What is organ donation?
Organ donation is a gracious act which provides an opportunity to save many lives after our death. The donated organs are transplanted into patients who are suffering form end stage organ failure. It gives a chance for second life in such patients.
What is brain death?
When brain stem is permanently damaged, the patient is declared brain dead as he cannot regain consciousness or breathe. Brain stem is a part of a central nervous system having centre for consciousness and respiration. Heart will continue to function for 36 to 72 hrs on life support. As the blood supply is maintained to the vital organs during this period, the organs can be taken from the dead with the consent of the relatives. Such patients are usually in an intensive care unit. These are typically patients who have had head injury or brain hemorrhage or brain tumors.
How is brain death declared?
Brain death is declared by the brain death committee. The committee consists of a team of four doctors registered by the government. They are not involved in performing the transplant. Brain stem death tests are performed twice at an interval of 6 hrs. Once the patient is identified as brain dead, the family of the brain dead person is approached by the social workers or transplant coordinators for organ donation.
Is organ donation legal?
Yes, it is legalized in India by “The Human Organ Transplantation Act” (HOTA). This Act was passed in the year 1994. With this Act brain death can be recognized and if consent is obtained, the organs of the brain dead individual can be used for the purpose of donation
It mainly covers three areas:
- It recognizes brain stem death
- It regulates removal, storage and transplantation of organs
- It prevents commercial dealings in human organs. No human organ can be bought or sold.
Which organs can be donated?
- The organs like heart, liver, kidneys, pancreas, intestines, lungs, cornea (eyes), heart valves, bones, tendons, skin and other tissues can be donated after death.
- A living person can donate a kidney, since we have two kidneys, and a part of liver, to his/her close relative.
- Even a face transplant has been recently described.
Is there any chance of survival of a brain death individual?
No. Brain death individual is dead and cannot be revived. Brain death is as good as death. Traditionally, we understand heart stopping to beat as death. The brain controls the functioning of the heart and lungs. Once the brain is dead, the heart and lungs will automatically stop functioning, unless they are kept working with medications and machines temporarily.
Is brain death different from a vegetative state?
Yes. Brain death is different from a vegetative state. In a vegetative state the heart and lungs are functioning independently, but the brain is severely damaged (not dead), and though the person is in a wakeful state, he is not aware of the surroundings.
Can organs be donated if death occurs at home?
No. The brain death individual’s vital organs have to be kept functioning by artificial means. Hence, the person has to be kept in ICU of the hospital. However, eyes can be donated up to 6 hours after the heart stops beating; hence this could be done even if the individual dies at home.
Is donor’s body given back to relatives?
Yes. The body is given back to relatives to perform the last rites, after the retrieval of organs. This is different than body donation where the whole body is given to an anatomy department of a Medical College for teaching purposes.
Why should we donate organs?
Each year the need for organ transplant goes on increasing, as more and more cases of end stage organ failure are detected. Majority of people die on the waiting list, since they do not get the organs on time. Donation of an organ can be seen as a noble act where the person continues to live through his organs in another individual.
Who can become an organ donor?
- Each individual is a prospective donor.
- People with Cancer, Intravenous drug users, HIV positivity and severe sepsis cannot be considered for organ donation.
- Patients infected with Hepatitis B/C can donate to a person affected with Hepatitis B/C respectively.
- Cancer patients may donate corneas.
- Brain tumor patients can donate all organs
- The following are the approximate ages permissible for organ donation:
- Till 40 years: Heart valves
- Till 50 years: Heart, lungs
- Till 70 years: Kidneys, liver
- Till 100 years: Corneas, skin
- Children can also donate organs
How can one become an organ donor?
You can become an organ donor by signing an organ donor card. You must inform your close relatives about your wish, as their consent is required before retrieving the organs even if the donor has signed the a donor card. The donor card has to be kept with the person who has signed it.
A child below 18 years age needs parent’s consent for organ donation. Children needing organ transplant need organs smaller than those an adult can provide.
The Transplantation of Human Organs Act allows the donation of organ and tissues for treatment purpose only. The Act states that it is mandatory that the next of kin (parents, spouse etc) should agree to donate the organs of a brain dead family member.
What impact does organ donation have on the recipients?
For patients with organ failure, the transplant provides a new life. Patients receiving heart, liver, kidneys, pancreas, or lung transplant, can return to a normal lifestyle. Cornea transplants offer the ability to see again.
Is identity of the recipient disclosed to the donor family?
No. The name and identity of the recipient is not given to the donor family and vice versa.
Is any compensation or payment made to the donor family?
