Indian Cadaveric Organ Donation Programme: A Distant Dream or an Achievable Goal?

Human-to-human transplantation of organs has been accepted by doctors worldwide as the best line of treatment and often the only one for a wide range of fatal diseases such as End Stage Renal Disease (kidney failure). Organ transplantation has been one of the greatest advances of modern science that has resulted in many patients getting a renewed lease of life. It would not be possible without organ donation. Organs can be donated by a living person, after natural death or after “brain death”. After natural death only a few tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain death almost 37 different organs and tissues can be donated including critical organs such as kidneys, heart, liver and lungs.

In the United States, in 2004, there were over 14,000 organ donors – an increase of 695 donors (7%) over 2003. During this time the number of cadaver donors grew by 11% to 7,152, the largest annual increase in deceased donors in the last 10 years. In 2005, the number of kidneys transplanted from cadavers was 9,914, while the number of patients who received transplants from living donors was 6,563. [1]

Dr AK Bhalla, Seceratary, Delhi Nephrology Society, & a Senior Consultant Nephrologist with Sir Ganga Ram Hospital, New Delhi, opines, “As shown by the US statistics human organ donation is fast developing into a major treatment protocol. However it is yet to make any significant dent in India. A country with a population of over 1 billion people, India lags behind in the implementation of a cadaveric donation programme”. Annually, while over 100,000 Indians suffer from End Stage Renal Disease, only a mere 3,000 are recipients of a donor kidney, of which only a small percentage are cadaver organs. In fact, the total number of patients who have received cadaver kidneys in India from 1995 to 2003 is only 524[2], an abysmally small figure. The major problem now facing transplant surgery is a critical shortage of available organs.

An Act was passed by the Government in 1994 to streamline various organ donations and transplant activities in the country. For years, India had the reputation of being a “warehouse for kidneys” and an “organ bazaar” as poverty forced people to sell their kidneys commercially. With a view to prohibiting the sale of organs in India, the Government introduced, in 1994, The Human Organ Transplantation Act. The Act had the following aims in mind – to curtail the kidney racket by introducing a rule that states that only a first-relative can be a living donor, to legalise the definition of “brain death”, and to encourage cadaveric organ transplants.

According to Dr Vijayakumar, Chief Nephrologist at the Kaliappa Hospital, Chennai, “The Human Organ Transplantation Act has legalised the concept of ‘Brain Death’ for the first time in India. Since the passing of the legislation in India, it has become possible to undertake organ transplants from brain dead donors. Improved infrastructure such as ventilators and other emergency measures are necessary to improve the lives of the accident victims. Also, routine ‘Brain Death’ certification in neurosurgical wards could significantly increase the number of cadaver donors. Furthermore, relatives need to be educated about the futility of keeping brain dead accident victims ‘alive’. A good motivator is needed to encourage people to donate organs.”

Until 1997, only four hospitals in India were undertaking cadaver transplants. However, now more and more hospitals are taking up the programme. The successful implementation of this programme however hinges on the education of the masses and having more trained transplant co-ordinators. According to a “Public Attitude Survey to Organ Donation”, less that 50 per cent of the population was willing to consider solid organ donation, and the concept of “brain death” was new to most people surveyed.

12 years after the Human Organ Transplantation Act has been passed, the cadaver programme in India is still in its infancy stage and there is potentially a huge pool of brain-dead patients who could meet the demands of the country for various organs.

Dr Vishwanath Billa, Hon. Nephrologist & Kidney Transplant Physician, Bombay Hospital & Medical Research Centre, Mumbai, states, “A proactive attitude towards cadaveric organ donation, counselling for relatives for organ donation in the event of brain-death, adequate hospital infrastructure, matching and distribution of the organs and co-ordination amongst hospitals will ensure that we convert the current programme to the level of Western Countries.”


[1] Source: http://www.ustransplant.org/annual_reports/current/chapter_i_AR_cd.htm

[2] Source: INOS, ZTCC