Many lives could be saved by making organ donation our default option
Summary
- A law that makes everyone opt for organ donation unless one chooses to opt out would serve a humanitarian cause by boosting supply. It would also do our economy a good turn.
In India, the gap between demand for organ donations and their supply is huge. With thousands of people spending years on organ waiting lists, this is worrisome. Estimates indicate around 500,000 people in the country are grappling with organ failure. About half of them rely on dialysis for kidney functions, 150,000 face liver failure and 100,000 suffer from underperforming hearts, lungs and other vital organs.
India’s organ donation rate is among the lowest globally, with only 0.86 donations per million people. Our pool of organ donors is egregiously inadequate. Regrettably, an average of around 20 individuals awaiting organ transplants lose their lives every day. Although living donors constitute the majority, accounting for 85% of all donations in India, post-death organ donations, especially of the liver, heart and kidneys, persist at alarmingly low levels.
Should we establish organ donation as a fundamental opt-in by law, with a provision allowing individuals to opt out for personal reasons? This needs a national debate. While the idea may appear stringent at first, it is underpinned by humanitarian principles. Note that it would still offer people a choice, while making donations the default option. Medical experts emphasize the profound value of a single cadaver donation: It can save up to eight lives and positively impact over 75 others. Organ donation is a powerful act of altruism, offering hope to those in desperate need of life-saving transplants.
In a welcome development, the annual number of cadaver donors in India surpassed four digits for the first time in 2023. According to the National Organ & Tissue Transplant Organisation (NOTTO), there were 1,028 deceased donors in 2023, up from 941 in 2022. Each cadaver, on average, contributes to three transplants. NOTTO, operating under the directorate general of health services, which works under the Union ministry of health and family welfare, serves as the apex centre for organ and tissue donation and transplantation in India.
The term ‘cadaver donors’ refers to those whose families donate organs after they are declared brain-dead so that patients facing end-stage organ failure can use them. Brain-stem death, legally recognized under the Transplantation of Human Organs Act, has reshaped the posthumous organ donation scenario. While only a limited number of organs and tissues can be donated after a natural cardiac death, the scope expands significantly after brain-stem death, with some 37 different organs and tissues becoming available for donation.
In the 99th episode of his Mann Ki Baat radio programme, aired on 26 March 2023, Prime Minister Narendra Modi highlighted the importance of cadaveric organ donation. A digital registry was set up for the willing to make an Aadhaar-verified pledge, and over 450,000 people have pledged their organs. However, it’s crucial to note that not all deaths qualify for organ donations. Vital organs such as the heart, lungs, kidneys and pancreas can only be harvested from individuals pronounced brain-dead by doctors.
There are strict time limits for harvesting and transplanting organs that vary from one organ to another. The window is shortest for the heart and lungs (about 4-6 hours), followed by liver and pancreas, and then kidneys. In the case of individuals who have pledged organs dying of natural causes at home, harvesting can only be done if the deceased’s family promptly informs the hospital or concerned NGO about the death. However, eye corneas, heart valves, skin and bones can still be harvested with some delay.
While many individuals support organ donation in theory, they may not take proactive steps to register as donors. Integrating organ donation as a fundamental duty, with an opt-out option to make it non-binding, would align well with the principle of dignity and respect for the deceased.
Aadhaar cards are used for various administrative purposes, including paper-work for the last rites of the deceased. The inclusion of organ-donation preferences in the Aadhaar database would ease the process. It would let the last wishes of people be honoured swiftly after their death without placing this burden on grieving families.
A policy that makes organ donation the default setting for everyone would not only have profound humanitarian implications, it would also make economic sense for India. Increasing the availability of organs for transplantation would serve the overall cause of healthcare well. It would reduce the need for costly long-term treatments such as dialysis for kidney patients or prolonged hospital stays for those awaiting vital organ transplants. This could deliver substantial healthcare savings, freeing up resources for other essential medical services and research initiatives. Moreover, a healthier society results in a more productive workforce, contributing to economic growth and national savings through reduced absenteeism and disability expenses.
Additionally, successful organ transplants can enhance productivity by enabling individuals to return to work and contribute actively to society. There would also be a positive impact on social productivity that cannot be overstated, as healthier individuals are always better equipped to participate in community activities. The well-being of people makes a society more productive. Organ donation thus serves both social and economic ends. Let’s opt in.
