Tamil Nadu has been a frontrunner in organ donation. Call it the collective effort between hospitals and not-for-profit organisations or the willingness of people, the state has the highest number of organ donors in India. The fact remains though that a majority of citizens are still ignorant about many aspects of donation, leaving a wide gap between organ availability and patients waiting for transplants. The NDTV-Fortis More To Give campaign indicated that an approximate 5 lakh people across the nation die each year, due to non availability of organs.

The number reiterates the need to acknowledge citizens who are hesitant towards donating organs due to various misconceptions.   Based on conversations with health activists and doctors, here is a step-by-step explainer that will help citizens pledge to donate their organs, besides of course answering the all-important question: why should we donate?

The basics

There are two types of donation — living donation and deceased donation.

Living donation involves a person taking a pledge to donate her own organs after her death. Any living being who is not suffering from a life threatening disease such as advanced cancer, Hepatitis and HIV can decide to donate her organs. It is always suggested that the donor gets a doctor’s opinion about the graveness of any disease that she may be afflicted with, and the consequent feasibility of donation.

The procedure is simple: go to a government hospital, ask for a consent form for organ donation, fill it up and keep it in your wallet. It is requisite to inform your family and friends about your donor card, so that they would fulfill your wishes. 

Arun Ravula and Anand Sagar, residents of Ekaduthangal, with their donor cards. Pic: Konda Somna

There are many not-for-profit organisations that have simple, online procedures to procure a donor card. For example, Mohan Foundation, an NGO that facilitates citizens in organ donation, provides a printable format of the donor card in not only English but also in Indian languages like Hindi, Tamil, Malayalam and Gujarati. The card has basic details pertaining to the contact numbers of your family and the organs you wish to donate. The card also acts as a substitute for an emergency card, as it has the contact number in case of any emergency.

It must be noted here that the organ donation card has no legal binding; it is just a wish that should be respected by the family and friends of the deceased. Getting a donor card is the first step towards donation and a way to engage your family, so that they would go for the option when the situation arises.

Deceased donation

Deceased donation can happen under two circumstances — natural death and brain death. In case of natural death, the family of the deceased can contact the nearest government hospital for donating his organs. Do a basic enquiry about the hospital, to ensure that it has good harvest and maintenance facilities identical to an Intensive Care Unit.

“In case of natural death, only few organs — cornea, skin, tendons and bones — can be donated, as the life saving organs get damaged, due to blood clots. As organs should be donated within six hours of death, no procrastination should be allowed. The eyes of the deceased should be covered with a wet cloth, to avoid dust accumulation,” said  J. Amalorpavanathan, former member-secretary of the Transplant Authority of Tamil Nadu.

The doctor from the government hospital confirms death, takes consent for donation from the family members and carries out the procedure.

For the brain dead

Brain death is declared when a person is alive, but there is a complete loss of brain function. A panel of four doctors —  the authorised Neurosurgeon/Neurologist, Head of the hospital, a medical officer treating the patient, and a doctor who is not involved in the case —  go through a series of procedures to declare a person brain dead.

“Neurological examinations and assessment of brainstem reflexes are conducted to check the organ’s functionality. The tests are repeated and when the results are unanimously negative,  grief counsellors in the hospitals talk to the family members about the scope of organ donation,” said P Bhuvaneswari, a doctor.

As the brain dead patient is placed on ventilator, there is no damage to the organs. Virtually every organ of the brain dead patient including heart, two lungs, liver, two kidneys, one small intestine, pancreas, skin, corneas, tendons and bones can be donated.

Hospital authorities should take clearance from police and forensic departments, so as to not thwart any investigation, as a majority of brain death cases are due to accidental injuries.

A special case – kidney donation

The only case in which a person may donate one of his organs while alive is when there is a need for a kidney in a transplantation case. If you have a family member who needs a kidney transplant, you may wish to donate one of your kidneys to the person, provided of course that all medical conditions and requisites are met. All organ transplantations in the country are governed by the Transplantation of Human Organs (Amendment) Act, 2011.

Living donors could either be a near relative or a non-related donor. A near-relative (spouse, children, grandchildren, siblings, parents and grandparents) needs permission of the doctor in-charge of the transplant center to donate his organ. A non-related donor needs permission of an Authorization Committee established by the state to donate his organs.

The Authorization Committee (AC) is a government body that reviews each case to ensure that the living donor is not exploited for monetary considerations. Under no circumstances is any kind of commercial dealing permitted by law in transplantation cases.

The detailed procedure for getting an approval for kidney donation and transplant by a living donor is detailed by Mohan Foundation here.

Gift of life

While 36 persons per million of population donated organs in Spain in 2014, 35 in Croatia and 27.02 donated in the United States, the number is a meagre and disappointing 0.34 for India, reveals the The NDTV-Fortis More To Give campaign speak.

This could be due to a slew of misconceptions that come in the way of organ donation by citizens, who often fail to recognise the huge worth of such an action.  “The human body starts decomposing four minutes after a person dies. Research says that the rate of decomposition of human body is close to 2 millimetres per hour, which means that it completely liquefies within a month after death,” said Arun R, a doctor.

The point, therefore, is clear. Would you rather let your organs decompose or give a gift of life to a person in need by donating them?

[** Errata: The helpline number originally published has been corrected following an intimation from the Foundation.]