Why in news?

As per the Union Health Ministry, poor identification and certification of brain stem death or brain death cases is keeping the rate of organ donations at low levels in India, despite the availability of many potential cases.

What’s in today’s article?

• brain death
• Organ transplantation in India – Statistics
• Regulatory frameworks guiding the organ transplantation in India
• Poor identification of brain death and low level of organ donations

Brain death

• About
  • Brain stem death, also known as brain death, occurs when the brain stem stops working and a person can no longer breathe or regain consciousness without support.
  • The brain stem is the lower part of the brain that controls vital functions like breathing, heartbeat, blood pressure, and swallowing.
  • A person who is brain dead is legally confirmed as dead. They have no chance of recovery because their body is unable to survive without artificial life support.
• Confirmation
  • Two senior doctors perform tests to confirm brain stem death, and one of them should not be involved in the patient's care.
• Brain death and status of other organs
  • Once brain stem death is declared, the person is legally dead, but their organs are still alive because they are kept alive artificially.
  • Hence, after brain death, it may be possible for the person's organs to be used in transplants.

Organ transplantation in India – Statistics

• According to the NOTTO data, there has been an overall increase in the number of transplants in the country, with a record high of 16,041 such procedures in 2022.
• India has an organ donation rate of about 0.52 per million population.
  • In comparison, the organ donation rate in Spain, the highest in the world, is 49.6 per million population.
• 

Regulatory frameworks guiding the organ transplantation in India

• Legislation
  • In 1994, The Transplantation of Human Organs Act (THOA) was promulgated by the government of India.
  • The Transplantation of Human Organs Rules followed in 1995 and were last amended in 2014, increasing the scope of donation and including tissues for transplantation.
  • The act made commercialization of organs a punishable offence and legalized the concept of brain death in India allowing deceased donation by obtaining organs from brain stem dead person.
• Institution
  • National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under Ministry of Health and Family Welfare.
  • Besides laying down policy guidelines and protocols for various functions, it coordinates all the activities associated with organ donation at national level.
• Organ transplant rules
  • In February 2023 the govt modified national organ transplantation guidelines.
  • The new guidelines have done away with the 65-year age limit for registration of patients seeking organs from a deceased donor.
    • There was no age cap for living donor transplants, where family members donate organs like kidneys and livers.
    • However, people over the age of 65 years couldn’t register to receive organs from deceased donors as per guidelines of NOTTO.
  • It has asked states to remove the domicile criterion for registering those seeking organs from deceased donor for transplant procedures.
    • Now the needy person can go to any state of the country and register for getting organ and also get the transplant done.
    • The patient will be allotted a unique ID by NOTTO on registering.
    • This will get carried forward even if the patient changes multiple hospitals in different States.
  • Noting that some states have been charging fees ranging between Rs 5,000 to 10,000 for registering such patients, this guideline has asked them not to charge money.

Poor identification of brain death and low level of organ donations

• Impact of Poor identification and certification of brain stem death on organ donation
  • Poor identification and certification of brain stem death or brain death cases is keeping the rate of organ donations at low levels in India.
  • The health ministry has expressed concern over the rate of organ donations in the country remaining at less than one donor per million population in a year.
• Identify each potential brain death case admitted in the ICU
  • The govt asked health authorities to identify each potential brain death case admitted in the ICU and inquire whether the potential donor had pledged for organ donation.
  • If not, hospital authorities should make family members aware of the opportunity to donate organs before the heart stops.
• Hospital to facilitate and monitor the certification of brain death cases
  • It asked every hospital to facilitate and monitor the certification of brain death cases to ensure compliance with the THOTA Act and Rules.
  • The Health Ministry also asked hospitals to install ‘Required Request Display Boards’ at strategic locations.
    • These boards should convey the message to the public that in the unfortunate event of brain death or cardiac arrest, donation of organs and tissues could save lives.
• Update the NOTTO on a monthly basis
  • The authorities were told to update the NOTTO on a monthly basis, on:
    • the number of brain death cases identified and certified,
    • number of cases where the family gave consent to donate organs and
    • the number of organs donated and utilised among other details.