Organ Donation India

Organ Donation India

Organ Donation in India 2020

The complete guide on organ donation and organ transplant in India.Organ donation day in India is celebrated on 13th August every year.

Imagine a 45 years old man living his normal life and one day at work he suddenly falls unconscious, When he is taken to the hospital the doctor diagnosed him with liver cirrhosis.

This leads to liver failure and the only way to treat it is by a liver transplant.

Now he has only two options either to find a living donor or wait for a liver from someone who has agreed to donate his liver after his death (A cadaver donor).

The problem is that if he wants to get a liver from a cadaver donor there can be a waiting period as long as 12 years,

The reason is that in our country about 200,000 livers are required for transplant but there are about 900 donors in India.

In a country like ours with one of the biggest population in the world we just have about 0.8 donors per million (Donors who agreed to donate their organs after their death)

Here are some quick statistics of organ donation in India (Source National Organ and Tissue Transplant Organization)

Organ Donation in India Statistics 2020
Organ Donation in India Statistics 2020

  • There is a demand of 5 Lakh organ transplant annually and only about 1-3 percent of this is met 

  • 4 Lakh people every year die due to the unavailability of an organ donor 

  • There is a huge gap between the demand and availability of organs in India, 
    • while we require about 200,000 livers we are only able to avail about 708
    • 200,000 kidneys are required but we only have 10,000 available
    • 50,000 heart transplants are required but we only have 339 available

  • Though there has been an increase in the number of organ donors according to the 2017 report only 905 organ donations occurred in 2017 

  • Even with a population of 135.26 crores (2018), India has about 0.8 donors per million which are far less as compared to that of the USA (31.96) and Spain(46.9)

  • Brain stem death due to road accidents every year is estimated to be 1.5 Lakh which can be used to save lives but still, our donor ratio per million is 0.85.
  • Tamil Nadu has the most organ donors in India. In 2017 176 donors donated 673 organs.

We require to spread more awareness in this field and encourage more people to register themselves as donors.

We at HealthifyFeed believe that

Anyone Can and everyone should donate organs

Did you know? 

The first organ transplant in India was performed in May 1965 at the King Edward
Memorial Hospital-Bombay. The performed operation was for a kidney transplant.

Let’s look in detail about learn about organ donation in India 

If a topic catches your eye feel free to skip ahead 

  1. Types of organ donation 
  2. Which organs and tissues can be donated?
  3. Rules for organ donation in India 
  4. How to register for organ donation India
  5. Allocation criteria of organs for organ transplant in India
  6. What is the procedure of organ transplant in India?
  7. What is the success rated of organ transplants?
  8. What is the cost of organ transplant in India 

Types of organ donation 

Organ donation in India is of two type

  1. Living organ donation 
  2. Organ donation after death or cadaver donor

Anyone above 18 years can willingly donate organs in India, Though some organs have an age restriction beyond which the organs can not be accepted

A person above 50 years can not donate his/her liver or kidney, Anyone above 40 years can not donate heart, you can donate your cornea up to 100 years.

Living organ donation 

This is the type of organ donation when organs are recovered from a healthy living person and transplanted in a person who requires it. someone suffering from an end-stage organ failure

The living organ donor can be a near relative like son, daughter, brother, sister or spouse, and distant relatives or friends of the patients.

But in the case of friends and distant relatives, the donor will require permission from the state authorization committee.

Organ donation after death or cadaver donor

People who register themselves as organ donors are registering themselves for donating their organs after their death.

A person can only donate organs after he/she has been declared brain stem dead by a team of doctors.

It is important to note that in India a person can only donate his/her organs in case of a brain stem death

What is brain stem death?

The brain consists of 2 parts,

The cortex and the brain stem. The cortex is the larger part of the brain and the brain stem is the smaller. The brain stem is actually the top of the spinal cord.

Brain stem death is a term used to describe a complete brain death in both the cortex and the brain stem. The brainstem is the central nervous system of our body and is the center of our consciousness.

Brain death can occur when a person receives a severe blow to the skull (Major cause of death in road accidents) or by a stroke.

When this happens the brain begins to swell and since the skull is a hard bone it does not allow the pain to expand. This starts increasing pressure in the brain.

When the pressure on the brain exceeds the pressure of the beating heart the heart can no longer supply or force oxygenated blood into the brain, Because of no supply, the brain cells die due to lack of oxygen.

In fact, the cells don’t just die but they start a process called lysis and the brain cells liquify which makes this death irreversible.

If the brain stem dies the respiration will stop and once the hearts stop getting the oxygen it too will die and all other organs would die due to lack of oxygen. 

what is the difference between brain stem death and coma?

