The success of cadaver transplant programmes depends to a great extent on the person asking for organs from relatives and his or her approach to the situation. In a “Brain Death” situation this is one of the most difficult tasks for a doctor or a social worker to accomplish. This is a problem that is faced by the transplant community all over the world. In countries where the awareness levels about the concept of organ donation and brain death are high: it is not unusual for a relative of the patient to come forward to donate the organs of their loved ones. Sometimes the patients are carrying a “Donor Card” in their wallet or the mention of “desire to donate” on their driving license. Austria, Holland and Singapore are some of the countries that follow the “Presumed Consent” option, where it is presumed that a person wishes to donate their organs unless they have expressed their wishes otherwise in writing with the authorities. In these countries the retrieval rates of organs from donors is very high. Spain has the best organ donation rates in the world (30 donors per million people). This is due largely to a very co-ordinated effort by the national transplantation coordinating committee and also because of a “Transplant Coordinator” (usually a doctor) being nominated in every hospital’s Intensive Care. The co-ordinators make sure that the precious organs from potential cadavers are not wasted.

In India, we have to evolve our own strategies. One interesting survey done at Sri Ramachandra Medical College, Chennai, looked into the public’s attitude towards organ donation and found that over 72% of the 5008 surveyed respondents were willing to donate their eyes against less than 50% willing to donate their solid organs like kidneys, heart, lung, liver and pancreas. They suggested that in the event of Brain Death and when asking for organs it would be more prudent to first find out the families’ wishes towards organ donation by asking the grieving relatives for “Eyes” first. Only if they agreed to eye donation should solid organs like kidneys, heart and liver be asked for. This soft approach was called “The Ramachandra Protocol to Ask for Organs” (The Antiseptic March 1997; vol.94 No.3: Pg.73-74) and it was felt that the approach was less likely to upset the sensibilities of the relatives in this emotionally very difficult situation. There is no easy way to tackle the situation. But till the Indian Cadaver programme receives enough publicity, the solid organ donation programme may benefit by this “piggy back riding” approach on the popular eye donation programme of our country.