The gift of life does not come from one's parents only; even relatives, friends or strangers can save your life by donating an organ. Over the last four decades, cases of organ transplantation have grown across the world. In India though the pace has been slow.
However, some recent
proposals show that we are probably inching towards a better record. The Union government has proposed a provision by which vehicle drivers will have to declare their intention to donate organs, in case of an accidental death. Maharashtra proposes to mandate college students to declare such intent in their identity cards.
On September 15, with a view to streamline the procedures for coordinating organ transplantation, the Maharashtra government has made it mandatory to declare 'brain death' and certify it accordingly. The Delhi government has launched an online registration system for voluntary organ donation in cases of brain death.
Increased awareness among the public may lead to more persons registering to be donors after their death. Among the Indian states, Tamil Nadu claims the highest rate of registration for voluntary donors.
Apart from kidneys, transplant procedures also involve heart, liver and pancreas. With corneal and bone marrow transplantation also being performed frequently, tissue transplantation is also a part of this field. In India too, there are many centres that perform one or more of these procedures.
Unfortunately, people are very reluctant to donate organs, in life or after death. There is a fear that parting with an organ can endanger one's health or there is the sentiment that the last rites must be performed on a 'full' body. These two reasons have been major barriers against people opting for organ donation.
The donation of corneas, after death, is emotionally more acceptable to donors and their families than the donation of other body parts. However, there is growing evidence on the safety of live organ donation and the immense benefit that many can get if organs can be harvested from dead persons.
Even as science and sentiment have progressed to create an expanding role for organ and tissue transplantation in medical care, there are several ethical, legal and technical issues to contend with. The evolution of relevant laws in India illustrates the complex interplay of these factors. While these reflect some of the global trends, the policy is substantially shaped by Indian sensibilities.
The first challenge was to define brain death, which is when a person's vital brain functions cease but blood circulation keeps other organs alive with the aid of life-support systems. Doctors have to be scrupulously sure about the patient being in a state of irreversible coma.
This is determined by a team of doctors, which should not be involved in the transplant procedure and must involve a neurologist, neurosurgeon, anaesthetist or intensivist.
The consensus on the definition of 'brain death' and the mode of its certification led to the enactment of the Transplantation of Human Organs Act in 1994. Despite the Act, the main barrier has been the reluctance of both doctors and close family members to engage in a discussion on organ donation immediately after the death of a person.
When it comes to a donor who is alive, a close relative is usually preferred. The 1994 law permitted spouse, mother, father, brother, sister, son or daughter to donate. The 2011 amendment has enabled grandparents and grandchildren to join the list of approved donors. In case of an unrelated person, who is adjudged to be a 'good match' for the intended recipient, the question is whether the donation is voluntary or induced through money or coercion.
The Act permits an unrelated individual to donate for reason of "affection and attachment", if approved by an authorisation committee. The compassionate donor clause has been open to much abuse. Transplant commercialism and organ trafficking have been reported from different parts of India. Transplant tourism was also promoted as part of medical tourism, raising concerns about denial of the donation of life to needy Indian patients.
That fact that the Act of 1994 needed amendments in 2008 and 2011, with fresh amendments under consideration of the health ministry reveals that the law has to dynamically adapt to the growing demand for organ transplantation, while preventing malpractice and exploitation of vulnerable persons.
The 2011 amendments made it mandatory for hospital staff to request relatives of brain-dead patients for organ donation, while doubling the punishment for illegal activities (imprisonment up to 10 years and fine of Rs. 20 lakh). An Indian may donate an organ or tissue to a foreign national only if both are related.
With hypertension, diabetes and diseases of the heart, kidney and liver on the rise, the need for organ transplantation will grow. How will this demand be met? The supply has to come more from dead donors than those who are alive.
Donation of organs or tissues is among the noblest acts one can perform, in life or death. Either way, it gifts life and good health to a person at death's door. At the same time, trafficking in human organs is a heinous crime that debases society. It is a test of our civilisation as to how well we can promote the former and eliminate the latter.
K Srinath Reddy is President, Public Health Foundation of India. The views expressed by the author are personal.
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