The Ministry of Health and Family Welfare has a - Proposal   under consideration of the Government on the recommendations made by the Transplantation of Human Organ Act (THOA) review committee in report dated 25th May 2005, posted on its website: (http://mohfw.nic.in/THOA%20Recommendation%20modified.htm ).

It has also issued public notices in the print media asking for suggestion for amendments of the act.

 The THO act can be broadly divided into three aspects –

1. Rules regulating Living donation
2. Rules regulating deceased donor programme as related to brain death and organ retrieval procedures
3. Rules regulating hospitals, certification and requirements

 Since the act was passed there have been problems with its implementation. The rules regulating living donation were meant to curb commerce in organs especially kidneys. But this has not happened. It has often left the government defending itself.  The bug bear has been the  sub clause 3, clause 9, chapter II of the THO Act that states: "If any donor authorizes the removal of any of his human organs before his death under sub-section 1 of section 3 for transplantation into the body of such recipient, not being a near relative as is specified by the donor, by reason of affection or attachment towards the recipient or for any other special reasons, such human organ shall not be removed and transplanted without the prior approval of the Authorization Committee."

 All the unrelated donors who are presented to the committee readily express 'reason of affection or attachment towards the recipient.' The committee often turns a blind eye knowing well that this may not be the case and clears the papers to proceed for the transplantation. In most instances an unofficial monetary transaction follows between the two parties. All goes well until a donor who does not get the promised sum makes a complaint to the police. Neither the complainant, nor the police realize that selling kidney is as much offence as buying the organ. All the three parties in this kind of medico-legal muddle have an undeniable responsibility.

The implementation process of the act is more complex than was ever envisaged by the pundits who put the framework together. If this section of the act is not adequately addressed by the review committee; organ sale will continue as donation in our country is a manifestation of poverty and desperation.

Rules regulating deceased donor programme in the act needs to protect the interests of a brain dead donor and at the same time facilitate the process of donation to ease the shortage of organs. In this regard the delays that results in organ donation process especially in medico-legal cases that require   post-mortem procedures can be very traumatic to the families and some simplification is required. The certification of brain death by specialists and the time interval between the two certification process also requires a review. Requirement for a separate license for organ retrieval of organs alone should not be required. This will help the programme tremendously and open more retrieval centers. 

Deceased donor programme can only become an alternative to living donation in India  if a mechanism is set to make the programme more visible and discussed and this can only happen by education first of our own medical fraternity and then of the Indian public. There are innumerable ways of accomplish this objective. Recently due to efforts of one of the member of MOHAN Foundation (Late Nayan) the syllabus of X STD in Maharastra state has the famous prose that talks about organ donation so eloquently by Robert. N.West, entitled 'Life Pass it On'.  A 'mandated choice' on driving license can instantly result in donor card being combined with the license. The current rate of deceased donation rate in India is only 0.05 per million population. If the ministry really means to do justification to the amendments, it needs to trash out all the issues before sending in its final recommendations.