India's Union Health Ministry, through the apex body for Organ donation and transplantation, NOTTO (National Organ and Tissue Transplant Organization), held 'Chintan Shivir' - a brainstorming session to bring about reforms for augmentation of organ and tissue donation and transplantation with respect to Technology, Processes and Legislations in India.

Ten subjects (mentioned below) were identified and a working group for each subject was formed. These groups met thrice virtually, and discussed extensively, while involving external stakeholders, as required. The lead person of each group summarised the discussion points and presented at the 2-day 'Chintan Shivir' hosted by NOTTO at NCVDC building, New Delhi, on August 30-31, 2024.

This was a commendable initiative that fostered meaningful discussions, involving important stakeholders – healthcare professionals and policymakers, facilitating comprehensive dialogues on improving organ donation practices. The Shivir underscored the need for a unified approach to address the persistent issues in organ transplantation, including disparities in access, loopholes in the current law, pain points of donors and recipients, and the need for greater public engagement through NGO involvement.

The Chintan Shivir inaugural was presided by Ms. L.S. Changsan, Additional Secretary, Ministry of Health and Family Welfare (MoHFW), Govt. of India, Prof. (Dr.) Atul Goel, DGHS, GOI, Shri Apurva Chandra, Secretary (MoHFW), GOI and Dr. Vandana Jain, Joint Secretary (MoHFW), GOI. “Organ donation needs to become a way of life for us so that we can give a new lease of life to those suffering from organ failure,” said Ms. L. S. Changsan, stressing the importance of need for policies and systems to be conducive to organ donation and transplantation.

Ten Subjects Discussed by the Working Groups at the 'Chintan Shivir'

GROUP 1 - Ensuring transparency in organ sharing for optimal use

• Registration of recipient – Identifying & correcting gaps
• Possibility of a digital dashboard for organ and recipient availability
• Way forward

GROUP 2 - One Nation One Policy: Issues and challenges

• One Nation, One portal: Single Digital registry
• Uniform allocation policy
• Permissible state-wise modifications in organ specific policy and criteria

GROUP 3 - Plugging legal loopholes

• Strengthening laws and their enforcement by authorities
• Increasing powers of NOTTO
• Punitive actions against defaulters
• Implications w.r.t eye, blood and tissues for research

GROUP 4 - Recent directives in Court Judgements

• Avoiding court cases in matters of organ donation
• Donation from minor living donors
• NOTTO Foundation (possibility and roles)
• NGO's perspectives (roles and responsibilities)

GROUP 5 - Improving transplant outcomes

• Experience from the past 25 years
• Optimising outcomes
• Alternative systems and their role in improving outcomes

GROUP 6 - Death related issues

• Uniform definition of death - challenges
• Difficulties in declaring Brainstem death - battling the perceptions
• Controversy surrounding BSD - Bioethical issues and way forward
• Donation after circulatory death

GROUP 7 - Correcting the ecosystem

• Organ retrieval centres in each medical college
• Training in organ retrieval
• Retrieval policy targeting zero loss of eligible donor
• Maximization of organ utilisation

GROUP 8 - Health insurance issues in organ transplantation

• Insurance related issues of donors and recipients in India
• Current status and future directions
• Health protection of Living donors – whose responsibility?
• Role and responsibility of IRDA

GROUP 9 - Bottlenecks, solutions and future of organ transplantation

• Identifying the problems
• Learning from mistakes
• Learning from each other
• Best practices
• Threat of Anti-microbial Resistance (AMR) with respect to future of organ transplant
• Adoptive cell transfer or Cell/organoids from Stem cells - Future possibilities
• Likely bioethical issues

GROUP 10 - Community participation and social mobilisation for augmenting awareness on organ donation and prevention

• Views of stakeholders on augmenting awareness on Brain death and donation
• Alternative medicine and their role in prevention
• The case for Prevention – Role of NOTTOs and NGOs

This initiative, 'Chintan Shivir' by NOTTO, exemplified a proactive step towards strengthening India's organ donation framework, aiming to save more lives through increased collaboration, awareness, and improved systems. It was a significant event that not only recognized the existing challenges but also celebrated the collective efforts of all involved in the noble cause of organ donation.