Organ donation in India

The Government of India enacted the Transplantation of Human Organs Act in 1994 to curb organ trading and promote deceased organ donation. After facing a multi-billion rupee kidney scandal in 2008, an amendment was proposed in 2009[10] and passed in 2011 to get rid of loopholes which previously made illegal organ trading possible.[11][12][13]

The states of Tamil Nadu and Andhra Pradesh were the frontrunners in organ donation during the initial years. Following the establishment of the Indian Network for Organ Sharing (INOS) in 2000, the two states retrieved 1,033 organs and tissues between 2000 and 2009.[14][15] In 2018, Tamil Nadu had an organ donation rate of 1.8 pmp, which was seven times higher than the national average (0.05-0.08).[3]

The number of deceased organ donations in India grew gradually from 2012. The total number of multi-organ deceased donors in 2012 throughout India was 196 (0.16 pmp). The deceased organ donation rate doubled from 196 donors (0.16 pmp) in 2012 to 411 (0.34 pmp) in 2014.[14]

Organ donors can be living or dead. The type of organ donations are as follows:

Deceased donors

Indian states with organ donation activities for deceased donors in 2015[14]

Deceased donors may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine. Uterus transplant is also performed, but it is not regarded as a life-saving organ.[17] Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained. Brainstem death is also recognized as a form of death in India, as in many other countries. After a natural cardiac 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.[2]

Organ transplantation is a medical procedure where one organ removed from one person and placed in the body of recipient.[18] Vital organs such as the heart, pancreas, liver, kidneys, and lungs can be transplanted from the donor to a person whose organs are failing, known as the receiver.

Studies have suggested that the chances of the transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.[3] Therefore, transportation of the organ is a critical factor. For this purpose, "green corridors" have been created in many parts of India.[19] A "green corridor" refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.[20] The hospitals involved in a transplantation, city traffic authorities, and in certain cases, airport authorities collaborate to transport an organ from one hospital to the next.[21][22] The formal name of "green corridor" was given in July 2014 when a hospital and police in Chennai coordinated to transport a heart from one hospital to another in half the regular time.[19] The system has been used effectively in cities such as Mumbai, Gurgaon, Hyderabad, Bangalore, Kolkata, and Indore.[21]

Green corridors are generally used for transporting heart and liver, which have the shortest preservation times of four to six and 12 to 15 hours, respectively.[23] The means of transportation is often by road, but air ambulances are also employed when the organs require transportation to different cities or states.[24][25] Usage of green corridors expedites organ transplantations while also ensuring that there is no organ wastage.[21] But the process of setting up a green corridor is complex, since it requires coordination of multiple stakeholders.[22] Due to the inconvenience to the public when using roads for this purpose, more prevalent usage of air ambulances or drones[26] has been suggested to the government.[19][23][27]

All states participate in the federal legislation except Andhra Pradesh and Jammu and Kashmir,[28] with Andhra Pradesh having its own law.[29] As of 2019, the nationwide deceased donation rate is around 0.34 per million population, much lower than developed countries. Some developed countries have adopted an opt-out system, which considers every citizen an organ donor unless they decide to 'opt-out'. Usage of such a system in India has been recommended by medical experts.[30][31] However, some others believe that it may not improve donation rates in India due to its high illiteracy rate and lack of public awareness.[7]

As of 2019, 13 of the 36 states and union territories have contributed to deceased donation in India.[32] Most of the deceased donation programs have been developed in the southern states.[33] The potential for deceased organ donations due to brain death is high in the country. About 80,000 persons die due to road accidents every year. An estimated 50% of such deaths are due to brain death. If the country's donation rate were to be improved to 1 per million population, it would satisfy the country's organ requirement completely.[34] The deceased donation rate consistently rose from 2012 to 2017, increasing more than four times. But since 2018, it has slowed throughout the country.[32]

Numerous government and non-government organisations work in the domain of organ donation in India.

A large majority of organ donations in India are from live donors.[7] Cadaver donations represent only about five percent of all donations.[46] For about 160,000 patients in need of organs, only 12,000 donors are available.[30] Factors such as lack of awareness (about brain death), religious beliefs, and inadequate transplantation centers affect the country's organ donation program.[7]

Data incomplete; includes only kidney, liver and heart donations; Source: NOTTO[46]

• Organ transplantation in Tamil Nadu

• National Organ and Tissue Transplant Organisation