Why in News?

• Despite India’s high burden of road traffic accidents and ICU-related deaths, organ donation rates remain low.
• A recent national survey highlights systemic gaps in brain death certification, training, and awareness among physicians, directly hampering deceased organ donation.

What’s in Today’s Article?

• Organ Donation in India
• Reasons Behind the Low Donation Rate
• Survey Findings on Brain Death Certification
• Government Steps to Boost Organ Donation in India
• Way Forward
• Conclusion

Organ Donation in India:

• Overview:
  • While India ranks third globally in the total number of organ transplants (over 18,900 in 2024), the country's organ donation rate remains critically low, particularly for deceased donations.
  • Though India reports 1,60,000 road traffic deaths annually, only 1,000–1,200 deceased organ donations occur per year.
  • This means, India is heavily reliant on living donors for most transplants, especially for kidneys (for which, overall 13,476 transplants performed in 2024) and liver (4,901 transplants).
• Statistics:
  • Living vs. deceased donors: In 2024, India recorded just 1,128 deceased donors compared to over 15,000 living donors. Over 700 of these deceased donors came from just six southern states.
  • Donor-per-million rate: India's donation rate is less than 1 donor per million population, far behind developed countries like Spain (~48 per million) and the US (~36 per million).
  • Supply-demand gap: With over 63,000 people needing a kidney transplant and 22,000 needing a liver, the demand for organs vastly outstrips the supply, and thousands die each year while waiting.

Reasons Behind the Low Donation Rate:

• Lack of awareness: Widespread lack of public knowledge about organ donation, especially the concept of "brain death," is a major barrier. This leads to misinformation and skepticism.
• Cultural and religious beliefs: Deep-seated social and cultural factors, including beliefs about life after death, create hesitation and prevent families from giving consent for donation, even if the deceased had previously pledged.
• Family refusal: Even with a donor pledge, family reluctance often results in refusal. A 2025 study cited family refusal as a significant factor for over 60% of respondents.
• Weak deceased donation system: Many hospitals lack the infrastructure, trained counselors, and trained intensivists needed to identify potential donors and counsel families effectively.
• Lack of medical training: Example, very few neurosurgeons, neurologists, and critical care specialists are trained during their MBBS studies to certify brain death.
• Geographical disparities: Transplant facilities are concentrated in major cities, and most deceased donation programs are confined to southern and western states.
• High cost of transplant: Most transplants occur in the private sector, and the high costs make them inaccessible for many people with end-stage organ failure.
• Legal and ethical hurdles: Complex legal and ethical issues, including concerns about illegal organ trafficking, can delay or hinder the donation process.

Survey Findings on Brain Death Certification:

• Conducted by AIIMS neurosurgeons, it surveyed 177 doctors involved in organ donation.
• Key findings:
  • Fewer than 50% received formal training in brain death certification during medical school.
  • Only 10% routinely trained their residents in brain death protocols.
  • 96% knew the apnea test (for determining brain death), but nearly 50% failed to screen for drugs or toxins - an essential step in ruling out reversible causes of coma.

Government Steps to Boost Organ Donation in India:

• Institutional reforms:
  • The Indian government has taken several steps to improve organ donation rates through the National Organ and Tissue Transplant Organisation (NOTTO).
  • These include establishing the National Organ Transplant Programme (NOTP) to provide financial support for infrastructure and setting up regional and state bodies (ROTTOs and SOTTOs).
• Legal reforms: In 2023, the government removed the upper age limit for deceased donor registration and the state domicile requirement.
• Digital initiatives: Include a unique NOTTO-ID system to monitor transplants.

Way Forward:

• Integration in medical education: Mandatory inclusion of brain death certification training in undergraduate and postgraduate curricula.
• Capacity building: Regular refresher courses and hands-on workshops for doctors and residents.
• Standardised protocols: Development of uniform national guidelines for brain death certification.
• Institutional reforms: Creation of hospital-level frameworks to streamline processes. Example, the need for hospital-level "green corridors" for smooth organ donation procedures.
• Awareness campaigns: Public and professional sensitisation to improve acceptance and trust in organ donation.

Conclusion: A comprehensive approach combining education, systemic reforms, and awareness can significantly enhance deceased organ donation rates, aligning with India’s healthcare goals and ethical imperatives.