Organ donation after brain death is the need of the hour. While a majority of organ transplants in the world are done from deceased donors, most of our programs are based on living donors. The concept of brain death is central to the process of organ donation. In patients with brain death, injury occurs to the brain due to stroke, head injury or brain tumour so that the brain dies but the heart continues to beat for a few hours or days, thus maintaining vital blood supply to all organs. A single non-living beating heart donor can save several lives by donating the heart, lungs, liver, kidneys, pancreas and small bowel. Once the heart stops beating, several tissues like cornea, heart valves, eardrums, ear bones, tendons and skin could be donated. Recently, protocols on ‘Donation after Circulatory Death’ are being developed in the country. There are several myths associated with organ donation after brain death.
Myth 1: Organ donation does not happen in India
Awareness of organ donation in the country is on the rise. In 2022 there were 941 donations after BD in the country, resulting in the transplantation of a total of 2,694 organs including 1,541 kidneys, 737 livers, 243 hearts and 144 lungs, 26 pancreas and three small intestines. These are not small numbers in a country where, till a few years ago, organ donation was synonymous with the donation of a kidney or part of the liver from a living donor.
Myth 2: Brain death is not death
Brain death is death. Brain death is not reversible. When brain death is declared, the death form is also filled, even as the heart is still beating. The ‘Dead Donor Rule’ is always followed in organ donation. The difference between brain death and conventional death is shown in the table.
|
Parameter |
Death | Brain death |
|
Spontaneous breathing |
No |
No |
| Heart beating |
No |
Yes |
| Reversibility | No |
No |
Myth 3: Diagnosis of brain death is complicated and expensive
The diagnosis of BD in India is based on bedside tests performed by a team of four doctors and repeated after 6 hours. No expensive tests are required.
Myth 4: Organ donation after brain death is illegal
The Transplantation of Human Organs Act 1994 first provided for the regulation of removal, storage and transplantation of human organs for therapeutic purposes in India. The Transplantation of Human Organs & Tissues Rules 2014 (THOTR 2014) has brought about several changes to streamline the process of declaration of brain death and organ retrieval.
Myth 5: My religion stops me from organ donation
Ans: No religion prohibits organ donation. Religious beliefs are a punching bag we tend to use as an excuse for poor organ donation in the country. Below are some relevant excerpts from religious texts:
Hinduism: “…it is said that the soul is invisible, knowing this you should not grieve for the body.” Daan is the act of selfless giving. -Bhagavad Gita, chapter 2:25.
Sikhism: “The dead sustain their bond with the living through virtuous deeds.” -Guru Nanak, Guru Granth Sahib, p 143.
Islam: “Whosoever saves the life of one person would be as if he saved the life of all mankind.” – Holy Quran, chapter 5:32.
Christianity: Sacrifice and helping others are consistent themes in Christianity, which teaches the principle of seeking for others what you hope others would do for you. The teaching of Jesus Christ:- “… Freely you have received, freely give.”- Mathew, chapter 10:8.
Myth 6: If I donate my organs I may be born without a kidney or liver in my next birth
Ans: This is easily countered by the argument that while getting rid of a part of the body surgically for a malignancy no such thought comes to mind! Then why have negative thoughts when it comes to doing something positive for someone else?
Myth 7: Organ donation affects the treatment and leaves the body disfigured
The subject of organ donation is raised only after brain death. The treating teams have a mandate to spare no effort in saving lives and have no part to play in the process of organ donation. There is no disfigurement or mutilation of the body. A brain-dead person perceives no pain. Organs are removed with the greatest care and dignity by a team of specially trained surgeons in the operation theatre.
Myth 8: Permission of the family is not required for organ donation and retrieval if I have a donor card
The donor card has no legal standing. At the time of brain death, the donor is on a ventilator and the family is required to make the decision. Pledging helps the family to make the right decision. Therefore, it is of utmost importance that at the time of signing up as an organ donor, one shares the decision with the family.
Myth 9: A miracle will happen and my loved one will wake up from brain death
No person has ever come back to life after a declaration of brain death. Brain death is death. Hoping for a miracle to happen is often a stumbling block towards acceptance of death and donation of organs.
Myth 10: Organ donation is expensive
Billing to organ donor families is stopped from the moment they consent to organ donation. It is mentioned in THOTR 2014 that ‘The cost for maintenance of the cadaver (brain-stem dead declared person), retrieval of organs or tissues, their transportation and preservation, shall not be borne by the donor family and may be borne by the recipient or institution or Government or non-Government organisation or society as decided by the respective State Government or Union territory Administration’.