December 18, 2025 • 28 mins
First, we talk to The Indian Express' Anonna Dutt about the recent govt data that underlines the wide gap between demand and availability in the country’s organ transplant system.
Next, The Indian Express' Sukrita Baruah discusses the protests that have brought academic activities to a complete halt in one of Assam’s central universities. (17:15)
And in the end, we also talk about the crisis looming over Tamil Nadu’s textile towns. (25:05)
Hosted by Ichha Sharma
Written and produced by Shashank Bhargava and Ichha Sharma
Edited and mixed by Suresh Pawar
Next, The Indian Express' Sukrita Baruah discusses the protests that have brought academic activities to a complete halt in one of Assam’s central universities. (17:15)
And in the end, we also talk about the crisis looming over Tamil Nadu’s textile towns. (25:05)
Hosted by Ichha Sharma
Written and produced by Shashank Bhargava and Ichha Sharma
Edited and mixed by Suresh Pawar
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
In this episode, we take a look at the protests
that have brought academic activities to a complete halt in
one of Assam's central universities. We also talk about the
crisis looming over Tamil Nadu's textile towns. But we begin
today by talking about the recent government data that underlines
the wide gap between demand and availability in the country's
(00:22):
organ transplant system. Hi, I'm Micha Sharma and you're listening
to Three Things The Indian Express new show. Across India,
thousands of individuals live in a state of constant waiting,
(00:43):
hoping that a hospital will call to say that the
organ they need has finally become available. And this weight
can last for months, if not years. In fact, new
data shared by the Union Health Ministry in Parliament last
week shows that nearly three thousand Indians died over the
last five years while waiting for an organ transplant and
(01:04):
that today more than eighty two thousand patients remain on
the national weight list, mostly waiting for kidneys and livers.
So why is that the weight for these organs is
so long and how can India bridge the demand and
supply divide in organ transplants to break that down and
understand what the data tells us. We speak to the
(01:25):
Indian expresses Anonada in this segment. I do not know
to begin with, Could you help our listeners understand how
serious is India's organ transplant gap today?
Speaker 2 (01:35):
So, the official data that was presented in the Parliament
recently showed that around two thousand, eight hundred and five
people died while waiting for the organ transplants over the
last five years. Now, of course, these numbers are likely
to be an undercount because not all the people who
(01:56):
do need an organ get registered to get one because
of various reasons, they might not have the resources, et cetera.
And this also does not account for people who might
have undergone the surgery and did not survive afterwards. This
is only people who've been waiting, and that too is
likely an undercount. But the thing is, the organ transplants
(02:18):
over the years have gone up in India, but the
gap between the requirement and the donation still remain slow.
Most of the organ transplants in India are from living
relatives instead of deceased donors, and even then we're not
able to keep up with the need for transplants, especially
considering that kidney damage et cetera happens with diseases such
(02:42):
as hypertension, diabetes, et cetera, which are also on the
rise and a known of For those who may not know,
what does this waiting window typically look like for a patient?
Speaker 3 (02:53):
Like?
Speaker 4 (02:54):
Is it months? Years? Yes?
Speaker 2 (02:57):
So it can range anywhere from between a few weeks,
two months, two years, depending on how serious your condition is,
what is your blood type, what is your body type,
because they have to match a donor who has similar
physique and has the same blood type, et cetera. So
all of that matching has to happen for someone to
(03:20):
receive the organ. Also, the organ is likely to go
to a SACRE patient first, depending of course, on their
chances of survival et cetera, and whether they have other
conditions which might make it difficult for them to get
a transplant. So all of these factors play in. So
this is typically what I'm talking about diseased donor organs,
(03:42):
which is when you know, people die in road accidents,
et cetera, brain death happens and their organs can be donated.
I'm not talking about living donor transplants, which can happen
within months of a person getting registered because they're the
donor is already fixed. Somebody from within the family donates,
so in that case the waiting is not too long.
(04:04):
But when it comes to deceased donor, what happens is
the hospital in which the patient dies gets one of
the kidneys and can keep other organs depending on their
patient waiting list, and if they cannot utilize it, then
it goes into So basically in the same area, the
hospital would try to look for other hospitals who can
(04:25):
do the transplant. If that doesn't happen, it goes into
the state level transplant committee, which looks at all hospitals
in the state. If that doesn't happen, then it goes
to the regional so you know, it would look for
hospitals in the north south east west region of the country.
If that also does not happen, then it reaches the
national pool, from where it can be allocated anywhere in
(04:47):
the country. So this whole allocation process, as well as
the patient's condition, both into how long they would have
to wait for an organ, right and so which organ
would you say is usually the most in demand, So
when it comes to the most common transplant, it is
a kidney transplant. That is because it is a transplant
(05:11):
that has been perfected by many of the hospitals in
the country, so there are just a lot more hospitals
offering kidney transplants. It is also much less complex than
the other transplants, and the cost of the kidney transplant
is also less than several other transplants like liver transplant,
(05:32):
et cetera. So that is the reason why kidney transplant.
It's not that that is the only reason. It's also
that people don't need kidney transplants more because that's the
organ also that gets damaged with like I mentioned, diabetes, hypertension,
et cetera. Other than that, we have liver transplant, lung transplant,
we have heart transplant. All of these are much less common.
(05:56):
So if we look at the number of transplants that
are been performed in the country of the last five years,
that is between twenty twenty and twenty twenty four, there
have been over fifty three thousand kidney transplants, almost eighteen
thousand liver transplant, nine fifty seven heart transplants, seven sixty
(06:17):
nine lung transplants, and only one thirty pancrea transplants. These
are the most common. There is also some small bowel
transplants that happen. There are also you know, people donating
their skins and et cetera for transplants, but those are
very infrequent.
Speaker 1 (06:34):
Right And I don't know if you understand that there
are multiple allocation systems. Some have scoring methods, some use
seniority based lists. So how does this system operate and
also does it affect like who gets an organ and
who keeps waiting?
Speaker 4 (06:50):
Definitely?
Speaker 2 (06:51):
So right now we have state lists, so every hospital
puts up their own list and then it's collated into
a state list, which is then collated into a national list. Now,
the problem is, while there is a centralized waiting list,
the allocation process is not the same in every state.