No. It is pure donation and hence a noble act. However, the family is not charged for the investigations after the consent for organ donation is given.
Can organs be sold?
No. The Transplantation of Human Organs Act makes it ILLEGAL to buy or sell human organs.
Important Articles on Organ Donation
- Factors associated with organ donation.
Kaur D, Ajinkya S.
N Am J Med Sci. 2012 Oct;4(10):514-5. doi: 10.4103/1947-2714.102011. No abstract available.
PMID: 23112980 [PubMed] Free PMC Article
2. India drafts new rules to combat organ shortage.
BMJ. 2012 Sep 11;345:e6120. doi: 10.1136/bmj.e6120. No abstract available.
PMID: 22968728 [PubMed - indexed for MEDLINE]
3. Can presumed consent overcome organ shortage in India? Lessons from the Belgian
Looze KD, Shroff S.
Natl Med J India. 2012 May-Jun;25(3):168-71. No abstract available.
PMID: 22963299 [PubMed - indexed for MEDLINE]
4. Evolution of the Transplantation of Human Organ Act and law in India.
Agarwal SK, Srivastava RK, Gupta S, Tripathi S.
Transplantation. 2012 Jul 27;94(2):110-3. doi: 10.1097/TP.0b013e31825ace15.
PMID: 22728294 [PubMed - indexed for MEDLINE]
5. How deceased donor transplantation is impacting a decline in commercial transplantation – the
Tamil Nadu experience.
Abraham G, Reddy YN, Amalorpavanathan J, Daniel D, Roy-Chaudhury P, Shroff S, Reddy Y.
Transplantation. 2012 Apr 27;93(8):757-60. doi: 10.1097/TP.0b013e3182469b91.
PMID: 22245870 [PubMed - indexed for MEDLINE]
6. Improving the rates of cadaver organ donation in a tertiary care transplant centre: a role for
Medical students and ancillary staff.
Patwardhan SS, Kulkarni GV.
J Postgrad Med. 2011 Oct-Dec;57(4):347-9. doi: 10.4103/0022-3859.90093.No abstract available.
PMID: 22120870 [PubMed - indexed for MEDLINE] Free Article
7. Organ donation for transplantation: hurdles imposed by thoughtless officials.
Natl Med J India. 2010 May-Jun;23(3):186-7. No abstract available.
PMID: 20949728 [PubMed - indexed for MEDLINE]
8. The costs of altruism in organ donation case analysis.
Netza Cardoso C, Casas Martínez ML, Ramírez García H.
Cuad Bioet. 2010 May-Aug;21(72):157-67. Spanish.
PMID: 20886909 [PubMed - indexed for MEDLINE] Free Article
9. Are we ready for non-heart-beating organ donation in India?
Indian J Med Ethics. 2010 Apr-Jun;7(2):106-7. No abstract available.
PMID: 20432885 [PubMed - indexed for MEDLINE]
10. Creating awareness about pediatric cadaver organ donation in India.
Sibal A, Kaur S.
Indian Pediatr. 2010 Feb;47(2):197. No abstract available.
PMID: 20228439 [PubMed - indexed for MEDLINE] Free Article
11. Deceased donor organ transplantation with expanded criteria donors: a single-
center experience from India.
Goplani KR, Firoz A, Ramakrishana P, Shah PR, Gumber MR, Patel HV, Vanikar
AV, Trivedi HL.
Transplant Proc. 2010 Jan-Feb;42(1):171-4.doi:10.1016/j.transproceed.2009.11.021.
PMID: 20172307 [PubMed - indexed for MEDLINE]
12. Organ donation, awareness, attitudes and beliefs among post graduate medical students.
Bapat U, Kedlaya PG; Gokulnath.
Saudi J Kidney Dis Transpl. 2010 Jan;21(1):174-80.
PMID: 20061720 [PubMed - indexed for MEDLINE] Free Article
13. Legal and ethical aspects of organ donation and transplantation.
Indian J Urol. 2009 Jul;25(3):348-55. doi: 10.4103/0970-1591.56203.
PMID: 19881131 [PubMed] Free PMC Article
14. First prospective study on brain stem death and attitudes toward organ donation in India.
Seth AK, Nambiar P, Joshi A, Ramprasad R, Choubey R, Puri P, Murthy M, Naidu S,
Saha A, Bhatoe H.
Liver Transpl. 2009 Nov;15(11):1443-7. doi: 10.1002/lt.21912.
PMID: 19877266 [PubMed - indexed for MEDLINE] Free Article
15. Tamil Nadu shows the way.
Natl Med J India. 2009 May-Jun;22(3):152-3. No abstract available.
