ORGAN DONATION IN INDIA

Introduction

Organ transplant is a medical procedure by which a person's dysfunctional organ or tissue is replaced by that of a healthy person, thereby restoring its function. Obviously, a transplant can only take place if there is an organ available from a donor. However, owing to the  major scarcity of organs available for transplant in India,  there exists a severe demand and supply mismatch. For eg:- it is estimated that  around 1.8 lakh people suffer from renal failure every year, but the number of renal transplants done is only around 6,000 per annum.

Types of Organ Donation

There are two types of organ donation -

a) Living organ donation - A living person donates an organ (or part of an organ) for transplantation to another person. Living donors are classified as either a near relative (spouse, son / daughter, sibling, parents, grandparents, grandchildren) or a distant relative /friends who will need the permission of the State Authorisation Committee to donate an organ. Living persons can donate a kidney, a lung, and a portion of the liver, pancreas or intestine and still continue to live a normal life.

b) Deceased organ donation - Organ donation from a person who has been declared brain stem dead by a team of authorised doctors at a hospital. A person is said to be brain stem dead when there is an irreversible loss of consciousness , absence of brain stem reflexes and irreversible loss of the capacity to breathe. 

The other type of deceased donor could be a donor after cardiac death. But after natural cardiac death, only a few organs / tissues can be donated such as cornea, bone, skin and blood vessels, whereas after brain stem death, almost 37 different organs and tissues can be donated. 

Organs commonly transplanted from a brain stem dead donor  include kidneys, liver, pancreas, intestines, lungs and heart, with the demand for kidneys being the highest.Tissues that can be transplanted include cornea, skin, bone, veins, muscles, tendons, cartilage, heart valves, ligaments etc. A single donor can save upto eight lives through organ donation and heal upto 50 recipients through tissue donation.

In India, there is an urgent need to promote deceased organ donation, because donation from living persons cannot take care of the increasing demand for organ transplants.

Legislation in India

The Indian Govt. enacted the Transplantation of Human Organs Act in 1994, which  provides a comprehensive system to regulate the removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs. It legalised the concept of "Brain Death", which is now recognised as a legal form of death.

 Brain death is the irreversible and permanent cessation of all brain functions. In situations of brain death, a person cannot sustain his own life, but vital body functions may be maintained in an ICU for a short period of time. Such persons are kept on artificial support to maintain oxygenation of organs so that the organs are in a healthy condition until they are removed. A panel of four doctors has to declare a patient brain dead before the organs can be harvested. This is done after a series of exhaustive tests which are repeated twice in a time frame of 6 hours.

Govt. Agencies

The National Organ and Tissue Transplant Organisation (NOTTO) was set up following the passing of the Transplantation of Human Organs and Tissues (Amendment ) Act of 2011. It functions under the Directorate General of Health Services, Ministry of Health and Family Welfare, Govt. of India, serving as the apex centre for registering of organs and tissue donation and transplantation in the country. It is also responsible for the overall co-ordination of the procurement and distribution of organs and tissues. 

There are five Regional Organ and Tissue Transplant Organisations  (ROTTO), which function as separate regional branches to oversee the functioning of the state level organisations enlisted under each of them. 

Procedure for organ donation 

To be an organ donor, it is necessary to register and  sign up for organ donation by filling up the prescribed consent form which can be downloaded  from the website of the National Organ and Tissue Transplant Organisation (NOTTO), or accessed from the medical facility that is approached for organ removal. Anyone can register to be an organ and tissue donor once they are 18 years old.

Given below are some of the NGOs with which  you can register in order to pledge your organ(s).

1. MOHAN (Multi-Organ Harvesting and Networking) FOUNDATION - www.mohanfoundation.org;  Ph: 1800 103 7100

2. SHATAYU - www.shatayu.org.in;  Ph: 079 6618 9000

3. GIFT YOUR ORGAN  FOUNDATION - www.giftyourorgan.org;  Ph: +91 9845088989

4. ORGAN INDIA - www.organindia.org;  Ph: 1800 120 3648

Pledging to be an organ donor -

A prospective donor is required to fill out the pledge form available online, after which a Donor Card will be sent, along with a unique Govt. registration number. All pledges are registered with NOTTO. Registering as an organ donor is merely an expression of a person's  intent to be an organ donor and does not carry any legal sanction. 

Deceased Organ Donation

By law in India, organ and tissue donation from a deceased donor cannot take place without the written consent of the donor's family. Therefore, if you have registered as an organ donor, it is very important to talk to your family about your decision to be an organ donor to help them understand your reasons for the same.

 Generally, there is no age bar to organ donation and one or the other organs or tissues can be donated at any age. However, all potential donors will require a virology screen to prevent possible transmission of any disease from the donor to the recipient. Decisions about an organ's usability are made at the time of the donor's death. The suitability of each organ and tissue is decided by the concerned medical personnel.

In India, many cultural and religious beliefs influence the decision making regarding deceased organ donation. Lack of awareness, religious beliefs and superstitions, and lack of faith in the healthcare system are believed to be the most important reasons for the family members refusing to give their consent for the organ donation of their close relatives. These are issues that need to be addressed in order to improve the availability of organs for transplant.