Awareness about deceased organ donations

The Ministry of Health and Family Welfare prescribing time limits for various steps in the process of considering an application for living donor organ transplantation is a welcome move. This will expedite the decision-making process related to organ transplantation. More awareness of organ donation is also crucial for reducing the wait time for organ transplantation. In India, the majority of organ transplantations are done with organs donated by living donors, mostly family members and relatives. Deceased organ donations account for less than 20%. This is indicative of the awareness drives being inadequate to motivate more people to take action on deceased organ donation. Guwahati Medical College and Hospital recently performed the first successful transplant of two kidneys from a brain-dead patient donated by family members to two patients, which has given a boost to the campaign for deceased organ donation. The campaign for body donation has gained momentum in the state, with the number of bodies donated to various medical colleges to aid medical education and medical research steadily increasing. More people have come forward in the state to take the pledge to donate their bodies after their deaths. The significant achievement in building awareness on organ and body donation after death and blood donation when alive has shaped the launch pad to take it to the next level of campaign for organ donation of brain-dead patients to increase the availability of organs for transplantation. Retrieving the organs of the deceased for transplantation is not possible, except for the cornea of the eye and tissues within a specific time limit, when death occurs at home or outside a hospital. In such a situation, after successful retrieval of the cornea, the body pledged by the donor is handed over to the medical college and hospital for anatomical research. Often, bodies of body donors who were critically injured or ill and declared to be brain dead are brought home for paying last respect by family members, relatives, and others following a formal death declaration. When family members of body donors are fully aware that the organs of the brain-dead patient can be retrieved for transplantation to save the lives of other critically ill patients, they can be expected to express their willingness to allow hospital authorities to retrieve the organs. The window period for the family to take the decision is very short, and they have to quickly give their consent after the patient has been declared brain dead. The retrieved organs also cannot be stored for long and must be transplanted fast: the heart within four to six hours, the liver within 6–12 hours, the kidneys up to 30 hours, the intestines within 6 hours, and the pancreas within 6 hours. The organ allocation process determines who is on the waiting list for the transplant of deceased organs in different hospitals, both government and private. If the eligible recipients on the wait list are not admitted to the same hospital, then the retrieved organs are put in the common pool and are first offered to patients on the waitlist in another government hospital. If there are no waitlisted patients in any government hospital, then these are allocated to private hospitals for transplantation. The strict adherence to the prescribed time limit is critical to ensuring that the allocation process is fast and needy patients are not deprived due to procedural delays in decision making. Under the prescribed timeline, processing of an application for organ donation must be completed in ten days, while a maximum of seven days will be given to the recipient or donor to submit the required documents. The new norm states that the entire process, from application submission to decision by the Authorisation Committee, must not exceed six to eight weeks. The sequence of organ allocation stipulated in the Transplantation of Human Organs and Tissues Rules, 2014, provides for consideration of patients on the state list first, then the regional list, and then the national list of waitlisted patients. The number of deceased donors in the country increased from 340 in 2013 to 941 in 2022, which indicates the pace of action based on awareness of deceased organ donation in the past decade. Altogether, 2694 transplants were done with organs retrieved in 2022 from 941 deceased donors, which demonstrates how one deceased organ donor can save many lives. Organs donated by one deceased donor can save eight lives; corneas can give eyesight to two people; and tissue transplantation can heal the lives of about 75 people. More people coming forward for deceased organ donation are not going to change the overall situation of an acute shortage of live and deceased organ donors in the country. The number of hospitals being equipped to successfully retrieve and transplant donated organs also must be adequate to increase the number of organ transplants. An intensified campaign on deceased organ donation is critical to bridge the wide gap between the number of patients requiring transplants and the availability of donated organs.