Organ donation strives to honor the true gift of life (donated organs) by fully using the organs to improve the quality of life of the recipients. Traditionally two concepts of donation have been practiced in India, a live-related donation which involves removing a healthy organ usually from a recipient near a relative as described in the organ donation act, and transplanting it in the recipient. However, this practice is only limited to the kidney and liver in solid organ transplantation. The second concept is organ donation after brain stem death also called cadaveric organ donation.
This is possible in patients who have an irreversible neurological condition, and who are on a ventilator in ICU with no brain function. The process of declaring brain stem death is described in the Transplantation of Human Organs Act (THOA) and once the second brain stem death testing is completed the patient is declared dead, by brain stem death criteria. The doctors and donor coordinator can then request the family for consent for organ donation. Through this process, if the family consents then almost eight to nine organs can be donated, which are the cornea, heart, lungs, two kidneys, liver, pancreatic islets cells, uterus, both hands, skin, bone, and muscle tendons.
India has come a long way in promoting cadaveric organ donation. The government, both central and state, the private sector, Non-Governmental Organizations, and several educational institutes have helped in the cause of organ donation. The central government has established a special organization called as National Organ and Tissue Transplantation Organization (NOTTO) which is the apex body under whom the entire program is coordinated. The NOTTO has a regional presence in the form of the Regional Organ and Tissue Transplant Organization (ROTTO) and a state presence in form of the State Organ and Tissue Transplant Organization (SOTTO).
The main objective of these bodies is to promote organ donation, convey the message to people, and request citizens to fill in organ donation pledge cards. On a technical front, NOTTO coordinates various clinical protocols, for donor maintenance and organ-specific donation. It also liaises with states for organ distribution. Apart from this, various state agencies and NGOs have their main objective to increase awareness of organ donation. Organizations have clinical experts, social workers, and donor coordinators who work hard to achieve this objective.
All transplant hospitals have a full time organ donor coordinator who help not only in donation and transplantation process, but also help in increasing awareness in the community. A lot of community awareness programs in community halls, schools and colleges are conducted. Organ donation is also now a part of the syllabus in medical schools and postgraduate education. This has helped to further improve its awareness.
India as a country has an organ donation rate of less than 1 per million population. However, some states like Maharashtra, Tamil Nadu, and Karnataka have a donation rate closer to 3 per million or even higher. I think world organ donation day will further augment the message to spread and help improve donation rates in India.
Author
Director Critical Care, Fortis Hospitals, Mumbai
