G. Jayalakshimi and Ayanti Guha , Transplant Coordinators – Global Hospitals, Hyderabad

Transplantation of human organs is undoubtedly one of the greatest medical breakthroughs of this century. However very few Indians patients are able to  benefit from this medical  advancement either  due to  the high costs involved to the  organ donor as in the case of live donation. In major organ transplants like the liver, the risk to the donor is inherent, and therefore, the ethics of live donation is being widely discussed across the globe.

The Indian Government passed the “Transplantation of Human organs Act” in 1994 recognising the concept of brain death and legalizing the retrieval of organs from brain dead persons. However, organ donation rates over the past ten years have been singularly low and this has severely limited the success of the cadaver transplant programme.

Major factors that may have hindered the cadaver organ donation movement in India are:

• Ignorance and misconceptions about brain death and organ retrieval process fear of mutilation of the dead body, belief that the presence of donor card may affect the treatment, delay in the funeral, superstitions related to rebirth et al.
• Loopholes in the law and lack of uniform legal framework.
• Reluctance and lack of motivation from the core group (neurologist and neurosurgeons).
• Treating hospitals apprehensions of being accused of providing inadequate care to the patient in case brain death is declared.
• Lack of infrastructure in many hospitals in maintaining brain dead patients.
• Lack of awareness and motivation along with the red tape in the police department as most of the brain deaths occur in cases designated as “medico legal cases”.
• Lack of trained professional to do grief counseling for the kith and kin of brain dead patients.

While a lot has been mentioned about the factors impeding the systematic and well regulated donation of organs, not much light has been shed  on the steps  that can be taken  to counter all the  difficulties. We can only suggest certain remedies which seem practical to us,   but whether they can be implemented will be  for the lawmaking  bodies to decide.

We can start off with what seems to be the simplest –have a law enacted which makes it mandatory for brain death to be declared without fearing repercussions of any kind.

Plug loopholes in the “Transplantation of Human Organs Act” with respect to   unrelated live donations and ensure that a uniform legal framework is followed in all states.

Carrying out propagation of organ donation and information about brain death in metros and major cities that have the medical facilities to maintain such cases.

 Propagation can be carried out in areas which are usually crowded (train/bus stations lobbies, theatres at al)  at most times of the day and in a manner which will attract  people’s attention.

Organs can and should be treated as  a national resource and no  organization should be allowed  to carry on a monopoly on deciding on the usage of organs.

 Promoting awareness in the police force   and other government officials involved in medico legal cases thereby leading to less delay and more streamlined approach in getting  the legal formalities completed.

Cooperation from the police department, in allowing the police  personnel from the area/jurisdiction wherein the donor hospital falls to act with sensitivity, instead  of getting matters unduly complicated  by bringing up issues of  jurisdiction and authority, at least  in cases where family of brain dead  patient  has already given their consent for organ retrieval.

Grating retrieval licenses to more hospitals  thereby minimizing the time taken  to procure  the organ.

Identifying a key person in each hospital; who will liaise with the organ procuring agencies about a potential brain death or a potential donor.

Each one of these suggestions has the potential of becoming a very practical solution for the multitudes that will join the ever growing line of people with organ failure and for whom a new tomorrow can be ensures only by the steps that we all take today.