So every state right now follows a different allocation pattern
(07:13):
because the law did not mandate a particular pattern of
allocation when it was initially asked. And I mean now slowly,
of course, the regulatory body, which is the National organ
and Tissue Transplant Organization, is trying to formalize the process
and trying to bring all the states on board and
have the same process of allocation. But at the moment,
(07:36):
different states two different things. So for example, some states
follow a scoring method where what is your condition, what
is your age, and sometimes if you're a woman, they
would score you higher. So all of these you're getting
points on it and then eventually then whoever gets the
higher point gets the organ. So states like Telangana, Maharashtra,
(07:57):
Gujrat they have this kind of a score ring method.
Then there are states like West Bengal, Karnataka, Rajasthan, Kerala
which allocate organs based on who is registered first on
their registry. Then there is Tamil Nadu which has created
zones within the state so you would get an organ.
So for example, a lot of people might pass away
(08:20):
in hospitals in Chennai, so you know places in and
around Chennai are much more likelier to get these organs
than says a place which is farther away, because Tamil
Nadu has its own internal regional allocation system.
Speaker 4 (08:34):
Then there are places.
Speaker 2 (08:36):
Like made Praadesh and Chattizgir which gave priority to patients
who do not have a living related donor. So all
of these different criterias are followed right now in India,
so you cannot always predict what your number on the
list will be.
Speaker 1 (08:52):
And so is this why the national organ in Tashu
Transplant Organization or NOT is now pushing to change that.
Speaker 2 (09:00):
Yes, the organization NOTTTO is trying to move towards a
uniform process where the patients will also get a login
ID and would be able to see where on the
state list, where on the regional list, where on the
national list they stand, so that they actually get a
fair idea of when they might get an organ through
(09:21):
this allocation process.
Speaker 1 (09:23):
And an one of the recent data suggests that Maharashtra
tops the wait list, followed by Tamil Nadu. So what
explains these regional concentrations, like is it because of the
population size or better registration systems? So definitely population size,
because Maharashta is I wouldn't say the most populous, but
it is a state where there is a high population
(09:46):
as well as good medical facilities where you can get
the transplants. Delhi of course is the place which performs
the highest number of transplants across the country, but most
of those transplants are from living related people.
Speaker 2 (10:01):
It's not the deceased organs. When it comes to organs
from deceased persons, I think Tamil Nadu is on top.
So yes, this waiting list is also accordingly. So states
which perform well on you know, transplantation are the states
where maximum number of registrations also happen. So you know,
(10:22):
people from other states might also come to Delhi or
Maharashtra to get their transplants and therefore be in their
transplant lists. So that's how the waiting list also works.
Speaker 1 (10:35):
Right, And as you mentioned earlier that most transplants in
India still come from living relatives, not deceased donors. So
why is that we rely so heavily on living donors.
Speaker 2 (10:47):
So the challenge with India is that even though we
have about a lack of people dying every year in
road clashes, we're not able to utilize organs from these people.
So actually, the people who die in road crashes make
for an ideal candidate for organ donation because usually they
(11:07):
would have brain death before circulatory death. Circulatory death is
what we associate with death, but brain death is when
the brain activity completely stops, but the patient is still alive,
so to say, the processes in their body is going
on because of the machines they are on, and they
are the ideal candidate for organ donation. Because the organs
(11:30):
can sustain only up to a certain number of hours
outside the body of the patient. The unfortunate thing is
that even though we have so many road crash deaths,
we are not able to convert them into donors. And
that could be because of several different reasons. One is
that counseling the families at the time this is happening.
(11:50):
It's a very difficult scenario where a family is losing
someone and it's very unexpected. It's not like they have
had some long illness or anything. It's just a very
sudden sort of death. So the families are grieving and
at that time, we do need the transplant coordinators to
be present there, to be counseling the families, to be
(12:12):
you know, explaining the process of how organ donation works.
And that does not happen everywhere. It would happen probably
in the big hospitals, but it doesn't happen everywhere.
Speaker 4 (12:23):
That is one reason.
Speaker 2 (12:25):
Second reason is there's also a lot of negative feelings
that people have towards organ donations. There are a lot
of myths surrounding it. So, for example, there are myths
which people believe that if they donate the organs then
the person would be born in the next life without
the organs. That's why they would say no, they don't
want to do it, or there are religious reasons where
(12:46):
they say that, okay, we do not want the body
to be cut open.
Speaker 4 (12:50):
You know, before you know the.
Speaker 2 (12:51):
Last riots happen. So that again plays in. So all
of these things have to be explained to the families.
And for that we do have people called transplant coordinators.
But right now our conversion from brain death to organ
donor is not very good. So that is one reason
(13:12):
for you know why we have more living donor transplants
than disease donors.
Speaker 1 (13:17):
And also a nona are hospitals equipped to identify and
retrieve organs quickly when a potential donor becomes available.
Speaker 2 (13:25):
So it has improved over the years. Over the last
ten years, the number of hospitals that can retrieve organs
and that can transplant organs have gone up a lot.
There are about seven hundred such centers across the country.
Of course, the density is much higher in cities like Delhi, Tennai, Bombay,
(13:45):
et cetera. So you would have a higher density of
hospitals who can do this in these cities. But also
in smaller cities. In Tier two cities also there are
hospitals that have come up which are equipped to do transplants,
and if not transplants, they're at least equipped to harvest
the organs and then they can preserve it and send
(14:06):
it onto hospitals that can do the transplants. There's also
a push from the government to ensure that all the
medical colleges that it runs are actually able to perform
transplants and at least, if not that do the organ retrieval.
So there has been a push and the numbers are increasing,
(14:27):
so the treatment is becoming more and more accessible.
Speaker 1 (14:31):
And also even when an organ becomes available, cost often
remains a barrier.
Speaker 4 (14:36):
So how does that affect the ecosystem?
Speaker 2 (14:39):
So yes, cost is a barrier when it comes to
Like I mentioned, kidney transplants are cheaper than the other transplants.
And of course there are government centers now that do
perform organ transplants where also the patients have to pay
some amount, but they can access it. So also people
may avail the benefit of Ayushmanparat for a kidney transplant
(15:03):
at least, So you know, there are certain ways and
there are other health schemes which can also support the
more expensive transplants like rash Arrow Giundi or there are
state funds et cetera which people may access. But yes,
cost does play a role in determining who can get
(15:24):
the transplant or not.
Speaker 1 (15:26):
And lastly, NONA can a longer waiting list sometimes indicate
better registration access rather than poorer healthcare.
