Organ Transplantation: Basic Knowledge; Legal Framework and Key Issues

The relocation of an organ from one body to another is known as the organ transplant. The donor
donates his organ while the recipient receives it. The sole purpose of an organ transplant operation is to
replace the recipient’s damaged organ with the donor's healthy one, to help him live and function
normally.

Who can donate organs?

People above the age of eighteen and related to the recipient are eligible to donate their organs after
the required consent from the authorities. Organs donation includes organs like kidneys, liver, pancreas,
lungs, and heart, while tissue donation includes donation of eyes, skin, bone, bone marrow, nerves,
brain, heart valves, eardrum, ear bones, and blood. There are two ways prevalent that can be carried
out to perform organs transplant. One is cadaveric which involves extraction of the organ within hours
of the donor’s death, “harvested” and then delivered to the recipient. Another way is living organ
donation which requires a volunteer; usually, a family member of the patient, who voluntarily donates
an organ or a portion of it for transplant.

Organ Transplantations in India:

Globally, Spain leads with the highest organ donation rate of about 34 donors per million. India, on the
other hand, barely has 0.03 donors per million, with Tamil Nadu being the state with the highest number

For Best Online IAS Coaching, visit: www.prepze.com

of organ donations. Ironically, India requires around 6 lakh kidney donations yearly, yet receives only
6,000 kidney transplants. Heart transplants are another sad sight with them barely making it to 500. In
2014, National Organ and Tissue Transplant Organization (NOTTO) under the ministry of health and
family welfare was established to monitor the process of Organ Transplantation. Under NOTTO
comprises of two functional organizations and they are Regional Organ and Tissue Transplant
Organization (ROTTO) and SOTTO (State Organ and Tissue Transplant organization).

Transplantation of Human Organs Act (THOA), 1994

The Transplantation of Human Organs Act (THOA), 1994 lays down rules and regulations governing the
organ transplantation in India. It regulates removal, storage, and transplantation of human organs for
therapeutic purposes and prevents commercial dealings in the human body parts. States of Andhra
Pradesh and J&K have not yet adopted THOA as they have similar laws of their own. The act was
amended in 2009 also to include and regulate transplantation of tissues of the body along with human
organs. Its important features are:

Source of Organ

Under THOA, the donor may be:

● A near relative
● If someone else, then they can donate only out of affection and attachment or for any other
reasons, all only on approval of the authorization committee.
● Deceased donor, especially after Brainstem death

Other Points

This act legalizes Brainstem death in India. Organ donation from a person other than a “near relative”
requires permission of the State Authorization Committee. If there is an occurrence of anything
associated with trade in human organs, both the donor and recipient shall face the consequences. The
2009 amended TOHA act expands the parameter of “near relative” to include grandparents and
grandchildren in addition to parents, children, brother, sister, and spouse.

Issues and Challenges

Organ scarcity will proliferate in the future because of the extensively increasing life-span, but there are
some challenges related to organ transplantation. These are:
● Article 246 of the Constitution states that public health and hospitals fall under the jurisdiction
of their respective states, leading to each state having its own transplantation laws.
● A vast gap persists between demand and supply of organs in India, a country with an alarmingly
low rate of 0.5 per million of organ donation, one of the weakest in the world.
● Lack of Brainstem Death awareness among stakeholders and absence of knowledge and attitude
towards organ donation.

For Best Online IAS Coaching, visit: www.prepze.com

 ● The dearth of a proper system for organ procurement from a deceased donor.
● India's law allows a non-relative donor to voluntarily donate an organ for reasons like "affection
and attachment” or some other particular reason, but never out of consideration of money.
Such a provision limits the possibility of getting a donor.
● Even though the TOHA law tries to bulletproof the entire organ transplant system, there persist
loopholes through which poor people get exploited, and illegal human organ trafficking gets
conducted.
● Authorization Committee is pretty stringent, and sometimes it gets challenging to convince
them about the altruism of the donor.
● Currently, only half a dozen states have active organ donation programmes, while others don't
even have the required infrastructure.
● Superstition also governs people's decision who believe that their religion prohibits them from
organ donation.
● The increasing popularity of social media has amplified the illegal organ trade.
● Majority of transplants in India performed by the private sector.
● Donation in India is also motivated by gender. Less than 20% recipients are women, while 55-
60% donors are men.

What needs to be done?

Organ trade in India comprises of the exploitation of the poverty-stricken people by alluring them with
financial gains. Unlike other exploitative social issues, this requires an invasive surgical procedure which
leaves the victim with grave physical as well as psychological implications.
● Bringing law for the Voluntary donation of an organ in exchange for a minimum stipulated
amount of money.
● India may adopt a system of ‘opt-out’ where organ donation will be conducted automatically
unless an explicit request is made before death for it not to happen.
● A uniform legislative policy is required to increase organ donations.
● The 1994 Transplantation of Human Organs Act fails to have a pan-India application when it
comes to monitoring and regulating the transplantation procedures, and therefore, a centralized
regulatory authority with a proper monitoring mechanism in place that would make the system
open and transparent is the need of the hour.
● Public sector too can establish a transplantation activity.
● All transplantations need to be registered in a national registry.
● If a person wishes to donate their organs after their demise, a robust system should be
constructed to record their will or pass on their message to the concerned authorities. This will
help to ensure timely retrieval of organs.
● Though there are existing rules for the organ transplant system in the country, stricter
implementation is the need of the day.

Some of the initiatives taken by government

For Best Online IAS Coaching, visit: www.prepze.com

The Central government of India plans to establish a fund for families of people who have donated
organs after brainstem death. This fund aims to support the education of children of deceased donors as
well as take care of the medical expenses of other family members. The National Organ Transplant
Programme (NOTP) is another attempt by the government of India to promote organ donation across
the country. The ministry of health and family welfare is also considering to include stepparents, step-
siblings and extended family members in its “near relatives” parameter, stated in the Transplantation of
Human Organs and Tissues Act of 1994, which aims to promote and increase the rate of organ donation
in India, and curb and eradicate organ trading.

Other information
Brain Death

Brain death is when your brain stops functioning permanently, with no option available to reverse it. In
this case, a person fails to perform life-sustaining functions. Instead, they are carried out by machines in
an ‘intensive care unit’ for a short period. These patients are kept on artificial support to maintain
oxygenation of organs so that they remain healthy condition until they are procured and transplanted
into the bodies of terminally ill patients with their chances of living still existing. In India, a panel of 4
doctors has to declare you brain dead before organs can be harvested which is repeated twice in a time
frame of six hours.

Opt-Out System

Recently, France adopted the opt-out system in organ donations, which is a “presumed consent”
assuming that a deceased person has agreed to donate their organs unless they have added their name
to a national “refusal register.” Spain also has the system of ‘opt-out’ where organ donation will be
automatic unless an explicit request is made before death for organs not to be taken.

For Best Online IAS Coaching, visit: www.prepze.com