Organs can be donated by a living person after natural death, and after "brain death". Brain Death is relatively new concept of death that was first recognised in Paris in 1959. In this form of death, the brain tissue dies first and the death of the other organs follows soon afterwards. This is an irreversable situation and usually happens after bleeding within the brain due to road traffic accidents or tumors in the brain or due to spontaneous bleeding of a blood vessel that carries blood within the brain . Brain death occurs in a controlled situation and in this situation if it is possible to donate organs to needy patients if the relatives agree.

The Government of India recognised brain death and passed a legislation accepting this form of death in 1994. The legislation entitled, 'Transplatation of Human Organs Act,' defined brain death and laid out guidelines to streamline organ donation and transplant activities in the country. The THO Act has made it possile for the hospitals in India to undertake multi organ transplant activity from brain dead donors.

After natural death only a few tissues can be donated (like cornea, bone, skin and blood vessels), whereas after brain death almost 50 different organs and tissues can be donated including critical organs such as kidneys, heart, liver and lungs. at any given time, there are 8 to 10 brain dead patients i.e., deceased  donors (called cadavers) in different Intensive Care Units in any major city of the country.

Potentially, there is a huge pool of brain dead donors available in India. Across the world , in 90% of all transplants done, the organs come from brain dead donors. In a brain death situation, where the family has agreed to donate the organs, time is of the essence in organising both retrieval of organs and transplant of various organs and tissues to various patients as all organs have a critical time limit beyond which they cannot be stored. Moreover, the sensiblities of the donor family should receive the highest consideration.

To undertake this deceased donor program successfully, adequate hospital infrastructure and support logistics are essential. The organs need to be properly matched and distributed. The organs that are donated do not belonhg to one particular hospital and should be distributed universally to the needy patients and should be trated like a national health resource.

In the last six years, 35 hospitals in the country from various regions have undertaken cadaver transplants. Chennai has done maximum number of cadaver transplants in the country (189). Besides Chennai, the other cities were cadaver organ transplantation is taking place include: New Delhi (68), Mumbai (55), Ahmedabad (120), Pune (40), Vellore (52), Bangalore (32), and Coimbatore (27).

Besides the above, it is estimated that currently 3500 live kidney transplants, 15 to 20 live liver transplants and 16000 corneal transplants are done in India every year.

However, the demand for organs is huge as it is estimated that another 3000 patients die in India of kidney failure due to non availability of kidneys. There are over 100000 patients annually who are diagonised to have end stage kidney failure. Similar figures are quoted for liver and heart failure. The incidence of diabetes in the India community is rising alarmingly and it is estimated that 10% of the India population may be suffering from this condition. Among them, are many young and so called brittle diabetics who would do well with pancreas transplants. Plastic surgeons need skin grafts for patients with burns; orthopedic surgeons need bones and cartilage to treat bone loss due to cancer. The demand for organs far outstrips the availability of organs and it is a great tragedy to lose potential cadaver donors because of ignorance and apathy. In the Western world, almost 37500 organs are transplanted annually using cadaver donors.

The future of the Indian transplant programme lies in supporting and encouraging the cadaver organ donor transplant programme. This will benefit all organ failure patients and will also propel India towards the cutting edge of medicine. There will be exponential growth in research in the field of transplant immunology, genetics and drug usage.