Speaker 2 (15:34):
Definitely. So the reason why there are so many people
waiting in Deli or Tamil Nadu or Marashtra is because
these are the places that also perform very well when
it comes to transplantation. They also have one of the
highest densities of hospitals which perform the transplants, so that
is the reason you would also see more people registering there.
(15:55):
But at the end of the day, our job is
to ensure that people do get this treatment and that
we do have more people donating the organs. And there
has been some change of behavior. There was a spike,
especially after the PM mentioned it in one of the
monkey Bath episodes like four or five years ago, there
was a jump in organ donations. So likely the awareness
(16:19):
campaigns and all should help and people should uh you know,
be more conscious and donate and for everybody else out there.
There is a government website which you can use. You
can go to the NOTO website and there is a
registration link everybody can sign up as an organ donor
and it actually asks for your ADHA numbers so that
(16:41):
if there is an unfortunate incident where you're in hospital,
they can verify that with your adh number and see
that you have consented to organ donation to just to
even have your family know your wishes and yes, it
also requires that you'd put in the number of one
of your loved ones, so it can be your partner,
or your parents or your sibling and you know, so
(17:01):
that kind of forces people to have the conversation about
organ donation. So hopefully more people register on this website
and become donors.
Speaker 1 (17:16):
And next we turn our attention to the protests taking
place at one of Assam's two central universities. For over
two months now, students, teachers and non teaching staff at
Taispur University have been protesting demanding the removal of the
Vice chancellor, a standoff that has brought academic activities to
a complete halt. Both students and staff have accused Vice
(17:39):
Chancellor Shambu natsingh of financial regularities and prolonged absence from
the campus, which according to them, has led to an
administrative stagnation. To understand their concerns better, michaelik Shishang Phakav
spoke to the Indian Expresses Skurta Barua, who has been
reporting on the issue.
Speaker 3 (17:57):
STA most cases involved wing protests at universities, we mainly
see students protesting, right, but this is not the case
in taste Port. There there we've seen both students and
teachers coming together. So tell us what are these two
groups concerned about.
Speaker 5 (18:16):
When I was speaking to protesting staff and students, I
kind of got the sense that this whole, the anger
that is there against the Vice chancellor by the protesters
is kind of greater than a sum of its parts,
because a lot of the grievances have been communicated by
the TESPO University Teachers Association and these are mostly administrative grievances. Okay,
So there are a bunch of different allegations that they've raised,
(18:38):
from alleged financial irregularities to say irregularities and appointments. So
they have an issue with the extension of the tenure
of the finance officer and they say that, you know,
a certain directorial position in the university which should be
occupied by a staffer, I mean by a faculty member,
a third party has been employed on a contract basis
with a full salary. So such concerns, and they've given
(19:00):
you know, a list of different financial irregularities that they're highlighting.
For example, they allege irregularities in a purchase of ebooks
for the library, in the purchase of you know, fourteen
crore's worth of furniture for the hostels. They're saying that,
you know, inflated tenders have been used for procuring this
material and so on.
Speaker 3 (19:21):
Right, But you know, a lot of these concerns seem
very administrative, So how is it that students are concerned
about it, and concerned enough that they have been staging
these protests.
Speaker 5 (19:31):
So actually the protest started more as an emotive thing,
and these administrative issues and these administrative allegations came later.
So the whole thing started in September when Zubin Gaig died,
and as you know, it's been like a huge emotive
issue in Assam and it's really influenced a lot of
things that have happened in the state, and a lot
of things in the state have been influent by emotion
(19:53):
since Zubin Gaig's death, and.
Speaker 3 (19:55):
Zevin Garg, of course, was a very popular singer and
composer from the state and who recently passed.
Speaker 4 (20:01):
Away, right, and something that has brought the state to
its knees.
Speaker 3 (20:04):
Right.
Speaker 5 (20:04):
So, on September nineteenth, Zuwna passed away and state mourning
was announced in as sam And the Tsper University doesn't
have a students' union, they have a students council. So
the student council elections were supposed to take place on
September twentieth, and it took place as scheduled, and apparently
there was a lot of student unhappiness about this, like
(20:26):
moving on as usual. And now the protesting students alleged that,
you know, they wanted to hold a condolence meet and
they need permission for that as well from the university.
So when they kind of approached that, they claimed that
it was met with insensitivity and you know, callousness, that's
what they say.
Speaker 4 (20:42):
So that is kind of the spark and our protests.
Speaker 5 (20:45):
And at that time, the VC was not in campus,
which is amongst the things that they alleged that he
is consistently not available on campus, and there was a
lot of protests and that's a spark, so that there
was a massive outpouring of outrage at that time.
Speaker 4 (20:59):
And then the students went on protest because of that.
Speaker 5 (21:02):
And then they say that our teachers came and they
told us, actually, you know, there are these these issues
as well, which made the protest gain momentum. And you know,
first they were demanding an apology from the vice chancellor
for the alleged you know, insensitive handling of sentiment in
the aftermath of zuwinga EXAs you know, we demand his resignation.
Speaker 4 (21:21):
I did speak to several of the protesting students and
they say that.
Speaker 5 (21:24):
You know, things have been mounting for a while because
apparently a lot of funding was cut for student welfare events,
say for example, hostil events, or say even department conferences
or even something small like fresher So they were saying
that we were feeling, you know, that corners were being cut.
The university used to employ a lot of guest faculty,
(21:44):
and all those guest faculty were discontinued and the PhD
students were brought on to you know, fill the gaps.
Speaker 3 (21:52):
Right, So the work that these guest teachers were doing.
Now the PhD students are having to do it.
Speaker 5 (21:57):
With much less remuneration. So that is amongst the things
that students say that they were experiencing throughout. But they
say that, you know, we couldn't put a finger on
what's wrong. And then they said that when our teachers
told us such and such, so obviously there was student emotions.
And then you know, the staff or obviously carrying grievances
also which they presented to students. And both these concerns
(22:18):
and student concerns and staff concerns have kind of come
together as one. So there's a whole list of grievances
that the staff have presented as well.
Speaker 4 (22:26):
I spoke to a senior administrative.
Speaker 5 (22:28):
Member and I asked, you know, how come it has
taken on such a scale the protest, and the staff
members said, you know, one of the big factors is
high handedness in communicating with colleagues, which is something that
was rankling amongst the staff for a long time. And
this tipping point was basically what happened in the aftermath
of Zubinkak's death. So that was of course more than
(22:48):
two months ago, and the protests have been carrying on
strong since then.
