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Bridging the organ donation divide

1/23/23 12:30 PM 

India’s organ donation demand is outstripping the supply, and this was only made worse by the Covid-19 pandemic, emphasizing the need to re-evaluate the approach and increase awareness around organ donation.

In India, cultural beliefs surrounding organ donation have been a key factor for years, but factors like poor infrastructure, collection issues, and transportation difficulties truly need to be addressed to improve the ecosystem.

As per latest estimates, India has an organ donation rate of 0.52 per million population, far below the world’s highest rate of 49.6 per million in Spain. India requires its citizens to register as organ donors and for families to give consent after death, while Spain operates under an opt-out system that assumes consent unless otherwise stated.

Statistics show that organ donations are not nearly enough to meet the demand, and this is due to more than simply an inadequate number of donors. Infrastructure must be improved, and organs must be utilized efficiently to prevent wastage. Transplant specialists, government, and non-government organizations are all hindered by the prohibitive cost of private hospitals and the lack of facilities and/or training in public hospitals.


Government initiatives over the years

In the last five years, government- and media-driven awareness campaigns have successfully helped boost the country’s organ transplant program. Initiatives like the Amendments to the Transplantation of Human Organs Act (THOA) and the founding of the National Organ and Tissue Transplant Organization (NOTTO) have streamlined the organ transplant system in the country.

On November 15, 2021, the Government of India enacted a change to its post-mortem protocols, allowing for post-mortem procedures to be conducted after sunset unless specified otherwise by law enforcement. Previously, autopsies had to be conducted before sunset.

These efforts have increased India’s organ donation rate from one in 20 million people to one in 2 million people within a five-year period.


Demand-supply mismatch

Every year, India performs the third highest number of transplants globally, yet only 8,000 out of 1.5-2 lakh people obtain a kidney transplant, 1,800 out of 80,000 receive a liver transplant, and 200 out of 10,000 are given a heart transplant.

A variety of factors have been identified as contributing to the shortage of donated organs, including a lack of awareness about organ donation, superstitions and misconceptions surrounding the practice, religious constraints, and infrastructural issues.

Protocols to declare brain death are vague and inconsistent between hospitals, leading to uncertainty and delays. While the Transplantation of Human Organs and Tissues Act, 1994, mentions brain-stem death as linked to organ donation in India, it is not acknowledged in the Registration of Births and Deaths Act, 1969.

This creates a dilemma when families of brain-dead people refuse to donate organs; hospitals are uncertain whether to continue ventilatory support, often resulting in extended ventilation.

Improving accessibility of donated organs to those from lower socio-economic backgrounds requires public hospitals to increase infrastructure capacity, enabling them to provide low-cost and effective transplant treatments.

Also, the Transplantation of Human Organs Act, 1994, needs to be revised to replace the cumbersome hospital bureaucracies with self-declaration and binding verification in partnership with civil society.

Partnerships between public and private entities are essential to maximize existing transplant infrastructure and provide services to a greater number of people.


Written by Subhrajit Mukhopadhyay, 

Executive Director, Edelweiss Tokio Life Insurance 

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