In 2011, the Transplantation of Human Organs Act underwent a crucial amendment aimed at boosting deceased organ donation rates in the country. This amendment introduced a provision allowing hospitals with the capability to treat potential organ donors in case of death to be registered as Non-Transplant Organ Retrieval Centers (NTORCs). However, over the past 13 years, these NTORCs have not effectively utilized their potential donor pool. A two-day conference held at the Indian Institute of Management in Bangalore on September 2nd and 3rd, 2023 aimed to address this issue. This conference was conducted in partnership with Jeevasarthakathe (SOTTO, Karnataka), National Institute of Mental Health & Neurosciences (NIMHANS) and Nephrology Association of Karnataka (NAK), under the guidance of National Organ & Tissue Transplant Organization (NOTTO).

The Need for NTORCs:

Out of 8.4 million deaths in the country, approximately 1 to 4% result from brain deaths with neurological causes. The remaining deaths are due to cardio-pulmonary or cardiac issues. While there are 645 licensed hospitals capable of both retrieval and transplantation, there are an additional 145 non-licensed hospitals equipped only for retrieval. Recognizing the potential for organ donation across all hospitals totalling approximately 69,264 is (1) essential. Data from 2018 indicates that there are 43,486 private hospitals in the country providing 1.18 million beds which comprise 59,264 ICU beds and 29,631 ventilators. Public hospitals, on the other hand, consist of 23,582 stablishments offering 710,716 beds which include 35,700 ICU beds, and 17,850 (2) ventilators. These figures underscore the necessity of expanding the pool of hospitals capable of identifying and certifying brain deaths without the requirement for transplantation facilities.

Key Recommendations from the NTORC

Conference at IIM Bangalore:

1. Simplify On-boarding: Grant adhoc/emergency licenses to non-licensed NTORCs when a brain death occurs to facilitate organ donation. Streamline the application process to make it more accessible, reducing the complexity of the current format (Application Form 13 for NTORCs with 49 fields.). In addition, automatically designate all 730 medical colleges as NTORCs and incentivize hospitals by offering extra credit for NABH certification or a Certificate of Appreciation upon successful donations.

2. Hub and Spoke Model: Adopt a Hub and Spoke model by assigning NTORCs to Transplant Centres (TCs) in their vicinity. This would create a seamless communication network between transplant centers and NTORCs, optimizing the organ retrieval and transplantation process.

3. Awareness and Training: Address the lack of awareness and knowledge about organ donation and brain death among medical professionals. Promote awareness through professional organizations like Indian Medical Association, Indian Critical Care Society, and Indian Society of Anaesthesiologists. Support them by providing online training modules and mobile apps tailored for educational purposes.

4. Streamline Reimbursement: Simplify the reimbursement process for NTORCs, allowing SOTTOs to independently manage funds. Offer incentives to doctors serving on Brain Stem Death (BSD) certifying committees and actively contribute to maintaining potential donors.

5. Transplant Coordinator and Post-Mortem Support: Ensure that all NTORCs have access to trained senior transplant coordinators, sourced from SOTTO, licensed transplant centers, or NGOs, whenever a donation occurs. Post-mortem procedures should be the responsibility of SOTTO or guidance shall be sought from the hospitals allocated organs.

6. Establish a Brain Death Certification Helpline: Create a dedicated support line to aid medical professionals in promptly identifying and certifying brain death. This helpline could also offer tele-ICU and online consultation support, along with the provision of e-signatures for brain death declaration.