Speaker 3 (22:53):
And how has Shamu nat Singh reacted to these protests
and also has he been pleasant at the campus while
all this been going on.
Speaker 5 (23:01):
No, so I think he was present for a short
while after you know, this alleged insensitivity issue came up,
and since late September, he has not been present in
the campus and he's been titled.
Speaker 4 (23:13):
So of course, while.
Speaker 5 (23:14):
Doing these stories, I have reached out to him multiple
times and he said that he's not willing to talk
to the media at all, so he declined comment. But
in the early days of the protest, there was a
clarification issued by his office in his name which said
that you know, there was a misunderstanding when it came
to this alleged insensitivity and he said that as for
(23:34):
the allegation of financial irregularities, everything has been done as
per the book.
Speaker 4 (23:38):
And if I have been away from campus, it's because
of work.
Speaker 5 (23:42):
But that's more than two months old now, So now
a lot has happened. There has been a fact finding
committee that was constituted by the governor of a Sandwich
came to the campus. Though you know, I did speak
to one of the fact Finding Committee members and they
said that there's been no follow up on their findings.
And I asked, you know, did you find any verse
to the allegations and he said to some degree yes,
(24:03):
So he says that there's.
Speaker 4 (24:04):
Not been much follow up in this regard.
Speaker 5 (24:06):
At the same time, MOE delegations have come to whom
the different stakeholders have given their statements, have submitted their memorandum,
and apparently the delegation proposed that they promised that there'll
be a visitorial inquiry, so visitor of the university the
president right the president of the country since the central university.
So they were not happy, and then they blockaded the exit.
So for a long time this delegation was trended in
(24:28):
the university. They could exit the university because the passageway,
the carriageway was blocked by protesters. So finally they gave
a handwritten assurance that you know, we will work towards
having a time bound inquiry. But they are still not
happy with that since there was no concrete action has
been taken yet, so the protests continue.
Speaker 3 (24:47):
So does that mean that all major university activities including
classes are not going on right now?
Speaker 5 (24:53):
No classes have not been going on, but the exams
were supposed to begin earlier this month, so those got postponed.
But the exams have begun now, so the protests continue
while exams are taking place, because you can indefinitely postpone exams,
so those are taking place, but the protests are still
taking place.
Speaker 1 (25:17):
And in the end, we take a look at how
global trade politics is impacting Tamil Nadu's textile towns. Chief
Minister MK Stalin yesterday wrote to Prime Minister and arranged
REMODI warning that steep US tariffs on Indian goods are
pushing some of the state's most employment intensive industries toward
a crisis. As reported by the Indian Expresses arun Janatanan,
(25:39):
the tariffs imposed by the Trump administration have hit textiles, apparel,
leather and footwear especially hard.
Speaker 4 (25:47):
Together, these sectors form the.
Speaker 1 (25:49):
Backbone of Tamil Nadu's export economy, employing nearly eighty five
black workers, many of them women and migrant workers.
Speaker 4 (25:58):
In Tirupur alone.
Speaker 1 (25:59):
Which is widely known as a major knitware hub, exporters
report canceled orders worth fifteen thousand Coro rupees and production
cuts of up to thirty percent. In his letter, Stalin
said the US has imposed tariffs of up to fifty
percent on certain Indian exports, which he described as having
an immediate and damaging impact on export oriented manufacturing clusters.
(26:22):
He noted that Tamil Nadu accounts for around twenty eight
percent of India's textile and apparel exports and nearly forty
percent of its leather and footwear exports. Stalin further said
that exporters in Turupur, Coimbatour, Erode and Karo districts are
facing combined revenue losses of about sixty kuro rupees per day.
(26:43):
He warned that many small and medium enterprises are struggling
to sustain operations under these conditions. Similar pressures are being
felt in footwear manufacturing clusters in Welure, Ranipet and Tirripatur
districts where export demand has weakened. The letters highlights that
exporters are being forced to offer discounts to retain overseas buyers,
(27:05):
which is reducing profit margins and affecting long term competitiveness.
Stalin said layoffs and wage deferrals have already begun, raising
concerns about income security for workers and the stability of
local economies dependent on these industries. He also warned that
international buyers are shifting orders to countries such as Vietnam,
(27:26):
Bangladesh and Cambodia, which currently faced lower tariffs. Stalin said
that one supply chains moved to other countries, they are
unlikely to return, potentially undermining India's manufacturing base and employment
generation efforts. Stalin urged the PM to prioritize an early
resolution of the issue through bilateral engagement with the United States.
(27:50):
You were listening to Three Things by the Indian Express.
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(28:13):
or write to us at podcast at Indianexpress dot com.
In this episode, we take a look at the protests
that have brought academic activities to a complete halt in
one of Assam's central universities. We also talk about the
crisis looming over Tamil Nadu's textile towns. But we begin
today by talking about the recent government data that underlines
the wide gap between demand and availability in the country's
(00:22):
organ transplant system. Hi, I'm Micha Sharma and you're listening
to Three Things The Indian Express new show. Across India,
thousands of individuals live in a state of constant waiting,
(00:43):
hoping that a hospital will call to say that the
organ they need has finally become available. And this weight
can last for months, if not years. In fact, new
data shared by the Union Health Ministry in Parliament last
week shows that nearly three thousand Indians died over the
last five years while waiting for an organ transplant and
(01:04):
that today more than eighty two thousand patients remain on
the national weight list, mostly waiting for kidneys and livers.
So why is that the weight for these organs is
so long and how can India bridge the demand and
supply divide in organ transplants to break that down and
understand what the data tells us. We speak to the
(01:25):
Indian expresses Anonada in this segment. I do not know
to begin with, Could you help our listeners understand how
serious is India's organ transplant gap today?
Speaker 2 (01:35):
So, the official data that was presented in the Parliament
recently showed that around two thousand, eight hundred and five
people died while waiting for the organ transplants over the
last five years. Now, of course, these numbers are likely
to be an undercount because not all the people who
(01:56):
do need an organ get registered to get one because
of various reasons, they might not have the resources, et cetera.
And this also does not account for people who might
have undergone the surgery and did not survive afterwards. This
is only people who've been waiting, and that too is
likely an undercount. But the thing is, the organ transplants
(02:18):
over the years have gone up in India, but the
gap between the requirement and the donation still remain slow.
