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Commentary

Organ Donation in India: Scarcity in Abundance


Sandeep Sachdeva
Professor, Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India

Summary
In modern era, India witnessed its first successful corneal, kidney and cardiac transplant in the year 1960, 1967 and 1994 though the
reverberations for organ donation and transplantation (ODT) existed since time-memorial with roots existing in Hindu mythology along with
vivid example of Guru Dadheech and lord Ganesha. No country in the world is able to meets its organ requirement. Government of India
promulgated Transplantation of Human Organ and Tissues Act in 1994 and with the view to enlarge its scope and promote organ donation
government has brought new amendments as of year 2014 and 2017. In the background of this journey many new developmental milestones
have been achieved in the country however organ donation which has assumed public health significance has been consistently lower than
expectations. This manuscript highlights the current status of ODT in the country; legislative environment, limitations, challenges, health
education activities, and newer initiatives.

Key words: Behavior change, cadaver, cornea, eye, health education, heart, kidney, legislation, national program, organ donation, organ
transplant, public health

The mention for organ donation and transplantation (ODT) of  <1/million population  (pmp); however, Tamil Nadu has
existed since time‑memorial with roots existing in Hindu shown exemplary performance in OD with 1.3 donor pmp.[5]
mythology along with vivid example of Guru Dadheech and The Tamil Nadu model is helping poor and rich people not
lord Ganesha. However the consequences of rising burden of only from India but foreigners also. Although India falls in
noncommunicable diseases, living geriatric population, other the second position with numbers of live donor transplants
risk exposures and behavior are propelling the graph of end undertaken in the world after the USA, but stand nowhere
stage organ failure across the globe including India. For last in the list of deceased donor transplant.[6‑9] Country needs
couple of decades, it has assumed public health significance 260,000 organs every year, i.e., 180,000 kidneys; 30,000 livers
due to ever increasing gap of need and supply of human organs. and 50,000 hearts, whereas only 6000 kidneys, 1200 livers and
Atleast twenty‑five different organs/tissues can be donated 15 hearts are transplanted annually (National Organ Transplant
by humans either through living or deceased donation under Program). India has a fairly well‑developed corneal donation,
certain contraindications, psychiatric, and medical fitness.[1] and transplant program however donation after brain death
Young death due to road traffic accident or cardiovascular has been relatively slow to take off. In the backdrop of annual
event provides a best option for organ donation. requirement of 100,000 corneas around 40,000 were collected
during the past few years yet <25% could be transplanted due
No country in the world till date collects sufficient organs to meet
to quality issues (personal communication).
the needs of their citizens. It is estimated that currently organ
transplantation covers <10% of the global need. Spain, Austria, Solid organ transplant activities are largely driven by
Croatia, USA, Norway, Portugal, Belgium, and France stand out the private sector in the country. The cost of solid organ
as countries with high rates of deceased organ donors. Kidneys are transplantation in private sector in India may vary from
the most commonly transplanted solid organs, followed by liver
and then heart across the globe while cornea and musculoskeletal Address for correspondence: Prof. Sandeep Sachdeva,
grafts are the most commonly transplanted tissues.[2‑4] Department of Community Medicine, North Delhi Municipal Corporation
Medical College and Hindu Rao Hospital, New Delhi, India.
Unfortunately, India with a 1.2 billion population is lagging E‑mail: sachdevadr@yahoo.in
behind in OD with a national deceased donation rate
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DOI:
10.4103/ijph.IJPH_230_16 How to cite this article: Sachdeva S. Organ donation in India: Scarcity in
abundance. Indian J Public Health 2017;61:299-301.

© 2017 Indian Journal of Public Health | Published by Wolters Kluwer - Medknow 299
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Sachdeva: Organ donation and transplantation

