title: Can evidence-based health policy from high-income countries be applied to lower-income countries: considering barriers and facilitators to an organ donor registry in Mumbai, India.
abstract: BACKGROUND
  Organ transplantation has become an effective means to extend lives; however, a major obstacle is the lack of availability of cadaveric organs. India has one of the lowest cadaver organ donation rates in the world. If India could increase the donor rate, the demand for many organs could be met. Evidence from high-income countries suggests that an organ donor registry can be a valuable tool for increasing donor rates. The purpose of this study is to determine whether the implementation of an organ donor registry is a feasible and appropriate policy option to enhance cadaver organ donation rates in a lower-income country.
  
  
  METHODS
  This qualitative policy analysis employs semi-structured interviews with physicians, transplant coordinators, and representatives of organ donation advocacy groups in Mumbai. Interviews were designed to better understand current organ donation procedures and explore key informants' perceptions about Indian government health priorities and the likelihood of an organ donor registry in Mumbai. The 3-i framework (ideas, interests, and institutions) is used to examine how government decisions surrounding organ donation policies are shaped.
  
  
  RESULTS
  Findings indicate that organ donation in India is a complex issue due to low public awareness, misperceptions of religious doctrines, the need for family consent, and a nation-wide focus on disease control. Key informants cite social, political, and infrastructural barriers to the implementation of an organ donor registry, including widely held myths about organ donation, competing health priorities, and limited hospital infrastructure.
  
  
  CONCLUSIONS
  At present, both the central government and Maharashtra state government struggle to balance international pressures to improve overall population health with the desire to also enhance individual health. Implementing an organ donor registry in Mumbai is not a feasible or appropriate policy option in India's current political and social environment, as the barriers, identified through the 3-i framework lens, may be too difficult to overcome. Despite the evidence supporting the use of donor registries as a means to enhance organ donation rates, it is clear that context is critical and that it is not always practical to apply evidence-based policy solutions from high-income countries to lower-income settings.
authors.affiliation: Global Health, Faculty of Health Sciences, McMaster University, 1280 Main Street West, DSB 509, Hamilton, ON, L8S 4M4, Canada. vaniadk@mcmaster.ca.
authors.forename: Diana K
authors.initials: DK
authors.lastname: Vania
authors.affiliation: Health Policy & Management, DeGroote School of Business, McMaster University, 1280 Main Street West, DSB 227, Hamilton, ON, L8S 4M4, Canada.|Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL Building 282, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Glen E
authors.initials: GE
authors.lastname: Randall
mesh_terms: D001364:Awareness; D002102:Cadaver; D019049:Developed Countries; D003906:Developing Countries; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D007194:India; D007407:Interviews as Topic; D008297:Male; D011050:Policy Making; D036301:Qualitative Research; D012042:Registries; D012067:Religion; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists