Flesh and spirit

The Centre's new guidelines should ease organ donation, instead of adding layers of procedure

Given the desperate scarcity of organ donors in India, the government has been considering ways to encourage more cadaver-based transplants. There is a huge gap between demand and legal supply, which has encouraged profiteering and exploitation in a ghoulish black market. Even those willing to donate their organs after death are rarely registered as donors. If the potential donor is not directly related to the person who needs the organ, a committee of medical professionals and government officers needs to sign off on the procedure, which takes up precious time. Now, a new Transplantation of Human Organs Act is being drafted to address these issues.

But instead of easing procedures and incentivising donation, the Centre's preliminary guidelines seem to create more bureaucratic layers. For instance, a forensic expert will have to be present while organs are being extracted from a legally dead patient. While it is important to have the donors declared unambiguously dead before the transplant, this does not require a forensic expert, who may not be immediately available in the short period when the operation can be conducted. Handing the body over to the bereaved family would also take that much longer.

While this is an attempt to bring the law in line with those of the US or Canada, it must be remembered that the Indian context produces special challenges. Fewer medical professionals and inadequate infrastructure, and overwhelming numbers of the needy. It may be more useful to consider the experience in states that have had relatively successful organ donation programmes, like Andhra Pradesh and Tamil Nadu. Tamil Nadu's donor rate is more than 10 times the national average, at one per million of the population. This has involved coordination between the government and the medical establishment from identification of brain death, maintenance, and organ retrieval, to counselling grieving families to make the right choice. As the Centre contemplates a larger law on organ donation, and a uniform national sharing mechanism, it must study the success stories more carefully. It must seek to simplify the process have trained transplant coordinators in hospitals, enlarge the pool of those medically qualified to certify death, and make post-mortem procedures shorter.

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