Most of the organ transplants in India are from living
relatives instead of deceased donors, and even then we're not
able to keep up with the need for transplants, especially
considering that kidney damage et cetera happens with diseases such
(02:42):
as hypertension, diabetes, et cetera, which are also on the
rise and a known of For those who may not know,
what does this waiting window typically look like for a patient?
Speaker 3 (02:53):
Like?
Speaker 4 (02:54):
Is it months? Years? Yes?
Speaker 2 (02:57):
So it can range anywhere from between a few weeks,
two months, two years, depending on how serious your condition is,
what is your blood type, what is your body type,
because they have to match a donor who has similar
physique and has the same blood type, et cetera. So
all of that matching has to happen for someone to
(03:20):
receive the organ. Also, the organ is likely to go
to a SACRE patient first, depending of course, on their
chances of survival et cetera, and whether they have other
conditions which might make it difficult for them to get
a transplant. So all of these factors play in. So
this is typically what I'm talking about diseased donor organs,
(03:42):
which is when you know, people die in road accidents,
et cetera, brain death happens and their organs can be donated.
I'm not talking about living donor transplants, which can happen
within months of a person getting registered because they're the
donor is already fixed. Somebody from within the family donates,
so in that case the waiting is not too long.
(04:04):
But when it comes to deceased donor, what happens is
the hospital in which the patient dies gets one of
the kidneys and can keep other organs depending on their
patient waiting list, and if they cannot utilize it, then
it goes into So basically in the same area, the
hospital would try to look for other hospitals who can
(04:25):
do the transplant. If that doesn't happen, it goes into
the state level transplant committee, which looks at all hospitals
in the state. If that doesn't happen, then it goes
to the regional so you know, it would look for
hospitals in the north south east west region of the country.
If that also does not happen, then it reaches the
national pool, from where it can be allocated anywhere in
(04:47):
the country. So this whole allocation process, as well as
the patient's condition, both into how long they would have
to wait for an organ, right and so which organ
would you say is usually the most in demand, So
when it comes to the most common transplant, it is
a kidney transplant. That is because it is a transplant
(05:11):
that has been perfected by many of the hospitals in
the country, so there are just a lot more hospitals
offering kidney transplants. It is also much less complex than
the other transplants, and the cost of the kidney transplant
is also less than several other transplants like liver transplant,
(05:32):
et cetera. So that is the reason why kidney transplant.
It's not that that is the only reason. It's also
that people don't need kidney transplants more because that's the
organ also that gets damaged with like I mentioned, diabetes, hypertension,
et cetera. Other than that, we have liver transplant, lung transplant,
we have heart transplant. All of these are much less common.
(05:56):
So if we look at the number of transplants that
are been performed in the country of the last five years,
that is between twenty twenty and twenty twenty four, there
have been over fifty three thousand kidney transplants, almost eighteen
thousand liver transplant, nine fifty seven heart transplants, seven sixty
(06:17):
nine lung transplants, and only one thirty pancrea transplants. These
are the most common. There is also some small bowel
transplants that happen. There are also you know, people donating
their skins and et cetera for transplants, but those are
very infrequent.
Speaker 1 (06:34):
Right And I don't know if you understand that there
are multiple allocation systems. Some have scoring methods, some use
seniority based lists. So how does this system operate and
also does it affect like who gets an organ and
who keeps waiting?
Speaker 4 (06:50):
Definitely?
Speaker 2 (06:51):
So right now we have state lists, so every hospital
puts up their own list and then it's collated into
a state list, which is then collated into a national list. Now,
the problem is, while there is a centralized waiting list,
the allocation process is not the same in every state.
So every state right now follows a different allocation pattern
(07:13):
because the law did not mandate a particular pattern of
allocation when it was initially asked. And I mean now slowly,
of course, the regulatory body, which is the National organ
and Tissue Transplant Organization, is trying to formalize the process
and trying to bring all the states on board and
have the same process of allocation. But at the moment,
(07:36):
different states two different things. So for example, some states
follow a scoring method where what is your condition, what
is your age, and sometimes if you're a woman, they
would score you higher. So all of these you're getting
points on it and then eventually then whoever gets the
higher point gets the organ. So states like Telangana, Maharashtra,
(07:57):
Gujrat they have this kind of a score ring method.
Then there are states like West Bengal, Karnataka, Rajasthan, Kerala
which allocate organs based on who is registered first on
their registry. Then there is Tamil Nadu which has created
zones within the state so you would get an organ.
So for example, a lot of people might pass away
(08:20):
in hospitals in Chennai, so you know places in and
around Chennai are much more likelier to get these organs
than says a place which is farther away, because Tamil
Nadu has its own internal regional allocation system.
Speaker 4 (08:34):
Then there are places.
Speaker 2 (08:36):
Like made Praadesh and Chattizgir which gave priority to patients
who do not have a living related donor. So all
of these different criterias are followed right now in India,
so you cannot always predict what your number on the
list will be.
Speaker 1 (08:52):
And so is this why the national organ in Tashu
Transplant Organization or NOT is now pushing to change that.
Speaker 2 (09:00):
Yes, the organization NOTTTO is trying to move towards a
uniform process where the patients will also get a login
ID and would be able to see where on the
state list, where on the regional list, where on the
national list they stand, so that they actually get a
fair idea of when they might get an organ through
(09:21):
this allocation process.
Speaker 1 (09:23):
And an one of the recent data suggests that Maharashtra
tops the wait list, followed by Tamil Nadu. So what
explains these regional concentrations, like is it because of the
population size or better registration systems? So definitely population size,
because Maharashta is I wouldn't say the most populous, but
it is a state where there is a high population
(09:46):
as well as good medical facilities where you can get
the transplants. Delhi of course is the place which performs
the highest number of transplants across the country, but most
of those transplants are from living related people.
Speaker 2 (10:01):
It's not the deceased organs. When it comes to organs
from deceased persons, I think Tamil Nadu is on top.
So yes, this waiting list is also accordingly. So states
which perform well on you know, transplantation are the states
where maximum number of registrations also happen. So you know,
(10:22):
people from other states might also come to Delhi or
Maharashtra to get their transplants and therefore be in their
transplant lists. So that's how the waiting list also works.
Speaker 1 (10:35):
Right, And as you mentioned earlier that most transplants in
India still come from living relatives, not deceased donors. So
why is that we rely so heavily on living donors.
