India has very low rates of deceased organ donation compared to the western world. It is estimated that almost 5, 00,000 people die every year in India which can be prevented by organ transplant.
15 people die every ten minutes waiting for an organ transplant with new names being added to the never ending waiting list. India has an organ donation rate of 0.01% which is sadly very low compared to a few countries like Croatia and Spain which are at 36.5 an 35.3% respectively.

There is a wide gap between patients who need transplants and the organs that are available in India. An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only.

An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant. Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed.

Similarly about 50000 persons suffer from Heart failures annually but only about 10 to 15 heart transplants are performed every year in India. In case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.

The laws:

Transplantation of Human Organs Act (THOA) 1994 was enacted to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. THOA is now adopted by all States except Andhra and J&K, who have their own similar laws. Under THOA, source of the organ may be:

• Near Relative donor (mother, father, son, daughter, brother, sister, spouse)
• Other than near relative donor: Such a donor can donate only out of affection and attachment or for any other special reason and that too with the approval of the authorization committee.
• Deceased donor, especially after Brain stem death e.g. a victim of road traffic accident etc. where the brain stem is dead and person cannot breathe on his own but can be maintained through ventilator, oxygen, fluids etc. to keep the heart and other organs working and functional. Other type of deceased donor could be donor after cardiac death.

Brain Stem death is recognized as a legal death in India under the Transplantation of Human Organs Act, like many other countries, which has revolutionized the concept of organ donation after death. After natural cardiac death only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated including vital organs such as kidneys, heart, liver and lungs.

Despite the law, organ donation from deceased persons continues to be very poor. In India there is a need to promote deceased organ donation as donation from living persons cannot take care of the organ requirement of the country. Also there is risk to the living donor and proper follow up of donor is also required. There is also an element of commercial transaction associated with living organ donation, which is violation of Law. In such a situation of organ shortage, rich can exploit the poor by indulging in organ trading.

Government of India initiated the process of amending and reforming the THOA 1994 and consequently, the Transplantation of Human Organs (Amendment) Act 2011 was formulated. Some of the important amendments under the (Amendment) Act 2011 include:-

• Tissues have been included along with the Organs.
• ‘Near relative’ definition has been expanded to include grandchildren, grandparents.
• Provision of ‘Retrieval Centres’ and their registration for retrieval of organs from deceased donors. Tissue Banks shall also be registered.
• Provision of Swap Donation included.
• There is provision of mandatory inquiry from the attendants of potential donors admitted in ICU and informing them about the option to donate – if they consent to donate, inform retrieval centre.
• Provision of Mandatory ‘Transplant Coordinator’ in all hospitals registered under the Act
• To protect vulnerable and poor there is provision of higher penalties has been made for trading in organs.
• Constitution of Brain death certification board has been simplified- wherever Neurophysician or Neurosurgeon is not available, then an anesthetist or intensivist can be a member of board in his place, subject to the condition that he is not a member of the transplant team.
• National Human Organs and Tissues Removal and Storage Network and National Registry for Transplant are to be established.
• There is provision of Advisory committee to aid and advise Appropriate Authority.
• Enucleation of corneas has been permitted by a trained technician.
• Act has made provision of greater caution in case of minors and foreign nationals and prohibition of organ donation from mentally challenged persons

Challenges:

1.High Burden (Demand Versus Supply gap)
2.Poor Infrastructure especially in Govt. sector hospitals
3.Lack of Awareness of concept of Brain Stem Death among stakeholders
4.Poor rate of Brain Stem Death Certification by Hospitals
5.Poor Awareness and attitude towards organ donation— Poor Deceased Organ donation rate
6.Lack of Organized systems for organ procurement from deceased donor
7.Maintenance of Standards in Transplantation, Retrieval and Tissue Banking
8.Prevention and Control of Organ trading
9.High Cost (especially for uninsured and poor patients)
10.Regulation of Non- Govt. Sector

A few facts about Organ donation:

• Anybody can be an organ donor irrespective of their age, caste, religion, community etc
• There is no defined age for donating organs. The decision to donate organs is based on strict medical criteria, not age.
• Tissues such as cornea, heart valves, skin, and bone can be donated in case of natural death but vital organs such as heart, liver, kidneys, intestines, lungs, and pancreas can be donated only in the case of ‘brain death’.
• Organs such as the heart, pancreas, liver, kidneys and lungs can be transplanted to those recipients whose organs are failing because it
  Anyone younger than age 18 needs to have the agreement of a parent or guardian to be a donor.
• Having a serious condition like actively spreading cancer, HIV, diabetes, kidney disease, or heart disease can prevent you from donating as a living donor.

Organ donation in India is in its early stages and major factors effecting are

1. Lack of awareness
2. Spiritual beliefs
3. Negative attitude towards organ donation

Off late through the coordinated efforts of various stake holders there has been a conscious rise in the rate of organ donation pledges.
National Organ Transplant Programme with a budget of Rs. 149.5 Crore for 12th Five year Plan aims to improve access to the life transforming transplantation for needy citizens of our country by promoting deceased organ donation.

The Ministry of Health & Family Welfare has urged people all of communities to come forth and generously donate organs to help the noble cause of saving precious lives.

NOTTO (National Organ Tissue Transplant Organization) celebrates Indian Organ Donation Day on 27th November every year since the last 10 years and urges its stakeholders to pledge their organs.
The main objective of the national organ donation day is to spread awareness among people and to recognize the selfless efforts made towards mankind, and reestablish our belief in humanity.

Dr. Chaitanya Challa (Director of Health at Homes and SurgyLife) summed up his position on organ donations by sharing that, “The truth is that one is more likely to “need” an organ, than (to likely consider to) ever become a donor. An accident or organ failure can happen to any one of us, family or friends. Thus, for the better of all, sign your donor card.” It’s such a simple act that has the power to save lives.