The waiting list for organ transplants of deceased people in the country is extremely long. According to existing rules, those above 65 years are not eligible. However, now with the change in rules, the elderly can expect a better chance at prolonging life as they will now be also registered in the list. The Union health ministry has modified national organ transplantation guidelines to allow those above 65 years of age to register for receiving an organ for transplantation from deceased donors.
Till now, youth were given priority for organ transplant in the country. This hurdle has been overcome by including older people in the amended rules. The health ministry is working on a “One Nation, One Organ Allocation” policy in discussion with states to come up with consistent guidelines for registration, allocation and other aspects of the process. The ministry has recommended several changes in organ transplant rules. The government is also planning to introduce a chapter in school curriculum to raise organ donation consciousness among students.
Further, the government has asked states to remove the domicile criterion for registering those seeking organs from deceased donors for transplant procedures. Now, those in need can go to any state of the country and register for receiving organs and also get the transplant done. On registering, the patient will be assigned a unique ID by National Organ and Tissue Transplant Organization (NOTTO), a national-level organization set up under the Union health ministry. This will be valid even if the patient changes multiple hospitals in different states. The Union health ministry has asked the state governments not to charge money while noting that some states have been charging fees, ranging between Rs 5,000 and 10,000, for registering such patients.
The Transplantation of Human Organs Act (THOA), 1994, has been adopted in all states except the erstwhile state of J&K as well as Andhra Pradesh which have their own legislations in this regard. The main purpose of the Act is to regulate the removal, storage and transplantation of human organs for therapeutic purposes and prevention of commercial dealings in human organs. The Act was amended in 2011 and the Transplantation of Human Organs (Amendment) Act, 2011, came into force on January 10, 2014 in Goa, Himachal Pradesh, West Bengal and Union Territories. Other states have also adopted the amended Act.
Brain stem death is recognized as a legal death in India under the Transplantation of Human Organs and Tissues Act since 1994 like many other countries which have revolutionised the concept of organ donation after death. After natural death, only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated, including vital organs such as kidneys, heart, liver and lungs. In pursuance to the amended Act, the Transplantation of Human Organs and Tissues Rules have been notified on March 27, 2014. The amended Act and revised rules have many provisions for promotion of organ donations from cadavers.
The Transplantation of Human Organs (Amendment) Act, 2011, has included the component of tissue donation and registration of tissue banks. Besides laying down policy guidelines and protocols for various functions, NOTTO streamlines all activities associated with organ donation at the national level.
India has an organ donation rate of about 0.52 per million population. According to official data, the number of organ transplant cases increased from 4,990 in 2013 to 15,561 in 2022. Also, there has been an increase in the number of kidney transplants from living donors. The total number of kidney transplants increased from 3,495 in 2013 to 9,834 in 2022, while those from deceased donors increased from 542 to 1,589 in 2022. Similarly, the total number of heart transplants has increased from 30 in 2013 to 250 in 2022, while the number of lung transplants has increased from 23 to 138.
Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives, or in some special cases out of attachment to the recipient. Deceased donors may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas and intestine. Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained. After a natural death, organs that can be donated are cornea, bone, skin and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs.
According to studies, the chances of the organ transplantation being successful are increased by reducing the delay between harvesting and transplant of the organ. Therefore, transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of our country which refers to a route that is cleared out for an ambulance carrying the harvested organ to ensure its delivery at the destination in the shortest time possible. Green corridors are generally used for transporting heart and liver which have the shortest preservation time. Usage of green corridors expedites organ transplantation while also ensuring that there is no organ wastage.
In 2008, the government of Tamil Nadu came out with orders laying down the procedures and guidelines for deceased organ donation and transplantation in the state. These brought in almost 30 hospitals under the programme and has resulted in enhancing the donation rate in the state. Tamil Nadu is the leader in deceased organ donation in the country. Most of the deceased donation programmes have been developed in the southern states. In 2012, besides Tamil Nadu, other southern states also increased the frequency of organ transplants through donation. An online organ sharing registry for deceased donation and transplantation is used by Tamil Nadu and Kerala.
Other countries have different rules. In Argentina, in 2005, the country introduced an opt-out policy on organ donation, where all people over 18 years of age will be organ donors unless they or their family state otherwise. Under Brazilian law, the family has the ultimate authority and the issuance of an organ donation card has eased the process.
In Chile, in 2010, “Law 20,413” was promulgated, introducing an opt-out policy on organ donation, where all people over 18 years of age will be organ donors unless they state their opposition. In Columbia, the Congress passed the “Law 1805”, which introduced an opt-out policy on organ donation where all people will be organ donors unless they state their opposition. Iran is the only country with a working and legal payment system for organ donation.
In Israel, signing an organ donor card has provided a potential medical benefit to the signer since 2008. If two patients require an organ donation and have the same medical need, preference will be given to the one who has signed an organ donation card. Organ donation in Japan is regulated by a 1997 organ transplant law, which defines brain death and legalized organ procurement from brain dead donors. In the Netherlands, the government sends everyone living in the country a postcard when they turn 18, and one reminder if they do not reply. They may choose to donate, not donate, to delegate the choice to family, or to name a specific person. If they do not reply to the notices, they are considered a donor by default.
Organ donation can give a second chance of life to someone who might die without a transplant. By donating their organs, people can potentially save many lives and also help overcome the shortage of organs for transplant. A living person can donate a kidney, a part of liver, a lung, a part of the pancreas and tissues such as the cornea, skin, bone and heart valves, while a deceased person can donate a whole liver, heart, lungs, whole pancreas, small and large intestines and tissues such as cornea, skin, bone and heart valves.
Unfortunately, due to ignorance and prejudice, there is a huge shortage of organs needed for transplant in India. Organ donation is not very popular in India due to factors like lack of awareness and religious and cultural beliefs.
—By Shivam Sharma and India Legal Bureau