Speaker 2 (10:47):
So the challenge with India is that even though we
have about a lack of people dying every year in
road clashes, we're not able to utilize organs from these people.
So actually, the people who die in road crashes make
for an ideal candidate for organ donation because usually they
(11:07):
would have brain death before circulatory death. Circulatory death is
what we associate with death, but brain death is when
the brain activity completely stops, but the patient is still alive,
so to say, the processes in their body is going
on because of the machines they are on, and they
are the ideal candidate for organ donation. Because the organs
(11:30):
can sustain only up to a certain number of hours
outside the body of the patient. The unfortunate thing is
that even though we have so many road crash deaths,
we are not able to convert them into donors. And
that could be because of several different reasons. One is
that counseling the families at the time this is happening.
(11:50):
It's a very difficult scenario where a family is losing
someone and it's very unexpected. It's not like they have
had some long illness or anything. It's just a very
sudden sort of death. So the families are grieving and
at that time, we do need the transplant coordinators to
be present there, to be counseling the families, to be
(12:12):
you know, explaining the process of how organ donation works.
And that does not happen everywhere. It would happen probably
in the big hospitals, but it doesn't happen everywhere.
Speaker 4 (12:23):
That is one reason.
Speaker 2 (12:25):
Second reason is there's also a lot of negative feelings
that people have towards organ donations. There are a lot
of myths surrounding it. So, for example, there are myths
which people believe that if they donate the organs then
the person would be born in the next life without
the organs. That's why they would say no, they don't
want to do it, or there are religious reasons where
(12:46):
they say that, okay, we do not want the body
to be cut open.
Speaker 4 (12:50):
You know, before you know the.
Speaker 2 (12:51):
Last riots happen. So that again plays in. So all
of these things have to be explained to the families.
And for that we do have people called transplant coordinators.
But right now our conversion from brain death to organ
donor is not very good. So that is one reason
(13:12):
for you know why we have more living donor transplants
than disease donors.
Speaker 1 (13:17):
And also a nona are hospitals equipped to identify and
retrieve organs quickly when a potential donor becomes available.
Speaker 2 (13:25):
So it has improved over the years. Over the last
ten years, the number of hospitals that can retrieve organs
and that can transplant organs have gone up a lot.
There are about seven hundred such centers across the country.
Of course, the density is much higher in cities like Delhi, Tennai, Bombay,
(13:45):
et cetera. So you would have a higher density of
hospitals who can do this in these cities. But also
in smaller cities. In Tier two cities also there are
hospitals that have come up which are equipped to do transplants,
and if not transplants, they're at least equipped to harvest
the organs and then they can preserve it and send
(14:06):
it onto hospitals that can do the transplants. There's also
a push from the government to ensure that all the
medical colleges that it runs are actually able to perform
transplants and at least, if not that do the organ retrieval.
So there has been a push and the numbers are increasing,
(14:27):
so the treatment is becoming more and more accessible.
Speaker 1 (14:31):
And also even when an organ becomes available, cost often
remains a barrier.
Speaker 4 (14:36):
So how does that affect the ecosystem?
Speaker 2 (14:39):
So yes, cost is a barrier when it comes to
Like I mentioned, kidney transplants are cheaper than the other transplants.
And of course there are government centers now that do
perform organ transplants where also the patients have to pay
some amount, but they can access it. So also people
may avail the benefit of Ayushmanparat for a kidney transplant
(15:03):
at least, So you know, there are certain ways and
there are other health schemes which can also support the
more expensive transplants like rash Arrow Giundi or there are
state funds et cetera which people may access. But yes,
cost does play a role in determining who can get
(15:24):
the transplant or not.
Speaker 1 (15:26):
And lastly, NONA can a longer waiting list sometimes indicate
better registration access rather than poorer healthcare.
Speaker 2 (15:34):
Definitely. So the reason why there are so many people
waiting in Deli or Tamil Nadu or Marashtra is because
these are the places that also perform very well when
it comes to transplantation. They also have one of the
highest densities of hospitals which perform the transplants, so that
is the reason you would also see more people registering there.
(15:55):
But at the end of the day, our job is
to ensure that people do get this treatment and that
we do have more people donating the organs. And there
has been some change of behavior. There was a spike,
especially after the PM mentioned it in one of the
monkey Bath episodes like four or five years ago, there
was a jump in organ donations. So likely the awareness
(16:19):
campaigns and all should help and people should uh you know,
be more conscious and donate and for everybody else out there.
There is a government website which you can use. You
can go to the NOTO website and there is a
registration link everybody can sign up as an organ donor
and it actually asks for your ADHA numbers so that
(16:41):
if there is an unfortunate incident where you're in hospital,
they can verify that with your adh number and see
that you have consented to organ donation to just to
even have your family know your wishes and yes, it
also requires that you'd put in the number of one
of your loved ones, so it can be your partner,
or your parents or your sibling and you know, so
(17:01):
that kind of forces people to have the conversation about
organ donation. So hopefully more people register on this website
and become donors.
Speaker 1 (17:16):
And next we turn our attention to the protests taking
place at one of Assam's two central universities. For over
two months now, students, teachers and non teaching staff at
Taispur University have been protesting demanding the removal of the
Vice chancellor, a standoff that has brought academic activities to
a complete halt. Both students and staff have accused Vice
(17:39):
Chancellor Shambu natsingh of financial regularities and prolonged absence from
the campus, which according to them, has led to an
administrative stagnation. To understand their concerns better, michaelik Shishang Phakav
spoke to the Indian Expresses Skurta Barua, who has been
reporting on the issue.
Speaker 3 (17:57):
STA most cases involved wing protests at universities, we mainly
see students protesting, right, but this is not the case
in taste Port. There there we've seen both students and
teachers coming together. So tell us what are these two
groups concerned about.
Speaker 5 (18:16):
When I was speaking to protesting staff and students, I
kind of got the sense that this whole, the anger
that is there against the Vice chancellor by the protesters
is kind of greater than a sum of its parts,
because a lot of the grievances have been communicated by
the TESPO University Teachers Association and these are mostly administrative grievances. Okay,
So there are a bunch of different allegations that they've raised,
(18:38):
from alleged financial irregularities to say irregularities and appointments. So
they have an issue with the extension of the tenure
of the finance officer and they say that, you know,
a certain directorial position in the university which should be
occupied by a staffer, I mean by a faculty member,
a third party has been employed on a contract basis
with a full salary. So such concerns, and they've given
(19:00):
you know, a list of different financial irregularities that they're highlighting.