Many people tend to confuse brain stem death with coma, But both are completely different phenomena and a person under a coma can not donate his/her organs.

The cortex of the brain controls all the higher functioning activities like reading, writing, talking, etc. 

When the cortex of the brain is damaged the person enters a coma and loses his consciousness, but even in coma a person might still feel pain and respond to external stimuli.

A coma patient might still regain consciousness, which is completely different from brainstem death which is irreversible.

Which organs and tissues can be donated?

Before we talk about the organs that can be donated you might be curious to know

How long can organs survive inside the body after death?

After a person has died using ventilators the organs can survive for a short period of time which can also last up to a few days or a few weeks.

List of organs that can be donated after death:

Organ donation in India

Rules for organ donation in India 

Rules for organ donation in India
Statue of lady justice, Law concept

You can read the complete rules at 

  1. Transplantation of Human Organs Act first 1994
  2. Transplantation of Human Organs Rules in 1995 (Original Rules)
  3. Transplantation of Human Organs Act (Amendment)Rules,2008
  4. Transplantation of Human Organs Act amendment 2011
  5. Transplantation of Human Organs and Tissues Rules, 2014

To simplify we will cover the key highlights of the rules of organ donation in India 

  1. The human organs act of 1994 identifies brain stem death as a form of human death for which detailed process and criteria have been defined.

    1. In case of a brain death a panel of 4, need to declare the brain stem death. The doctors include 

      1. a medical practitioner in charge of the hospital,
      2. A medical practitioner approved by the government,
      3. A Neurologist a Neurosurgeon who has been approved by the government and 
      4. the medical practitioner treating the patient in reference.

    2. The test has to be done twice with a gap of 6 hours

  2. Living donors have been categorized as a relative or non-relative donors

    1. Relative donors require permission from the doctor in charge of the hospital
    2. A non-relative donor requires permission from an authorization committee of the state

  3. A doctor is authorized to remove organs from a donor only if

    1. The doctor has in writing and in presence of two witnesses approval of the organ from the patient.

      After the death,

      If the relatives of the patient who have the lawful possession of the body believe that the patient had disapproved removal of organ then the process of organ removal shall not be permitted.

    2. If no such written approval is given by the patient the relatives who have the lawful possession of the body can authorize an organ removal from the deceased’s body.

    3. In case the dead body is lying in the hospital or prison and is unclaimed by any relative within 48 hours from the death of the person

      the organ removal can be authorized by the person in charge in the hospital or prison

      unless the person in charge believes that the near relative might claim the body even if he/she has not come to claim the body in 48 hrs

    4. In the case of a person below the age of 18, either of the parents has the authority to donate the organs of the minor.

  4. The donor and his family will not bear any cost of organ retrieval, donor management, and preservation.

    In the whole organ transplant operation, the recipient of the organ would not be charged with any cost for the organ itself.

    Any cost involved is associated with the transplantation procedure.

How to register for organ donation in India

Organ donor card in India

The process of registering yourself as an organ donor is really simple, And even if you have a donor card after your death your family will still have the last say in whether they would like to donate your organs or not.

The donor card is not a legal document, It just helps in easing up the process of organ donation.

To get a donor card you will have to take a donor pledge which is available at the ORBO or you can also apply for the donor card online

The donor form requires 2 witnesses one of which is a near relative to sign the form

Once you have filled out about all the organs you want to donate your application is reviewed and if accepted you will receive a donor card.

Donor Form

Allocation criteria of organs for organ transplant in India

While a lot of patients are there on the waiting list for organ transplant the organs are not allocated just on a first come first serve basis.

Before we discuss the allocation criteria please note that

Only those patients for whom all the necessary data is provided and registration charges are paid are considered on the active waiting list

This list gets updated every month to update the status of the recipient.

The criteria (In no particular preference order) are 

  1. Urgency: based on the urgency of the organ for the patient the priority of giving an organ is determined there are 3 categories

    1. Emergency: Patients on a ventilator or ventricular assist devices
    2. Semi-Emergency: People in ICU depending on inotropic support 
    3. Elective: Patients electively waiting for transplantation.

  2. Blood Group Matching: When organs are transplanted in a body they face a phenomenon called organ rejection

    so it’s really important that the organs that are being given to a patient have lesser dissimilarities.

    An O blood group is a universal donor but can only receive a transplant from an O group patient hence only.

    If no O group patients are on their waiting list only then the organs will be given to a non O group patient.