rupees fifty thousand to fifteen lakhs depending on organ 8. Swap donations of organs between near relatives allowed
involved, and there are some definitive charges at selected 9. Procedures for foreign nationals notified if they happen
government institution also (personal communication). There to be donor or recipient
is no direct cost implication on the deceased organ donor’s 10. Detail procedures notified to prevent commercial
family while live donor has definitive cost implications. India activities and exploitation of minors
is acknowledged as favorite destination for foreign nationals 11. Establishment of a National Organ Retrieval, Banking,
seeking high quality low‑cost medical care in the world with and Transplantation Network
well‑established accredited health system capacity, adoption of 12. Maintenance of registry of donors and recipients waiting
global best practices, English speaking work‑force, courteous for organ transplants
support team, availability of air‑ambulance, provision of 13. Mandatory position of a “Transplant Coordinator” in all
health visa, utilization of high end health/communication hospitals registered for ODT
tool/techniques/technology, etc.[10] leading to the popularity 14. Every authorized transplantation center should have its
of medical, reproductive and transplant tourism. own website. The identity of the people in the database
shall not be in public domain
There have been instances of organ trafficking in India as in
15. The authorization committee is required to take a final
other parts of world leading to resistance/negative publicity,
decision within 24 h of holding the meeting for grant of
but since then many corrective interventions have been taken
permission or rejection for transplant. The website of
to eliminate this menaces. In spite of all efforts commercial
transplantation center shall be linked to state/regional/
activities involving poor donors are still being reported that
national networks through the online system for organ
arouses cautious, suspicious approach and further checks
procurement, sharing, and transplantation
leading to critical delays. Financial and other policy initiatives
16. The cost for maintenance of the cadaver  (brain‑stem
including cleanliness drive, interventions, activities, and
dead declared person), retrieval of organs or tissues,
steps taken by the new central government is not only
their transportation and preservation, shall not be borne
uplifting general sentiments in the society but also improving
by the donor family and may be borne by the recipient or
behavior, work ethics, discipline, and system transparency.
institution or government or nongovernment organization
This will in‑turn lead to the elimination of black money and
or society as decided by the respective state government
corruption‑free environment but would also influence all aspect
or union territory administration
of the health sector positively.
17. Detailed procedures regarding quality assurance, donor
The government of India promulgated Transplantation of screening, qualification and experience of doctor/
Human Organ and Tissues Act in 1994 and with the view to transplant coordinator, laboratory investigations,
enlarge its scope and promote cadaver organ donation has equipment, documentation, and other requirements
brought amendment into legislation  (2011) and notification notified.
of rules (2014). Some of the broad areas included in recent
With other demanding and pressing public health issues being
amendments are:[11‑13]
faced by the country government of India has not committed
1. Provision of registration and renewal of retrieval and
substantial funds into ODT in the 12th 5‑year plan since it is
transplant centers
a very cost‑intensive activity. At the same time, government
2. Definition of term “near relatives” to include grandparents
has not shunned from its role and responsibility. Many diverse
and grandchildren in addition to parents, children,
and collateral activities have been established under favorable
brother, sister, and spouse
legislative environment with the involvement of stakeholders.
3. Removal of eyes/corneas permitted by a trained
National Organ and Tissue Transplant Organization (NOTTO)
technician
situated at Safdarjung Hospital, New  Delhi has been
4. Brain death certification board has been simplified
commissioned and has two divisions[1] National Human
to enable a surgeon/physician and an anesthetist/
Organ and Tissue Removal and Storage Network[2] National
intensivist to be included in the medical board in the
Biomaterial Centre  (National Tissue Bank). Regional/
event of nonavailability of a neurosurgeon/neurologist
State level organ and tissue transplant institutions would be
for certification of brain death
established in a phase manner at Kolkata, Chennai, Mumbai,
5. Authorization committee to be hospital based if number
Chandigarh and Guwahati in‑addition to six cities were AIIMS
of transplants undertaken is twenty‑five or more in a
are established. The NOTTO website http://notto.nic.in has
year at the respective transplantation centers, and if the
become functional and various operational guidelines of
number are <25 in a year, then the state or district level
National Organ Transplantation Program have been released
authorization committee would grant approval(s)
in public domain.[14]
6. Medical practitioner involved in transplantation team will
not be a member of authorization committee Organ retrieval and banking organization and national eye bank
7. It is mandatory for the Intensive Care Unit/treating established in AIIMS, New Delhi are acting as mentor, research
medical staff to request relatives of brain‑dead patients center and coordinating unit in the national capital region with
for organ donation other public sector and private hospitals. A call centre is being

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Sachdeva: Organ donation and transplantation

set up which will set up contact between established centers, donation movement. The debate on accountability, ethics,
donors and people in the waiting list on a real‑time basis. equity, cost‑effectiveness, safety, surveillance, standardization,
Technical, administrative and sensitization training of doctors, unscrupulous activity, incentives, and competing priorities will
paramedics and transplant coordinators is underway. Registry continue to dominate organ donation and transplant platform
and surveillance activity has been established. Memorandum in current and future socio‑political environment.
of understanding has been linked with other countries and
international organization for learning and sharing of best References
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