The World Organ Donation Day is observed globally on August 13, every year. This day is celebrated to raise awareness about the importance of organ donation and motivate people to donate organs after death. Did you know that one organ donor can save up to eight lives. and even more if a donor can give corneas and tissue? Almost anyone, regardless of age, race or gender, can become an organ and tissue donor. So why is it that organ donation in India is so dismally low?
Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994. The law allows both deceased and living donors to donate their organs. It also identifies brain death as a form of death. The National Organ and Tissue Transplant Organisation (NOTTO) functions as the apex body for activities of relating to procurement, allotment and distribution of organs in the country.
Although India has performed the second largest number of live organ transplants in the world in 2019 (after United States), in organ donation she lags far behind nations like Spain (37 per million population), United States (21.9 pmp) and United Kingdom (15.5 pmp) with a donation rate of only 0.8 pmp! According to the World Health Organization, only around 0.01 per cent of people in India donate their organs after death.
Covid-19 impacts organ donation
Lalitha Raghuram, Country Director, MOHAN (Multi Organ Harvesting Aid Network) Foundation said, “At MOHAN, we create an eco system for people to enable them to donate organs after brain death. Instead of burning or burying the body, families can donate the organs. India’s organ donation rate is just 0.8 pmp - which means that for a 1.3 billion population our rate is not even 1 pmp..which is very sad. When Covid-19 struck, for almost six months last year, we did not do any organ donations at all. because at that time there was not much understanding of the virus and its complications. Besides, the Ministry of Health and Family Welfare (MOHFW) Government of India had issued a directive to stop organ donations because they wanted to avoid the transmission of the virus to the recipient if the donor was Covid infected.”
As a result India’s organ donation rate has seen a slump. Another impact of Covid is that there has been a surge in demand for lung transplants. “We get a lot of requests for lungs as organs. So we have been counselling families of brain dead patients to donate their lungs as well,” added Lalitha.
MOHAN Foundation gets notified when ICU patients in hospitals are declared brain dead. Then Transplant Coordinators visit and counsel the patient’s families to donate their organs, usually multi organs. MOHAN is the largest organ donation NGO in India with seven offices in Chennai (HQ), Hyderabad, Mumbai, Delhi, Nagpur, Bengaluru and Jaipur. MOHAN also offers Transplant Coordinator courses with durations of one week, one month and one year. MOHAN has trained more than 3,000 Transplant Coordinators in the country.
Lalitha informs that among organs, the highest demand is for the kidneys - at any given time nearly five lakh patients are waiting for a kidney donor. She said, “The longest waiting list is for kidneys...One brain dead donor can save 8 lives - donating two eyes, two kidneys, one liver, heart and two lungs. Additionally, heart valves can also be donated as well as bone and skin, so in actuality one donor can impact the lives of upto 50 people! We see a lot of patients dying for lack of getting an organ on time. So it’s crucial to step up India’s organ donation rates.”
Role of the government
Lalitha affirms that organ donation must be a national priority. The central and state governments must create more awareness about organ donation and how it can save lives. Many parliamentarians including our prime minister have pledged to donate their organs but they must let the public know about this. Our national elected representatives must promote organ donation in their own constituencies and talk about it, she opines.
It is indeed ironical that in small countries like Spain and Croatia organ donation rates are very high - that’s because they have good infrastructure and a system in place so whenever there is a potential organ donor or a brain dead patient, the counselors are alerted and immediately they can counsel the families to agree.
Lalitha pointed out, “Once the doctors know they cannot save a patient, their focus is on saving 8 other lives. But in India, the organ donation demographics are uneven. In the south, Tamil Nadu, Karnataka, Telangana and Kerala are very developed in organ donation. So are Maharashtra and Gujarat. In the north, Delhi is a little developed so is Rajasthan and Chandigarh. But if you look East, West Bengal is just picking up. The North East and Odisha are yet to get on the organ donation map. In fact, we just started working in Manipur last year. Alongwith public education programs, we have started ICU training as well.”
So there is skewed distribution of organ donation numbers because the infra and systems are not uniformly developed for organ donations to happen. Lalitha lamented that, “Though there is a Central law which defines brain death, not all doctors know how to declare brain death. A minimum of four doctors are required to declare a patient brain dead two times in a gap of 6 hours. Only if they can do that, can they pave the way for counsellors like us to be able to counsel and motivate the families to agree. That is not happening. A lot of awareness is needed even in the hospitals so that doctors are also sensitised to this cause.”
India’s young generation are the bright spot in this cause. They are open, aware of the cause and they pride themselves on pledging their organs. Lalitha shared that a lot of them walk into MOHAN’s offices on their birthdays or wedding anniversaries to pledge their organs for donation. So the future looks bright.
As for spurious transplant incidents, Lalitha informed that this is mostly in the area of live transplants when only blood relatives or near relatives can donate the organs. “Nearly 90 per cent of kidney transplants that happen in the country are live transplants. Nowadays with smaller families, it falls upon the secondary or near relatives to organ donate but every state has an authorisation committee for this. It involves a lot of paperwork and it has to be proven to the committee that the donor is donating purely for the cause not for monetary benefits. This is the grey area for spurious operations. In Odisha there have even seen Kidney marriages - the marriages taking place only for the sake of a transplant! That is why we at MOHAN promote only deceased organ donation,” said Lalitha.
So this World Organ Day, pledge to donate your organs - you can save 8 lives and more. Click here for MOHAN Foundation's Organ Donation Helpline (Toll Free) or call 1800 103 7100.
Apart from MOHAN Foundation, other institutions accepting organ donations include Organ India.
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