Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994. The law allows both deceased and living donors to donate their organs. It also identifies brain death as a form of death. The National Organ and Tissue Transplant Organisation (NOTTO) functions as the apex body for activities relating to procurement, allotment and distribution of organs in the country. Although India performed the second largest number of transplants in the world in 2019 (after United States), it lags far behind the western nations like Spain (35.1 per million population or pmp), United States (21.9 pmp) and United Kingdom (15.5 pmp) in national donation with a donation rate of only 0.65 per million population (2019) due to its huge population. According to the World Health Organization, only around 0.01 percent of people in India donate their organs after death. Some of the reasons behind such poor performance are lack of public awareness, religious or superstitious beliefs among people, and strict laws. There is a huge gender disparity among organ donors in the country as women donate disproportionately high while being disproportionately low number of organ recipients. In 2019, the Government of India implemented the National Organ Transplant Programme with a budget of ₹149.5 crore (US$16 million) for promoting deceased organ donation.
Background 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 and passed in 2011 to get rid of loopholes which previously made illegal organ trading possible. 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. 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). 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.
Law
Organ donors can be living or dead. The type of organ donations are as follows:
Living donors Living donors are permitted to donate the following:
one of their kidneys portion of pancreas part of the liver 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 affection and attachment towards the recipient.
Deceased donors
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. 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.
Organ transplantation Organ transplantation is a medical procedure where one organ removed from one person and placed in the body of a recipient. 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.
Green corridors 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. Therefore, transportation of the organ is a critical factor. For this purpose, "green corridors" have been created in many parts of India. 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. 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. 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. The system has been used effectively in cities such as Mumbai, Gurgaon, Hyderabad, Bangalore, Kolkata, and Indore. 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. The means of transportation is often by road, but air ambulances are also employed when the organs require transportation to different cities or states. Usage of green corridors expedites organ transplantations while also ensuring that there is no organ wastage. But the process of setting up a green corridor is complex, since it requires coordination of multiple stakeholders. Due to the inconvenience to the public when using roads for this purpose, more prevalent usage of air ambulances or drones has been suggested to the government.
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