Organ donation is the entire process of retrieving a human organ from a living or deceased person who is referred to as a donor and transplanting it into a recipient. The recipient will be patient who is suffering from organ failure and who will not survive unless he /she receives an organ replacement.

In India, there are over 150,000 people currently in need of kidney transplants. The wait-list for patients with heart and liver failure is growing all the time as well And each year, thousands of people die while waiting for a transplant, because no suitable donor can be found for them. The need for organ donors has never been greater. It can be hard to think about what's going to happen to your body after you die, let alone donating your organs and tissue. But being an organ donor is a generous and worthwhile decision that can be a lifesaver. All people can be considered as being potential organ and tissue donors after death. However, the presence of active cancer, active HIV, active infection (for example, sepsis) or Intravenous (IV) drug use would absolutely rule out donation. Patients who have Hepatitis C may still donate organs to a patient who also has Hepatitis C. The same is true for Hepatitis B — but this happens in very rare cases. Most cancer patients may donate corneas.

Tissue donation is the process of retrieving or procuring tissues from a living or deceased person called a donor and transplanted into a recipient who needs it. An organ donor can save eight lives through multiple organ and tissue donation, if they are suitable for transplant. Most organs are gifted to recipients from deceased donors.

Anyone, regardless of age, race or gender can become an organ and tissue donor after his or her Death (Brainstem/Cardiac). Consent of near relative or a person in lawful possession of the dead body is required. If the deceased donor is under the age of 18 years, then the consent required from one of the parents or any near relative authorized by the parents is essential. Medical suitability for donation is determined at the time of death.

Everyone has a choice as to whether or not they want to become an organ donor after they die, and if you choose to donate, you can choose to donate either some or all of your organs. In organ donation, a person pledges during her/his lifetime, that after death, certain (or all) organs from the body can be used for transplantation to help terminally ill patients get a new lease of life. With recent advances in transplantation, people of all ages and medical histories can donate organs – even people in their 80s have donated organs in the past. However, the final call on the organs and tissue that can be donated is taken only after doctors analyze the donor’s medical condition.

• • Living Donation

  Living donation takes place when a living person donates an organ (or part of an organ) for transplantation to another person. The living donor can be a family member, such as a parent, child, brother or sister, grandparent or grandchild (living related donation). It can also come from someone who is emotionally related to the recipient, such as a good friend, a relative, a neighbour or an in-law (living unrelated donation).
  Living organ donors can donate: one kidney, a lung, or a portion of the liver, pancreas, or intestine. What tissues can be donated? Layer of cells that function together to serve a specific purpose are called tissues. Most tissues should be donated within 6 hours of the donor’s death. Cornea. Bones, Skin, Veins

• • Deceased Cadaver Donation

  The patient has to register in a hospital that does transplants. The patient will be put on a wait list. As and when the organ from an appropriate deceased donor (brain death) is available, the patient will be intimated.
  Deceased organ donors can donate: kidneys (2), liver, lungs (2), heart, pancreas, and intestines. All of these forms of donation can greatly enhance or even save the life of someone in need.

The medical condition of the person at the time of death can determine what organs and tissues can be donated and what cannot be. Organs need to be removed as soon as the person is declared brain-dead. Without the necessary oxygen supply, the organs stop functioning right.
The approximate amount of time between recovering the tissues/organs and transplanting them is:
Lung - 4 - 6 hours
Heart - 4 - 6hours
Liver – 6-12 hours
Pancreas - 24 hours
Kidney – 24-48 hours
Cornea - 14 days
Intestine- 6 -10 hours
Bones - 5 years
Skin - 5 year
Heart Valves - 10 years
A deceased organ donor is kept on ventilator after he/she has been declared brain death. A brain stems dead person’s organ may stay alive for a period of time that may range from few days to a few weeks. The longer it takes to retrieve organs, the more will deteriorate inside the body. Therefor the entire process of grief counselling of family, taking permissions etc. should be quickly taken care of it. Once the organs have been retrieved, they cannot be kept outside the body for very long and need to be transplanted fast.

The legislation called the Transplantation of Human Organ Act (THO) was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence. With the acceptance of brain death, it became possible to not only undertake kidney transplantations but also start other solid organ transplants like liver, heart, lungs, and pancreas. The main provisions of the THO act and the newly passed Gazette by the Government of India include the following:

1. For living donation - it defines who can donate without any legal formalities. The relatives who are allowed to donate include mother, father, brothers, sisters, son, daughter, and spouse. Recently, in the new Gazette grandparents have been included in the list of first relatives. The first relatives are required to provide proof of their relationship by genetic testing and/or by legal documents. In the event of there being no first relatives, the recipient and donor are required to seek special permission from the government appointed authorization committee and appear for an interview in front of the committee to prove that the motive of donation is purely out of altruism or affection for the recipient.
2. Brain-death and its declaration - brain death is defined by the following criteria: two certifications are required 6 hours apart from doctors and two of these have to be doctors nominated by the appropriate authority of the government with one of the two being an expert in the field of neurology.
For more information on transplant act in India…Read our resources

THE TRANSPLANTATION OF HUMAN ORGANS ACT:
Organ donation and transplantation is permitted by law and is covered under the “Transplantation of human organs act (THOA) 1994”, which has allowed live and deceased organ donation. In 2011,the amendment of the Act also brought in, donation of human tissues thereby calling the amended act “Transplantation of human organs and tissues Act 2011” This act regulates removal, storage and transplantation of organ for therapeutic purposes and prevents commercial dealings in human organs. No human organs can be bought and sold.


National Organ and Tissue Transplant Organization (NOTTO) is a National level organization set up under Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.

