital spokesperson.

For every three cardiac surgeries that happen in the hospital, two are performed on a man. “Women have equal or more complex cardiac problems, yet the numbers are stacked up unevenly. Moreover, due to their smaller-calibre arteries their heart surgeries often tend to become more complex,” the spokesperson added.

Data from Delhi’s Indraprastha Apollo Hospitals in the last financial year shows that of the total cardiovascular surgeries performed in the hospital, 66 per cent were for males and 34 per cent for females.

Out of those who underwent kidney transplants, 76 per cent were males and 23 per cent females. For liver transplants done in this period, 62 per cent were for males and 38 per cent for females.

Here too, orthopaedic surgeries presented a different picture. Out of all the knee replacement surgeries, 25 per cent were done on males and 75 per cent on females. For hip replacement surgeries, 58 per cent were performed on males and 42 per cent on females.

Another exception tends to be transplant surgery involving cadaver donations, where the gender skew is not very pronounced.

Dr Kunal Sarkar, chief cardiac surgeon and senior vice-chairman at Medica Superspecialty Hospital in Kolkata told ThePrint that out of 250 cardiac transplants that have taken place there, the gender breakup is about 65:55 in favour of males.

Unlike liver and kidney transplants, where most transplants involve living donors, cardiac transplants exclusively involve cadavers.

‘Difference in mental set-up’

When asked about gender differences in surgery, Dr Vanita Arora, consultant cardiologist at Apollo, told ThePrint that she attributed it partly to the “mental set-up of women” and how they view their own health.

She explained that while there are some cardiac diseases with a higher incidence in males, there are others that occur more in women.

“But in my own practice I see every day that if I ask a man to get a procedure done, nine out of 10 will come back for it. There is more urgency on the part of the family, the patient himself is more willing. But if I say the same thing to a woman, eight out of 10 will not get it done. They will say ‘I will be fine, it is just gas’,” Dr Arora said.

In addition, she said, families did not place equal importance on women’s health. “At the family level too, spending money on the health of a female is looked down upon.”

It is worth noting that a 2016 paper published in the journal Heart Asia (which ceased publication in 2019) pointed at gender bias towards children in the health-seeking behaviour of families in north India.

The study covered paediatric patients referred for free cardiac treatment at a centre under the School Health Programme. Of the 519 children studied, only 37.6 per cent were girls despite the almost gender equal prevalence of congenital heart disease in children.

Regional divide?

When it comes to transplant and cardiac surgeries, the gender gap in south India is less than in the northern part of the country, doctors claim.

“There is definitely a south-north divide,” said Dr Ravichand C Siddachari, head of transplants at KIMS Hospital, Hyderabad.

“In this part of the country, there are a lot of instances of sons or brothers coming forward to donate their kidneys so I would say only about 30-35 per cent of my donors are women,” he told ThePrint. “But one also has to understand that after the rules were made stricter, only spouses or children are considered ‘first degree’ relatives so that if a wife comes forward, getting clearance from the committee (that clears living donor transplants) is usually easier.”

In the case of liver transplant patients, Dr Siddachari said that in his practice, about 60-65 per cent of the recipients were men, but attributed this largely to alcohol consumption.

“One needs to understand that alcohol use is much more in men and that is still a significant contributor to our burden of liver diseases,” he said.

However, it appears that some of the attitudes that beleaguer women in the north also exist elsewhere.

Dr Praveen K Varma, head of the department of cardiac surgery at Amrita Institute of Medical Sciences and Research Centre in Ernakulam, Kerala, said that only about 25 per cent of his patients undergoing coronary artery bypass grafting are women.

“In general in our practice we see that females because of various reasons, including their attitude of ‘family comes first’, opt for surgery much later than males. But it is difficult for us to say whether women are missing out on surgeries because we see only the tip of the iceberg. We see people who actually undergo surgeries,” he said.

(Edited by Asavari Singh)


Also read: Women in India live longer than men but don’t have healthier lives, finds new report


 

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