Dr Narayana Swamy Moola, KIMS Hospital, Mahadevapura, Bangalore, shares his expertise and opinion on organ donation.
For someone living with severe heart failure, kidney damage, liver and lung failure, a transplant provides a new ray of hope for survival and a better quality of life. However, in such situations, finding an organ donor has been one of the biggest challenges. Despite significant progress, awareness remains low, and there is a huge gap between demand and supply. Only a few on the waiting list can receive organs each year.
So, how do we bridge this gap and address the issue on time? What could be the way forward? On this World Organ Donation Day, observed every year on August 13, Dr Narayana Swamy Moola, Director, Department of Critical Care, KIMS Hospital, Mahadevapura, Bangalore, shares his expertise and opinion in a conversation with Indiamedtoday.
- How is the organ donation scenario in India?
The organ donation scenario in India presents a stark contrast with massive demand and a critical shortage due to decreased donation rates despite significant improvement in clinical infrastructure and legislative changes. Despite being the most populous country with 1.4 billion people, deceased donation rates in India are 0.8 per million population, compared with countries like Spain (43/million) and the USA (35/million). India ranks third in living organ donation, in which donations occur among blood relatives and are possible for one lobe of the Liver and One Kidney.
2. Despite the awareness, the demand-supply gap in terms of organ donation is still huge in India; what could be the possible reasons? Can you elaborate?
1) Clinical and hospital-level bottlenecks:
A major barrier is the delayed or inconsistent identification and certification of brain stem death. Many doctors in non-transplant ICUs lack formal training or confidence in conducting brain stem function tests. Without timely identification and declaration, many potential donors can be lost forever.
2) Shortage of registered retrieval centers:
While major metropolitan cities have super speciality facilities, many government or regional hospitals are not registered as Organ Retrieval Centers and lack basic equipment or facilities for organ retrieval. So many potential deceased donors are being lost annually.
3) Lack of Transplant Co-ordinators / Grief Counsellors:
Successful conversations require empathetic, timely counselling by trained grief counsellors. Many hospitals lack trained grief counsellors who play an important role during this critical time window.
4) Logistical and Technological Constraints:
Strict time windows and Cold ischemia time. Organs like the heart and lungs must be transplanted within 4 to 6 hours. Transportation across dense urban traffic or from tier 2 / 3 cities requires rapid green corridors, dedicated air transport, and a good cold chain preservation infrastructure should be available across the country. This is seriously lacking at present.
5)Public vs. private hospital asymmetry:
Nearly 90 to 95% of transplant surgeries happen in private tertiary care hospitals. Most of the government hospitals, where many trauma and accident cases are admitted, lack licensed retrieval programmes and Transplant units, dedicated funding.
6)Prohibitive Costs:
Organs cannot be bought; transplantation and long-term post-transplant care are expensive, which the majority of the population cannot afford.
3. What are the myths that need to be dispelled in terms of organ donation?
1) Brain death is same as Coma:
Fact – A Coma is a state where the brain still retains some activity and function, meaning recovery is still possible, whereas Brain Stem Death is a state with complete cessation of all activities of the brain stem and reflexes. Legally and clinically, it is equivalent to death. Medical protocols require two rigorous tests by a panel of doctors (Spaced time interval) before declaring brain dead.
2) My religion prohibits organ donation:
Fact – Most of the religions like Hinduism, Islam, Christianity, Sikhism, Jainism and Buddhism support organ donation. Most faiths view organ donation as a selfless act of sacrifice, compassion, charity, and saving life.
3) Organ donation disfigures the body, delaying funeral rites:
Fact- Organ donation is a precise surgery performed with the same care and respect as any major operation. The surgical incision is closed cleanly with utmost respect and dignity. It does not cause disfigurement or open casket viewing or traditional funeral rites.
4) Rich and famous people get priority in organ donation:
Fact – Allocation is strictly done by National and State regulatory authorities (Such as NOTTO in India). Priority is determined by objective medical criteria, urgency of medical need, blood type, tissue match, time spent on the waiting list, and geographic proximity, not social status, wealth, or public status.
4. Which organs and tissues can one donate? How can one register for organ donation?
Medical Science categories donations into solid organ donation and life-enhancing tissues.
Solid organs like Heart, Liver, Kidneys, Lungs, Pancreas, Intestine can be used from a deceased donor.
Tissues like Cornea, Heart valves, Skin, Bones, Cartilages, and Blood vessels from a deceased donor can be used.
If one wishes to donate in India, they can visit the NOTTO website notto.mohfw.gov.in., then provide identification, authenticate with Aadhar Card, fill form 7 and pledge, and then you can download your donor card.
Alternatively, you can register with a state organ registry like Jeevasartha Kathe in Karnataka, Jeevan Dhan in Telangana.
5. What are the conditions in which one can donate their organs?
Any patient who has suffered irreversible head injury following RTA, severe intracranial hemorrhage, or large strokes with delayed presentation to hospital. A brain-dead patient, who has cessation of all brain stem functions, but the heart still keeps beating and is being supported by a ventilator, can donate their organs.
6. What could be the way forward to generate more awareness regarding organ donation?
- Youth and educational integration:
In schools and colleges – Incorporate modules on human anatomy, bioethics, and the impact of organ donation into the curriculum for Class 9 / 10 and College students. Conduct interactive sessions, debates about organ donation.
2) Empowering health care institutions:
Focus on training health care professionals.
Identify and train grief counsellors for early identification and empathetic engagement with deceased donor families.
3) Digital accessibility and Policy integration:
Streamline pledge registration through institutive centralized platforms.
Explore opt-out policy through legislative measures.
4) Cultural and Community advocacy:
Involve faith leaders to influence the community.
Living recipient and donor storytelling.
Authentic accounts from donor and recipient families normalize conversation and make impact tangible.
5) Normalize conversation among the family members:
Whenever you pledge your organs, you need to talk to your other family members and update your wish in case you die.