Vision: Save life by preventing premature deaths due to organ failure within the framework of THO (Amended) Act and revised rules.

MIssion: To set up an effective national deceased organ & tissue donation system.

Aim: To improve access to life transforming transplantation for needy citizens by promoting deceased organ donation.

ROTTO: ROTTO Monitors and surveillances transplantation activities in the region ,collects statistic from SOTTO and maintains data bank including transplant, follow up organ donor registry of the region and operates various scheme for organ donation, donor health checkup and safeguards vulnerable population. Organizes and conducts training programmes for region. It also creates awareness for deceased organ and tissue donation and organizes interacts oral meetings and advocacy workshop for the region and states. It disseminates the information and provides Technical guidance and support.

SOTTO: At the State Level: SOTTO is to be set up tentatively at 6 new AIIMS like institutions to maintain the waiting list of patients requiring needing transplant and Facilitate multi organ retrieval from a BSD (Brain Stem Death) donor, coordination from procurement of organs from a donor till the transplantation into a recipient. Matching of recipients with donor and organ allocation as per the designated policy within the state including distribution of organs and tissues is also done by SOTTO and Disseminates information to concerned hospitals, organizations and individuals. It also collects data from ROTTO.

• • Identification of potential donor by the ICU physicians.
• • Screening of donor (no active infection, malignancy, and donor age).
• • Organizing for the brainstem death tests.
• • Declaration of death to the relatives by the treating physician
• • Informing the (zonal transplantation coordination Centre( ZTCC).

What does brain death mean? Brain death occurs in patients who have suffered a severe injury to the brain. As a result of the injury, the brain swells and obstructs its own blood supply causing brain tissue to die and permanent loss of brain function. Brain death is permanent and irreversible. It is a legal definition of death. However, the vital organs such as the heart, lungs, liver, pancreas and kidneys can be kept viable for a few days if supported by artificial or mechanical support.

Evaluation team:
In India, according to the transplantation of Human Organs (THO) Act, 1994 (subsection 6 of section 3),3 “brainstem death” is referred to the stage at which all functions of the brainstem have permanently and irreversibly ceased. This requires certification by a “Board of Medical Experts” consisting of
(1) the medical superintendent (MS)/in-charge of the hospital in which “brainstem” death has occurred
(2) a specialist
(3) a neurologist or a neurosurgeon nominated by the MS, from a panel approved by the appropriate authority
(4) the doctor under whose care the “brainstem” death has occurred.

Amendments in the THO Act 2011 have allowed selection of a surgeon/physician and an anesthetist, if an approved neurosurgeon or neurologist is unavailable. In many countries, including India, the diagnosis of brain death is made after fulfilling the mandatory criteria and by the apnea testing which is a safe technique for documentation.4 A checklist of requirements5 that need to be fulfilled before proceeding with tests for brain death is indicated in Table 1. For certifying brain death, the following needs to be evaluated: Presence of irreversible coma, the cessation of spontaneous respiration confirmed with apnea tests, absence of pupillary light reflexes, corneal reflexes, doll’s eye movements, gag reflex, cough reflex (tracheal), eye movements on caloric testing bilaterally, motor response in any cranial nerve distribution, and motor response on stimulation of face/limb/trunk.
Organ donation is the process of donating organs or biological tissue to a living recipient, who needs a transplant. While transplants can save or greatly enhance the lives of other people, this relies on donors and their families agreeing to donate their organ. There are two types of organ donation - living donation and deceased or cadaver donation.

Living donations: For living donors, the process typically involves extensive testing before the donation, including psychological evaluation to find out whether the would-be donor understands and consents to the donation. A transplant may take place only after the donor's medical compatibility with the recipient is confirmed by a doctor. After organ retrieval has taken place, the donor will need to stay under medical care for a few days.
It may be noted that a living donor may only donate a limited list of organs and tissues.
Deceased donations: Here, before a patient can become an organ donor, he/she - who is a victim of a fatal injury to the head - needs to be declared brain dead by a board of medical experts. Brain death is defined as the complete loss of brain function, including involuntary activity necessary to sustain life. A brain-dead person cannot sustain his own life, but his vital body parts can be transplanted into the body of a living recipient. Before the process of organ procurement is carried out, a consent from the deceased donor's family is obtained. Meantime, the donor’s body is kept on a ventilator under special medical care to ensure that his or her organs are in a healthy condition until they are harvested. After the organs are retrieved, the donor's body is surgically restored to as normal an appearance as possible and given back to the family in a dignified way. Organs of deceased donors can be transplanted to terminally ill patients.

Each year, hundreds of people die while waiting for an organ transplant. There is a shortage of organs, and the gap between the number of organs donated and the number of people waiting for a transplant is getting larger. Transplants, as an option, have successful outcomes, and the number of people needing a transplant is expected to rise steeply due to an ageing population and an increase in organ failure In India, a large number of people die due to road traffic accidents. However, only a small number of people that die due to these circumstances are able to donate their organs. As organs need to be transplanted as soon as possible following the donor’s death, they can only be donated by someone who has died in the hospital. Usually, organs come from people who are certified as dead while on a ventilator in a hospital intensive care unit, which can be as a result of a hemorrhage, major accident like a car crash or stroke.
Key reasons for shortage of organ donors in India:

• • Ignorance and Lack of Knowledge about Organ Donation There is a major lack of awareness about organ donation in India, and recent polls and surveys reveal that people would come forth with their wish to donate if they had received more information.
• • Registering one’s Wish to Donate: A major reason for the shortage of organs is that many people have not recorded their wish about organ donation or discussed it with their families.
• • Myths and Beliefs Myths and misconceptions about organ donation discourage potential donors from making the decision to donate organs or tissue after death.