In the ten years since the transplantation of human organs Act was passed, we have not got very far with the programme due to various reasons. First and foremost have been a lack of direction and the will to seriously consider this as a serious alternative to living organ donation. The government surely passed the act but has hardly done anything afterwards, in this direction. The law governing transplants is only a simple framework but the actual organ donation process and transplant is a much more complicated event and its complexities cannot be necessarily perceived in this framework. The number of variables in this event especially in India for outnumbers those who in the west. A cadaver organ donation is the result of the chain of events and even smallest hitch in this chain can lead to a futile attempt or can create misunderstandings among colleagues and hospital administration. This may be one important reason why so few hospitals have undertaken this programme; while the majority has been unable to give it a kick start.

Another problem has been clubbing the cadaver and living donation programme and policies in the same basket. The cadaver events cannot be compared in any way with the events take place in a living donation situation. These are two entirely different entities. Unless this is clearly understood and we learn to give equal importance to both the programmes, the cadaver programmes is unlikely to develop in India.

However, the potential of cadaver programme in this country is huge. Let us see if the cadaver programme can be of benefit the problem of organ shortage that is currently such a major issue in the world. In India, we know that the number of patients having end stage renal, liver or heart failure requiring organ replacement therapy can run in to hundreds of thousands; however it is only a few thousands who can afford to undergo a transplant surgery due to financial implication of the surgery.

  The current kidney transplant rate in India is estimated to be approx.3, 000. The liver and heart probably will not require 1000 organs over the next 3 to 5 years. It is also estimated that another 3000 patients could afford a transplant if organ donor supply was possible. can the cadaver programme in India meet his shortage? This is how the calculation would work.

• At 1 per million donation rates would have 1100 organ donors or 2200 kidneys, 1000 hearts, 1100 livers, 1100 pancreas and 2200 Eyes. This should take care of almost all current demands for organs.
• At 2 per million donation rates there would be 2200 organ donors and the above figures would double and there would be no necessity to undertake living kidney donations.
• If we did 3 per million, we could take care of all SAARC countries' demand for organs.
• At 5 per million we would have 10,000 kidneys, 5000 hearts, and 5000 livers- and we could start looking at the problem of organ shortage in rest of Asia and other parts of the world. At this stage let us not even conceive any further, however the point is India with some effort in this field has the potential of completely doing away with living donation and not only meeting its own demand but also demand of organ shartage of other countries.

We in India may not be able to compare our economic progress with some of the wstern countries, but countries in the second league like Poland and Hungary are today able to do an organ donation rate of 6 per million. Even the conservative society of a country like Hong Kong does 3 per million.

The last ten years have resulted in approximately 1000 cadaver transplants of almost all organs. If not anything else, at least the programme has proved two things - one, that it is possible to organize the chain of events that lead to cadaver transplants and second, that it is not only kidneys, but also our hospitals and  doctors can do other organ transplants successfully. India today is on the threshold of taking a jump from a developing nation towards a developed nation. This is the dream of many proud Indians including our President APJ Kalam. In this issue we have printed a special extract of what our President thinks of this complex field.