PMID: 19764695 [PubMed - indexed for MEDLINE]
16. Will presumed consent make transplantation accessible, ethical and affordable in India?
Indian J Med Ethics. 2009 Jul-Sep;6(3):155-6. No abstract available.
PMID: 19653593 [PubMed - indexed for MEDLINE]
17. Organ transplant and presumed consent: towards an "opting out" system.
Indian J Med Ethics. 2009 Jul-Sep;6(3):149-52.
PMID: 19653591 [PubMed - indexed for MEDLINE]
18. Brain death and organ donation.
Nurs J India. 2009 Mar;100(3):58. No abstract available.
PMID: 19588655 [PubMed - indexed for MEDLINE]
19. Working towards ethical organ transplants.
Indian J Med Ethics. 2007 Apr-Jun;4(2):68-9. No abstract available.
PMID: 18630226 [PubMed - indexed for MEDLINE]
20. Asia's organ farms.
Jafarey A, Thomas G, Ahmad A, Srinivasan S.
Indian J Med Ethics. 2007 Apr-Jun;4(2):52-3. Review. No abstract available.
PMID: 18630220 [PubMed - indexed for MEDLINE]
21. Brain death: some conundrums.
Natl Med J India. 2007 Mar-Apr;20(2):93. No abstract available.
PMID: 17802990 [PubMed - indexed for MEDLINE]
22. Organ donation and transplantation-the Chennai experience in India.
Shroff S, Rao S, Kurian G, Suresh S.
Transplant Proc. 2007 Apr;39(3):714-8.
PMID: 17445579 [PubMed - indexed for MEDLINE]
23. Brain death and our transplant law.
Issues Med Ethics. 2001 Apr-Jun;9(2):51-2. No abstract available.
PMID: 16334472 [PubMed - indexed for MEDLINE]
24. Organ transplantation: ethical issues and the Indian scenario.
Issues Med Ethics. 2001 Apr-Jun;9(2):41-3. No abstract available.
PMID: 16334468 [PubMed - indexed for MEDLINE]
25. Factors influencing refusal by relatives of brain-dead patients to give consent for organ
donation: experience at a transplant centre.
Singh P, Kumar A, Sharma RK.
J Indian Med Assoc. 2004 Nov;102(11):630, 632, 643.
PMID: 15868874 [PubMed - indexed for MEDLINE]
26. Organ donation in mental retardation: a clinical dilemma.
Malhotra S, Balhara YP, Varghese ST.
Indian J Med Sci. 2004 Oct;58(10):444. No abstract available.
PMID: 15523167 [PubMed - indexed for MEDLINE] Free Article
27. Indian doctors debate incentives for organ donors.
BMJ. 2004 Oct 23;329(7472):938. No abstract available.
PMID: 15499095 [PubMed - indexed for MEDLINE] Free PMC Article
28. Awareness of brain death and organ transplantation among select Indian population.
Wig N, Gupta P, Kailash S.
J Assoc Physicians India. 2003 May;51:455-8.
PMID: 12974425 [PubMed - indexed for MEDLINE]
29. Level of awareness about transplantation, brain death and cadaveric organ donation in
hospital staff in India.
Singh P, Kumar A, Pandey CM, Chandra H.
Prog Transplant. 2002 Dec;12(4):289-92.
PMID: 12593068 [PubMed - indexed for MEDLINE]
30. Attitude of patients, the public, doctors, and nurses toward organ donation.
Reddy AV, Guleria S, Khazanchi RK, Bhardwaj M, Aggarwal S, Mandal S.
Transplant Proc. 2003 Feb;35(1):18. No abstract available.
PMID: 12591287 [PubMed - indexed for MEDLINE]
31. Ethics of paid organ donation.
Phadke KD, Anandh U.
Pediatr Nephrol. 2002 May;17(5):309-11.
PMID: 12042884 [PubMed - indexed for MEDLINE]
32. Awareness of brain death and organ transplantation among high school children.
Wig N, Aggarwal P, Kailash S, Handa R, Wali JP.
Indian J Pediatr. 1999 Mar-Apr;66(2):189-92.
PMID: 10798059 [PubMed - indexed for MEDLINE]
33. Resolving the conflict in traditional ethics which arises from our demand for organs.
Transplant Proc. 1993 Dec;25(6):2983-4. No abstract available.
PMID: 8266424 [PubMed - indexed for MEDLINE]
34. Ethics in organ donation: contrasts in two cultures.
Dossetor JB, Manickavel V.
Transplant Proc. 1991 Oct;23(5):2508-11.
PMID: 1926454 [PubMed - indexed for MEDLINE]