Analysing Process of Organ Donation and Transplantation Services in India at Hospital Level: SAP-LAP Model

Organ donation and transplantation services portray a sub-system of modern healthcare organizations, which is a complex adaptive system. Across the world, there is a marked gap between the numbers of available organs for transplant and potential recipients in the waitlist. To date, researchers have struggled to comprehend the reasons for these disparities, yet the subject received relatively little attention from the system’s perspective. The outcome of organ transplantation requires the coordinated effort of many actors like donors, recipients, families, physicians, transplant coordinators and other hospital staff. They may belong to cross-functional departments and institutions, often operating with different motivations and objectives. In this study, we use Situation-Actor-Process (SAP) and Learning-Action-Performance (LAP) inquiry model, to systematically inquire the organ donation in India. With SAP-LAP, we attempt to understand the complexities and interactions among the current situation, involved actors and processes affecting organ donation at the macro- and micro-level of policy formation. The SAP part brings an insight into the present condition of the organ donation system in India. A model representing flexible interaction among situation, actors and processes is developed for a better systemic understanding. Then, LAP fetches the learning followed by the suggested actions that need to be taken for improving the performance of the organ donation system. Through a case study conducted in an Indian hospital, we explore the reasons for operational inefficiencies at the micro-level. The study identified non-value-adding activities like waiting, excess motion, inappropriate processing and defects; and value-adding activities like training intensivist, training transplant coordinator, raising awareness among family members, excess inventory and use of information and communication technology. The research brings up multiple, self-adjusting, unpredictable and interacting pathways that lead from a potential organ donor to an organ receiver, thus targeting process improvement through a holistic approach.