Organ donation crisis in India

Prof. (Dr.) Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

Organ donation and transplantation provide a second chance at life for thousands of people in India each year. However, thousands of Indians die every year while waiting for an organ transplant due to an acute imbalance between the number of organs donated and the number of people waiting for one. For example, while the number of patients requiring kidney transplantation in India is estimated to be 200,000 lakh annually, only about 11,300 kidney transplantations are carried out.

Finding an organ donor is the main issue in India. Improper infrastructure, administrative hurdles, the lack of a centralised registry for organ donation, limited awareness, a conservative mindset, and numerous myths associated with organ donation affect the organ donation and transplantation scenario in India. Currently, organ transplantation relies either on relative donors or on unrelated donors. According to the Transplantation of Human Organs and Tissues Rules, 2014, if the donor is unrelated and the donor and/or recipient belong to a State or Union Territory different from where the transplantation is proposed, a no-objection certificate (NOC) from the State or Union Territory of the donor’s and/or recipient’s domicile is required. Such a certificate is not required for a donor who is a relative of the recipient.

Most unrelated transplants are currently conducted with the approval of an authorisation committee. The quorum of the committee should be a minimum of four and is not complete without the participation of the Chairman, the Secretary of Health or nominee, and the Director of Health Services or nominee. The authorisation committee must make a final decision within 24 hours of the meeting, granting or denying permission for the transplant, and the committee’s decision should be displayed on the hospital’s notice board and website within 24 hours. The website of the transplantation centre is linked to state/regional/national networks through an online system for organ procurement, sharing, and transplantation. The National Organ and Tissue Transplant Organization (NOTTO), an autonomous body under the Union Health Ministry, is the nodal agency coordinating all organ transplants in India.

Kidney transplants in India began in the 1970s, and since then, the country has been a leading nation in the subcontinent in the field of organ transplantation. There are currently over 250 centres in India performing kidney transplants. Very few transplant centres undertake liver transplants, while some occasionally perform heart transplants. The field of organ transplants in the last five decades has witnessed commerce in organ donation becoming an integral part of the programme. The growing disparity between the rich and poor, increased demand for human organs, and the availability of technology in the country make organ trade a quick route to riches for some and a relief for others. Invariably, organ trade leads to exploitation of poverty-stricken people through financial temptations rather than only addressing their immediate financial needs.

Making organs a commodity compromises social, moral, and ethical values and is not a viable alternative for meeting organ requirements in a civilised society. The World Health Organization (WHO), in its statement on the sale of human organs, states that it violates the Universal Declaration of Human Rights as well as its own constitution. Consequently, the Government of India passed the Transplantation of Human Organs Act in 1994, making unrelated transplants illegal and deceased organ donation a legal option with the acceptance of brain death. Deceased organ donation is the process of giving an organ or part of an organ at the time of the donor’s death for transplantation to a person in need.

The concept of brain death has not been promoted or widely publicised in India. Therefore, there is a problem of certifying brain deaths, as most Indians are not aware of the concept. This lack of awareness makes it difficult to convince the relatives of patients in India to consent to deceased organ donation. 

Cadaveric organ donation or organ donation from brain-dead individuals remains very low in India. While Spain has 43.9 deceased organ donors per million people and the US has 30.9, India’s count stands at a mere 0.8 deceased organ donors per million. In Assam, it is almost nonexistent. Anyone, from a child to an elderly person, can be an organ donor. Vital organs such as the heart, liver, lungs, kidneys, pancreas, and intestines, as well as tissues like corneas, heart valves, skin, bones, ligaments, tendons, and veins, can be donated in case of brain death. It is not that the Indian people are not willing to donate organs, but hospitals lack mechanisms to identify and certify brain deaths. Moreover, there is no authority to empower the relatives of a brain-dead person to save lives by donating the individual’s organs.

In India, the potential for deceased organ donation is huge due to the high number of fatal road traffic accidents, and this pool remains largely untapped. At any given time, every major city would have eight to ten brain deaths in various ICUs. Approximately 4 to 6 percent of all hospital deaths are due to brain death. Road accidents in India account for around 1.40 lakh deaths annually, of which almost 65 percent involve severe head injuries, according to an AIIMS, Delhi study. This implies that about 90,000 patients may be brain-dead each year.

A living person may wish to donate organs after his or her brain death. Signing a donor card is the first step in expressing one’s willingness to donate. Although a donor card is not a legal document, it signifies a person’s intention to donate. While signing a donor card shows a desire to donate organs after death, informing family members or friends is crucial, as family consent will be sought for the donation. Their decision will be considered final. In the near future, the emerging field of regenerative medicine could create organs from the patient’s own cells (stem cells or cells extracted from the failing organs), which would improve the availability of compatible organs.