New Delhi: The government is drafting new regulations to allow organ harvesting after a patient's heart stops beating, in a major policy shift that could help reduce the acute transplant shortage in the country, according to two government officials.
The National Organ and Tissue Transplant Organisation (Notto), under the health ministry, is framing guidelines for Donation after Circulatory Death (DCD), a system used in Europe and North America, which expands the donor pool beyond the current brain-stem death criteria. It is also planning standardised procedures for brain-stem death donations and organ-swap programmes, filling procedural gaps that have left hospitals without clear operating norms.
Acute shortage
The country urgently needs these changes. India records roughly 18,900 transplants a year against a massive unmet need—over 70,000 patients are registered and waiting for a kidney alone, while only about 2,000 kidneys are retrieved annually from deceased donors, leaving most patients on daily dialysis.
Doctors say DCD could transform medical systems, but only if it is supported by systematic implementation, including a medico-legal framework, clinical protocols, infrastructure for organ preservation, and governance mechanisms to prevent ethical lapses or legal exposure for clinicians.
Queries emailed to the health and family welfare ministry spokesperson on Thursday remained unanswered till press time.
A senior official said, “Notto is working on the detailed Donation after Circulatory Death (DCD) guidelines that will standardize the organ donation, including antemortem treatments to prevent blood clotting, rapid organ retrieval techniques, and local-to-national distribution systems.”
“The rules only state which tests to do, not how to perform them, so work is underway on detailed procedures. Similarly, hospitals are performing swap donations—where families exchange non-matching donors—but they need detailed protocols to prevent misuse," the official added.
The expert committees have already been notified regarding the swap and brain stem death guidelines, with formal drafting progressing alongside the new circulatory death framework.
“While these options are legally permitted, detailed operating procedures are urgently needed to ensure smooth, standard implementation,” the second official said.
Non-communicable diseases (NCDs) now account for roughly 63-65% of all deaths in India, according to the Indian Council of Medical Research (ICMR) data published in the 2022 Lancet report.
Public health experts said the new protocols could transform the country's healthcare landscape.
Dr Mohan Keshavamurthy, principal director - Renal Sciences, Fortis Hospitals, Bengaluru, said, “With nearly 95% of patients continuing to wait for a suitable organ, DCD can substantially expand the donor pool and help bridge the gap between demand and availability.”
However, Dr. Keshavamurthy warned that success depends entirely on a robust execution strategy. "Hospitals intending to undertake DCD programmes will also need augmented infrastructure, including advanced organ preservation capabilities such as extracorporeal membrane oxygenation (ECMO) support, as well as the expertise and multidisciplinary capability to perform multi-organ transplants,” he said.
The government has been working to improve the low success rates of organ transplants, including by ensuring affordable premiums for organ transplant policies.