For example, they allege irregularities in a purchase of ebooks
for the library, in the purchase of you know, fourteen
crore's worth of furniture for the hostels. They're saying that,
you know, inflated tenders have been used for procuring this
material and so on.
Speaker 3 (19:21):
Right, But you know, a lot of these concerns seem
very administrative, So how is it that students are concerned
about it, and concerned enough that they have been staging
these protests.
Speaker 5 (19:31):
So actually the protest started more as an emotive thing,
and these administrative issues and these administrative allegations came later.
So the whole thing started in September when Zubin Gaig died,
and as you know, it's been like a huge emotive
issue in Assam and it's really influenced a lot of
things that have happened in the state, and a lot
of things in the state have been influent by emotion
(19:53):
since Zubin Gaig's death, and.
Speaker 3 (19:55):
Zevin Garg, of course, was a very popular singer and
composer from the state and who recently passed.
Speaker 4 (20:01):
Away, right, and something that has brought the state to
its knees.
Speaker 3 (20:04):
Right.
Speaker 5 (20:04):
So, on September nineteenth, Zuwna passed away and state mourning
was announced in as sam And the Tsper University doesn't
have a students' union, they have a students council. So
the student council elections were supposed to take place on
September twentieth, and it took place as scheduled, and apparently
there was a lot of student unhappiness about this, like
(20:26):
moving on as usual. And now the protesting students alleged that,
you know, they wanted to hold a condolence meet and
they need permission for that as well from the university.
So when they kind of approached that, they claimed that
it was met with insensitivity and you know, callousness, that's
what they say.
Speaker 4 (20:42):
So that is kind of the spark and our protests.
Speaker 5 (20:45):
And at that time, the VC was not in campus,
which is amongst the things that they alleged that he
is consistently not available on campus, and there was a
lot of protests and that's a spark, so that there
was a massive outpouring of outrage at that time.
Speaker 4 (20:59):
And then the students went on protest because of that.
Speaker 5 (21:02):
And then they say that our teachers came and they
told us, actually, you know, there are these these issues
as well, which made the protest gain momentum. And you know,
first they were demanding an apology from the vice chancellor
for the alleged you know, insensitive handling of sentiment in
the aftermath of zuwinga EXAs you know, we demand his resignation.
Speaker 4 (21:21):
I did speak to several of the protesting students and
they say that.
Speaker 5 (21:24):
You know, things have been mounting for a while because
apparently a lot of funding was cut for student welfare events,
say for example, hostil events, or say even department conferences
or even something small like fresher So they were saying
that we were feeling, you know, that corners were being cut.
The university used to employ a lot of guest faculty,
(21:44):
and all those guest faculty were discontinued and the PhD
students were brought on to you know, fill the gaps.
Speaker 3 (21:52):
Right, So the work that these guest teachers were doing.
Now the PhD students are having to do it.
Speaker 5 (21:57):
With much less remuneration. So that is amongst the things
that students say that they were experiencing throughout. But they
say that, you know, we couldn't put a finger on
what's wrong. And then they said that when our teachers
told us such and such, so obviously there was student emotions.
And then you know, the staff or obviously carrying grievances
also which they presented to students. And both these concerns
(22:18):
and student concerns and staff concerns have kind of come
together as one. So there's a whole list of grievances
that the staff have presented as well.
Speaker 4 (22:26):
I spoke to a senior administrative.
Speaker 5 (22:28):
Member and I asked, you know, how come it has
taken on such a scale the protest, and the staff
members said, you know, one of the big factors is
high handedness in communicating with colleagues, which is something that
was rankling amongst the staff for a long time. And
this tipping point was basically what happened in the aftermath
of Zubinkak's death. So that was of course more than
(22:48):
two months ago, and the protests have been carrying on
strong since then.
Speaker 3 (22:53):
And how has Shamu nat Singh reacted to these protests
and also has he been pleasant at the campus while
all this been going on.
Speaker 5 (23:01):
No, so I think he was present for a short
while after you know, this alleged insensitivity issue came up,
and since late September, he has not been present in
the campus and he's been titled.
Speaker 4 (23:13):
So of course, while.
Speaker 5 (23:14):
Doing these stories, I have reached out to him multiple
times and he said that he's not willing to talk
to the media at all, so he declined comment. But
in the early days of the protest, there was a
clarification issued by his office in his name which said
that you know, there was a misunderstanding when it came
to this alleged insensitivity and he said that as for
(23:34):
the allegation of financial irregularities, everything has been done as
per the book.
Speaker 4 (23:38):
And if I have been away from campus, it's because
of work.
Speaker 5 (23:42):
But that's more than two months old now, So now
a lot has happened. There has been a fact finding
committee that was constituted by the governor of a Sandwich
came to the campus. Though you know, I did speak
to one of the fact Finding Committee members and they
said that there's been no follow up on their findings.
And I asked, you know, did you find any verse
to the allegations and he said to some degree yes,
(24:03):
So he says that there's.
Speaker 4 (24:04):
Not been much follow up in this regard.
Speaker 5 (24:06):
At the same time, MOE delegations have come to whom
the different stakeholders have given their statements, have submitted their memorandum,
and apparently the delegation proposed that they promised that there'll
be a visitorial inquiry, so visitor of the university the
president right the president of the country since the central university.
So they were not happy, and then they blockaded the exit.
So for a long time this delegation was trended in
(24:28):
the university. They could exit the university because the passageway,
the carriageway was blocked by protesters. So finally they gave
a handwritten assurance that you know, we will work towards
having a time bound inquiry. But they are still not
happy with that since there was no concrete action has
been taken yet, so the protests continue.
Speaker 3 (24:47):
So does that mean that all major university activities including
classes are not going on right now?
Speaker 5 (24:53):
No classes have not been going on, but the exams
were supposed to begin earlier this month, so those got postponed.
But the exams have begun now, so the protests continue
while exams are taking place, because you can indefinitely postpone exams,
so those are taking place, but the protests are still
taking place.
Speaker 1 (25:17):
And in the end, we take a look at how
global trade politics is impacting Tamil Nadu's textile towns. Chief
Minister MK Stalin yesterday wrote to Prime Minister and arranged
REMODI warning that steep US tariffs on Indian goods are
pushing some of the state's most employment intensive industries toward
a crisis. As reported by the Indian Expresses arun Janatanan,
(25:39):
the tariffs imposed by the Trump administration have hit textiles, apparel,
leather and footwear especially hard.
