What is the procedure for organ donation in India? What are the laws related to organ donation here?
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Dr Avnish Seth
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The Transplantation of Human Organs Act (THOA) 1994 provides the regulation for removal, storage and transplantation of human organs for therapeutic purposes in India. The Act recognised the concept of brain death and gave legal sanction for deceased organ donation, but failed to provide the much-needed boost to altruistic organ donation. The process of organ donation involves diagnosis of brain death, consent of family, documentation and organ retrieval in a hospital approved for the purpose by the appropriate State authority.
Is the Indian law for organ donation different from the rest of the world?
There is a fair amount of uniformity in the laws on organ donation all over the world but THOA 1994 is considered more restrictive. Declaration of brain death and organ retrieval is allowed only from hospitals approved for organ transplantation. Four doctors, including a neurologist, are required to ascertain brain death and the tests have to be repeated after six hours, when already time is at a premium. In most countries, one or two doctors are enough to certify brain death and there is no mandatory time interval between two sets of tests. Some of these issues are addressed in The Transplantation of Human Organs (Amendment) Act 2011 which shall be implemented as rules shortly.
Do you feel that the existing law is good enough?
I feel that the existing law safeguards the interests of all concerned but tends to slow down the process of organ donation. I am also concerned with an aspect of THOA 2011 which mandates that forensic expert should be present during organ retrieval in medico-legal cases where post-mortem examination is not waived off by concerned authorities. All patients with head injury, which is the most common cause of brain death, are medico-legal. When we are trying to promote organ donation in the country one should avoid changes in the law which make the procedure even more difficult. Currently, we just obtain a no-objection certificate from the forensic authorities and go ahead with organ donation.
In India, does the government provide subsidies for efforts directed towards encouraging organ donation?
Increasing awareness on organ donation is the need of the hour. This does not happen overnight but requires years of dedicated effort and money. I am afraid that as a nation we have been found wanting in this aspect. The government does not provide any subsidy on this count.
Deep rooted religious beliefs are one of the causes for hampering organ donation in India. There are many healthcare providers, media personnel and NGOs who struggle to dispel these myths. Tell us how can we break these shackles?
Religious beliefs, in my opinion, are a punching bag we tend to use as an excuse for poor organ donation in our country. Lack of awareness on brain death and the process of organ donation amongst medical professionals as well as the public and failure to put systems in place is the prime reason for lack of organ donation in India. Those of us who have strived to make this work have found an acceptance rate of 40 to 50 per cent, which is comparable to the best in the world. This is true for Fortis Organ Retrieval and Transplant (FORT), Armed Forces Organ Retrieval & Transplant Authority (AORTA) and MOHAN Foundation in the South. It is a myth that any religion prohibits organ donation. It is mentioned in the Bhagwat Gita that one should not grieve for the body and that ‘Daan’ is the act of selfless giving. Similarly, Guru Nanak said, ‘The dead sustain their bond with the living through virtuous deeds.’ The Holy Quran mentions, ‘Whoever saves the life of one person would be as if he has saved the life of all mankind’. ‘Freely as you have received, freely give,’ says the Holy Bible.
Also, illegal organ trade in India is on the rise. Organised gangs are believed to be harvesting organs such as kidneys and livers.
What could be the reasons for such a practice?
I do not think that is the truth. However, the absence of a robust and transparent organ donation system in the country tends to promote acts of desperation. The families of patients with end stage liver and kidney diseases will do anything to save the life of their loved ones.
How can we curb this practice? How is the healthcare industry working towards this?
Promoting organ donation and having an effective organ donation programme is the only way to curb illegal activities. Increasing awareness on the concept of brain death and organ donation is the first step. Brain death usually occurs in a setting of head injury, stroke or brain tumour, leading to irreversible loss of consciousness, absence of brainstem reflexes and requirement for ventilatory support. The heart continues to beat for 12 to 48 hours after brain death, thus maintaining blood supply to the vital organs. This is the concept which is difficult to understand by a grieving family ‘How can my loved one be dead when the heart is still beating?’ Education has to start from school level and continued at all levels by involving the media. Organ pledging facility should be made available extensively. We have hundreds of individuals who have pledged to donate their organs through FORT. We make organ donor cards on request at fort@fortishealthcare.com or our Helpline number 08447743868 may be contacted. In Bangalore, the option for organ donation in case of brain death is being exercised at the time of making driving licence. The public must know that a single heart beating but brain-dead donor can save several lives by donating the liver, kidneys, heart, lungs, pancreas and small bowel.
What is the need of the hour?
India has the maximum number of road accident related deaths in the world but one of the lowest organ donation rates at 0.18 per million population. There are hundreds of individuals with brain death in ICUs across the country but counselling for organ donation does not happen because of lack of awareness and non-availability of documentation. Declaration of brain death and counselling families for organ donation should be made mandatory. Look at what happened in Croatia. 10 years ago they had the lowest organ donation rate in Europe but today they are second highest in the world. They earmarked a key donation person for every hospital to monitor and promote all organ donation activities and also placed trained transplant coordinators in every hospital. In our setting the medical administration has to consider organ donation as key area and the Medical Superintendent or his team should supervise all activities related to brain death and organ donation in the hospital. The State government should ask for monthly return on the same from each hospital.