  3. Geographical proximity: Since the organs can not survive outside the body(Like in case of heart it can only survive for 4-6 hrs) for a long duration of time the nearest available suitable donor is preferred.

  4. Organ match: based on what type of organ is involved their are different organ match criteria involved

    In the case of heart and lungs there can not be a mismatch of more than 20% in the size of the organ of the donor and recipient.

You can check out the following links to know more 

NOTP Operational Guidelines

Standard Operative Procedure

Updated Allocation criteria for Kidney(24.08.2016)

Updated Allocation Criteria for Liver (24.08.2016)

Allocation Criteria for Heart, Lung and Heart-Lung

Allocation Criteria for Cornea

What is the procedure of organ transplant?

organ transplant process
Image Source: NDTV

Organ donation is a noble act and a great effort should be made so that there is no malpractice wastage.

Step-1 Declaration of brain stem death

When a person is declared brain stem dead by the operating doctor a panel of 4 doctors is invited to confirm this declaration.

There are 6 tests that are done to confirm brain stem death 

  1. Absence of pupillary response to light
  2. Absence of corneal reflex
  3. Apnoea test
  4. Absence of gag and cough reflexes
  5. Absence of vestibular-ocular reflex
  6. Absence of cranial nerve response to death.

Step-2 Confirming organ donation from the donor’s family

This is where a donor card is really helpful, It helps doctors to interact and counsel the deceased’s family.

Once the family has given their approval, preparation to remove organs begins.

How are organs still functional when the patient has died?

Usually, the people with brain death are kept under a ventilator which provides oxygen to all organs of the body.

It is important to note that the heart is an autonomous organ so it can function independently of the brain since the heart is the organ that pumps blood in the whole body the organs receive oxygen and blood.

Step-3 Organ Retrieval-Preservation-Transportation 

Once a suitable recipient has been identified the organ retrieval process is initiated. Organs can not survive outside the body for long so in the whole process time is of great concern.

Organs are preservation techniques and perfusion solutions

Static Cold Storage: you may have seen on the television that organs are transported in a cool box,

The main idea behind static cold storage is flushing the procured organ with a preservation solution at low temperature (0–4°C),

then immersing it into a preservation solution at the same temperature until transplantation.

Lowering the temperature slows the cellular metabolism and the preservation solution along with lowering cellular metabolism provides cytoprotection.

The preservation solution used currently is the The University of Wisconsin (UW) solution

The organs are transported through the fastest means of transport to the recipient hospital and transplanted to the patient.

What is the success rated of organ transplants?

To understand the success rate of organ transplants we need to understand the concept of organ rejection.

When organs are transplanted our body’s immune system identifies it as an antigen and can attack the organ therefore with organ transplants immunosuppressant drugs are recommended.

All organ transplants face organ rejection except in the case of identical twins.

The organ rejection is of 3 types

  1. Hyperacute Rejection: Immediate rejection by the body within minutes of transplant, This usually occurs when the blood type of the donor and recipient is mismatched.

    The transplanted organ should be immediately removed if this happens.

  2. Acute Rejection: This type of organ rejection occurs in a few weeks within 3 months, Though all organ transplants face some level of acute rejection the level of rejection may differ.

  3. Chronic Rejection: The body constantly rejects the organ over a long period of time which damages the organ and tissue.

The success rate of organ transplants is subjective every year, based on the data of the national registry of recipients in the Ministry of Health and Medical Education (MOHME), Iran.

Among 403 organ transplant 85.3% people were still living 1 year after the transplant

What is the cost of organ transplants in India?

An Important thing to note is that there is not the cost of organs that are being transplanted and commercialization of organ and tissues in India is not legal 

Hence the cost associated with the procedure only involves the price of the organ transplant operation and not the organ itself.

India Rupee Note

Organ transplants in India cost around 15-20 Lakh Rupees.

The costs mentioned below are an average of the cost of organ translate as listed by some of the trusted platforms and Hospitals.

The most expensive organ transplant is the intestine transplant with an average cost of  ₹40,00,000.00

Name of the organ Avg Cost of organ transplant in India 
Cost of liver transplant in India ₹2,820,000.00
Cost of kidney transplant in India ₹6,00,000.00
Cost of heart transplant in India ₹21,50,000.00
Cost of lung transplant in India ₹20,00,000.00
Cost of pancrea transplant in India ₹10,00,000.00
Cost of intestine transplant in India ₹40,00,000.00

Final words

I think that organ donation is really a Nobel process and we can save many lives by donating our organs.

This is a really emotional decision and everyone has a right to decide for their loved ones

but I would like to say that life is precious for everyone and if you can save the one you should never back down.

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