Speaker 4 (25:47):
Together, these sectors form the.
Speaker 1 (25:49):
Backbone of Tamil Nadu's export economy, employing nearly eighty five
black workers, many of them women and migrant workers.
Speaker 4 (25:58):
In Tirupur alone.
Speaker 1 (25:59):
Which is widely known as a major knitware hub, exporters
report canceled orders worth fifteen thousand Coro rupees and production
cuts of up to thirty percent. In his letter, Stalin
said the US has imposed tariffs of up to fifty
percent on certain Indian exports, which he described as having
an immediate and damaging impact on export oriented manufacturing clusters.
(26:22):
He noted that Tamil Nadu accounts for around twenty eight
percent of India's textile and apparel exports and nearly forty
percent of its leather and footwear exports. Stalin further said
that exporters in Turupur, Coimbatour, Erode and Karo districts are
facing combined revenue losses of about sixty kuro rupees per day.
(26:43):
He warned that many small and medium enterprises are struggling
to sustain operations under these conditions. Similar pressures are being
felt in footwear manufacturing clusters in Welure, Ranipet and Tirripatur
districts where export demand has weakened. The letters highlights that
exporters are being forced to offer discounts to retain overseas buyers,
(27:05):
which is reducing profit margins and affecting long term competitiveness.
Stalin said layoffs and wage deferrals have already begun, raising
concerns about income security for workers and the stability of
local economies dependent on these industries. He also warned that
international buyers are shifting orders to countries such as Vietnam,
(27:26):
Bangladesh and Cambodia, which currently faced lower tariffs. Stalin said
that one supply chains moved to other countries, they are
unlikely to return, potentially undermining India's manufacturing base and employment
generation efforts. Stalin urged the PM to prioritize an early
resolution of the issue through bilateral engagement with the United States.
(27:50):
You were listening to Three Things by the Indian Express.
Today's show was edited and mixed by Surreyesh Pavar and
produced by Shishang Haghev and me Ichasharma. If you like
the show, do subscribe to us wherever you get your podcast.
You can also recommend it to someone you think may
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is the best way for people to get to know
about us. You can also tweet us at Express Podcasts
(28:13):
or write to us at podcast at Indianexpress dot com.
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The Burden
The Burden is a documentary series that takes listeners into the hidden places where justice is done (and undone). It dives deep into the lives of heroes and villains. And it focuses a spotlight on those who triumph even when the odds are against them. Season 5 - The Burden: Death & Deceit in Alliance On April Fools Day 1999, 26-year-old Yvonne Layne was found murdered in her Alliance, Ohio home. David Thorne, her ex-boyfriend and father of one of her children, was instantly a suspect. Another young man admitted to the murder, and David breathed a sigh of relief, until the confessed murderer fingered David; “He paid me to do it.” David was sentenced to life without parole. Two decades later, Pulitzer winner and podcast host, Maggie Freleng (Bone Valley Season 3: Graves County, Wrongful Conviction, Suave) launched a “live” investigation into David's conviction alongside Jason Baldwin (himself wrongfully convicted as a member of the West Memphis Three). Maggie had come to believe that the entire investigation of David was botched by the tiny local police department, or worse, covered up the real killer. Was Maggie correct? Was David’s claim of innocence credible? In Death and Deceit in Alliance, Maggie recounts the case that launched her career, and ultimately, “broke” her.” The results will shock the listener and reduce Maggie to tears and self-doubt. This is not your typical wrongful conviction story. In fact, it turns the genre on its head. It asks the question: What if our champions are foolish? Season 4 - The Burden: Get the Money and Run “Trying to murder my father, this was the thing that put me on the path.” That’s Joe Loya and that path was bank robbery. Bank, bank, bank, bank, bank. In season 4 of The Burden: Get the Money and Run, we hear from Joe who was once the most prolific bank robber in Southern California, and beyond. He used disguises, body doubles, proxies. He leaped over counters, grabbed the money and ran. Even as the FBI was closing in. It was a showdown between a daring bank robber, and a patient FBI agent. Joe was no ordinary bank robber. He was bright, articulate, charismatic, and driven by a dark rage that he summoned up at will. In seven episodes, Joe tells all: the what, the how… and the why. Including why he tried to murder his father. Season 3 - The Burden: Avenger Miriam Lewin is one of Argentina’s leading journalists today. At 19 years old, she was kidnapped off the streets of Buenos Aires for her political activism and thrown into a concentration camp. Thousands of her fellow inmates were executed, tossed alive from a cargo plane into the ocean. Miriam, along with a handful of others, will survive the camp. Then as a journalist, she will wage a decades long campaign to bring her tormentors to justice. Avenger is about one woman’s triumphant battle against unbelievable odds to survive torture, claim justice for the crimes done against her and others like her, and change the future of her country. Season 2 - The Burden: Empire on Blood Empire on Blood is set in the Bronx, NY, in the early 90s, when two young drug dealers ruled an intersection known as “The Corner on Blood.” The boss, Calvin Buari, lived large. He and a protege swore they would build an empire on blood. Then the relationship frayed and the protege accused Calvin of a double homicide which he claimed he didn’t do. But did he? Award-winning journalist Steve Fishman spent seven years to answer that question. This is the story of one man’s last chance to overturn his life sentence. He may prevail, but someone’s gotta pay. The Burden: Empire on Blood is the director’s cut of the true crime classic which reached #1 on the charts when it was first released half a dozen years ago. Season 1 - The Burden In the 1990s, Detective Louis N. Scarcella was legendary. In a city overrun by violent crime, he cracked the toughest cases and put away the worst criminals. “The Hulk” was his nickname. Then the story changed. Scarcella ran into a group of convicted murderers who all say they are innocent. They turned themselves into jailhouse-lawyers and in prison founded a lway firm. When they realized Scarcella helped put many of them away, they set their sights on taking him down. And with the help of a NY Times reporter they have a chance. For years, Scarcella insisted he did nothing wrong. But that’s all he’d say. Until we tracked Scarcella to a sauna in a Russian bathhouse, where he started to talk..and talk and talk. “The guilty have gone free,” he whispered. And then agreed to take us into the belly of the beast. Welcome to The Burden.