Opinion: Organ donation — let life continue
By Prof Sree Bhushan Raju
Organ transplantation is one of the remarkable achievements of modern medicine. A patient with irreversible kidney, liver, heart or lung failure, who once had very limited prospects for survival, can today receive a functioning organ and return to a . Yet transplantation has a limitation that medical technology alone cannot overcome: an organ must first be donated before it can be transplanted.
India performs a large and increasing number of organ transplants, but the need remains far greater than the availability of organs. Thousands of patients continue to wait for a suitable kidney, liver, heart or lung. Some deteriorate or die while waiting. National Organ Donation Day should remind us that organ donation is a shared responsibility involving individuals, families, hospitals, governments and society.
Transplant Law
Organ transplantation began developing in India several decades ago. However, the absence of an adequate legal framework in the early years created serious concerns. Commercial kidney transplantation, brokers arranging donors, exploitation of economically disadvantaged people and transplantation based on financial transactions threatened both medical ethics and public confidence. India needed a law that could enable legitimate transplantation while preventing the human body from becoming a commodity.
The Transplantation of Human Organs Act, 1994, provided a framework for organ retrieval and transplantation and, importantly, gave legal recognition to brain-stem death. Amendments in 2011 expanded its scope to tissues, leading to the present Transplantation of Human Organs and Tissues Act (THOTA) and the rules governing transplantation.
The principle behind the law is fundamental: human organs may be donated for transplantation, but they cannot be traded for financial gain. Commercial dealings in organs, the involvement of brokers, fraudulent documentation and illegal transplantation are offences. The law provides for imprisonment and substantial financial penalties, apart from professional consequences for medical practitioners found participating in unlawful transplantation.
These safeguards are essential because transplantation can retain public confidence only when donation is voluntary, allocation is fair and financial power cannot determine access to an organ.
Living, Deceased Donation
Living donation has played an enormous role in India, particularly in kidney and liver transplantation. Living donation must, however, remain voluntary and medically safe. Financial hardship should never compel a person to become an organ donor. The second source is deceased organ donation, particularly following brain-stem death.
Brain-stem death is the irreversible loss of all brainstem functions and is death as recognised under the transplant law when established according to prescribed medical criteria. Following certification of brain-stem death and the required consent, organs such as the kidneys, liver, heart and lungs may be retrieved for transplantation. Tissues including corneas, skin, bone and heart valves can also benefit patients.
Countries such as Spain have consistently demonstrated the potential of a well-organised deceased-donor programme. The United States and several European countries have also developed extensive systems for donor identification, organ retrieval, allocation and transplantation.
India has made impressive progress in transplantation, but a substantial proportion of kidney and liver transplants still depend on living donors. The lesson from countries with strong deceased-donation programmes is not merely about legislation. Successful systems identify potential donors in , have trained transplant coordinators, communicate sensitively with families, maintain transparent waiting lists and allocation systems, and build public confidence over many years.
NOTTO and a National System
The National Organ and Tissue Transplant Organization (NOTTO) provides the national framework for organ and tissue donation and transplantation, supported by Regional Organ (ROTTO) and Tissue Transplant Organisations and State Organ and Tissue Transplant Organisations (SOTTO). A transparent system for registering patients awaiting transplantation, allocating deceased-donor organs and coordinating retrieval and transplantation across hospitals is essential.
Every donated organ is precious. An organ donated in one hospital may need to reach a recipient in another hospital or even another city within hours. Coordination among doctors, transplant coordinators, hospitals, government agencies, police and transport systems can determine whether that organ is successfully transplanted.
The experience of Telangana and Andhra Pradesh demonstrates how state-supported deceased-donor programmes can change the transplantation landscape. Green corridors and rapid transport arrangements have enabled organs to reach recipients within the narrow time available for successful transplantation. The next step should be to extend donor identification beyond major transplant centres. Every hospital with an intensive care unit should understand its responsibility in recognising potential brain-stem-dead , completing certification according to law and providing families with an opportunity to consider donation. A potential donor should not be lost simply because the hospital lacks awareness or coordination.
Organ Trafficking
The shortage of organs creates another danger: illegal organ trade. When poverty, debt or social vulnerability is exploited to obtain an organ, donation loses its ethical meaning. Brokers, commercial transactions, forged relationships and coercion must be investigated and punished under the law. At the same time, reports of illegal transplantation should not create fear about legitimate organ donation. The answer to organ trafficking is not less transplantation. It is more transparent, regulated and equitable transplantation.
A strong deceased-donation can itself reduce dependence on desperate arrangements and commercial exploitation. Signing a donor pledge is valuable, but discussing the decision with family members is equally important. When death occurs suddenly, relatives are grieving and must make difficult decisions within a limited period. Knowing what their loved one wanted can make that decision clearer. This conversation does not require a hospital. It can begin at home.
Families who are approached for donation must also be treated with dignity. They deserve clear explanations about brain-stem death, the donation process and what will happen afterwards. Consent must be informed and voluntary. There should be no coercion and no commercial consideration. That is the sanctity of organ donation.
Awareness to Action
India does not lack compassion. What we need is a system that converts willingness into . Potential donors must be identified in hospitals. Brain-stem death certification should become consistent and timely. Transplant coordinators need appropriate training. Waiting lists and organ allocation must remain transparent.
National and State registries should provide reliable information about donation, transplantation and outcomes. Above all, the public must trust the system. An organ should never be available to the highest bidder. It should go to an appropriate patient according to transparent medical and allocation criteria.
National Organ Donation Day gives every family an opportunity to discuss a question that is usually avoided: What should happen to our organs if they can save another person’s life? We spend our lives helping our families, colleagues and society in many ways. Death need not necessarily end our ability to help another human being. A donated kidney can free someone from dialysis. A liver can save a child or an adult with terminal liver disease. A heart can give another person years of life. Corneas can restore sight.
Organ donation is not about death. It is about what life can still make possible after death. Let us understand it, discuss it with our families and make an informed choice. Donate organs. Let life continue.
(The author is Nodal Officer, SOTTO Telangana [Jeevandan])