Is India ready for the opt out model of organ donation?

Marking Organ Donation Day, Dr PK Bhardwaj, Medical Director, Saroj Super Speciality Hospital, Delhi gives insights on the impact of organ donation and encourages measures to improve the current organ donation stats

Nationally, with a population of 1.2 billion people, the statistic stands at 0.08 persons as organ donors per million population (PMP). This is an incredibly small and insignificant number compared to the statistics around the world. Countries like the US, UK, Germany, Netherlands have a ‘family consent’ system for donations where people sign up as donors, and their family’s consent is required. These countries have seen the donations double per million population (PMP) averaging between 10-30 PMP. Other countries like Singapore, Belgium, Spain have a more aggressive approach of ‘presumed consent’, which permits organ donation by default unless the donor has explicitly opposed it during his lifetime. These countries have seen the rate of donations double, averaging between 20-40 PMP.

In India, each year, thousands of people die while waiting for a transplant, because no suitable donor can be found for them. The need for organ donors has never been greater. Virtually anyone can become a donor. Your medical condition will determine what organs and tissues can be donated for transplant.One organ donor can save up to eight lives. One eye and tissue donor can save or improve the lives of up to 50 people. This means an organ, eye and tissue donor can potentially impact the lives of 58 people!

Organ donation is the harvesting of an individual’s organs after he or she dies for the purpose of transplanting them into another person. Organs that can be donated for transplantation include kidneys, heart, lungs, liver, small bowel and pancreas. Tissues that can be donated include eyes, heart valves, bone, skin, veins and tendons. Vital organs like heart, liver, kidneys, intestines, lungs, and pancreas can be donated only in case of ‘brain death’. However other tissues like corneas, heart valves, skin, bones etc can be donated only in case of natural death.

However active cancer, active HIV, active infection (for example, sepsis) or intravenous (IV) drug use are some of the contra-indications. Patients who have Hepatitis may still donate organs to a patient who also has Hepatitis .Most cancer patients may donate corneas.”

If you are age 18 or older, you can enroll in the donor registry. You can also add the words ‘organ donor’ to your driver’s license and complete a living will or health care proxy. Individuals in their 80s and 90s have successfully donated organs including liver and kidneys to save the lives of others.It is becoming more common to donate organs and partial organs while living. Kidneys are the most common organs donated by living donors.

Brain death occurs in patients who have suffered a severe injury to the brain as a result of trauma or some other medical cause. As a result of the injury the brain swells and obstructs it’s own blood supply. Without blood flow, all brain tissue dies. Artificial support systems may maintain functions such as heartbeat and breathing for a few days, but not permanently.

Brain death is an established medical and legal diagnosis of death. Brain death is the most common circumstance under which patients donate organs, because while they have been declared dead the mechanical support has maintained blood flow to the organs. This occurs only in the hospital, typically in an intensive care setting. If all brain activity is absent, the patient is dead. The protocol to be declared brain dead is the same whether a person is an organ donor or not.

The buying and selling of organs is illegal as part of the Organ Transplant Act. No set age limit exists for organ donation. At the time of death, the potential donor’s organs are evaluated to determine their suitability for donation.

A registry is an essential part of understanding who and where potential donors are. A registry gives a planner enough information to devise strategies to get more public cooperation and commitment towards organ donation. Having a registry in place allows doctors and transplant coordinators to check if a brain dead person wished to donate and then approaching the family for consent becomes easier. It helps in saving crucial time in the process of organ donation. At present, we do not have a central registry in India. Through this initiative we intend to make the government of India create one.

All of the major religions in this country approve of organ and tissue donation and consider it a gift – an act of charity. All of us can be organ donors, irrespective of age, caste, religion, community, current or past medical condition. Children can also be organ donors after taking consent for organ donation from their parents.