Organ Donation: Should It Be Made Mandatory?


As I turned the radio volume up, stuck in the Mumbai traffic for the umpteenth time amid the rains, I smiled to myself as I heard the pleasing advertisement on becoming an organ donor on the eve of World Organ Donation Day, observed on the 13th of August every year. But I could not battle with the nagging voice in my head: Is awareness enough? Indeed, it is only the rising awareness due to activities undertaken by the multitude of organisations set up by the government that got us this far. Nevertheless, we cannot embark upon the path ahead without more resolute steps and policies. 

So, where exactly does India currently stand? 

If we look at the ratio of organ donations per million population, it is merely 0.86 (2020), just shy of 1 per million, at which it would almost meet current demands for organs. But when it comes to the actual number, it leaves everyone behind, coming only after the USA. 

As you read this article, 1.366 billion people are walking the ground here; but according to the WHO, only around 0.01% of those people donate their organs after death, infinitesimal. To face the glaring reality, we must address the root causes, weed out the inconsequential and cater to those lakhs of people, many of whom would lose their lives before the next world organ donation day if they don’t get a transplant in time. 

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To make matters worse, as the COVID-19 pandemic evolved, with the entire world in its clutches, we saw another crisis dawning on the ill-fate of organ transplants, not only in India but the world as a whole. Healthy lungs being rendered utterly disabled, a loom of despair befell as scientists all over the world struggled to find a cure. Patients with entirely and permanently ravaged lungs, as a result of ARDS due to SARS-CoV-2 lung infection, beyond repair, could be rescued after a double lung transplant, a glimmer of a ray of hope, the first of its kind done in Austria followed by the USA in the first wave of this pandemic. 

Considering the limited number of transplants worldwide, although lung transplants may not make a significant difference on the final toll, it makes all the difference in the world for the little few. India, following suit, undertook lung transplants for COVID-19 affected patients, with Telangana reporting 46 surgeries over one year, as opposed to a mere 23 such surgeries in seven years. Truly commendable!


Shedding Some Light on the Current Situation 

About 200,000 corneal donations are needed annually; however, only 50,000 corneas are donated in India every year. Similarly, 200,000 kidneys are required, but only 1684 are available; 50,000 hearts and livers are needed, but merely 339 hearts and 708 livers are available for a transplant. 

Enough troubling with deplorable statistics, let’s get down to talks of work. First things first, this limitless sea of people must appear like the start and end of all hindrances to achieving a half-decent rate of transplants in our country. 

Nevertheless, our biggest shot at a solution lies in this very sea, for if there were policies making organ donation mandatory, a cornucopia of transplants would be possible, and nobody would die waiting for a healthy organ. Wishful thinking? Perhaps, in a country like ours with a myriad of religious beliefs prevalent, ostensibly deep-rooted, it is best to say that ethically organ donation after death cannot be made “compulsory”. However, not all “faith” is lost; some issues are not as unaddressable as this, such as a fear of disfigurement, non-acceptance of brain death, and migrant workers not having relatives on-site to give consent. Sometimes, even people who have a donor’s card do not know how and when to use it, and the black marketing of organs perturbs many. 

Spreading awareness and making the whole process completely transparent is one way to tackle issues, but as I mentioned before, changing people’s perceptions will only take us so far. Although, concrete steps taken to broaden people’s mindset must not be undermined in the light of the fact that a majority of our population is rural and has no prior knowledge of organ donation- an untapped gold mine. We will not see results in a fortnight, but needless to say, future generations will undeniably get a slice of the cake. Maybe we need expert counsellors in the public sector to sensitise the family members of a potential donor and address their concerns well, generating trust in the system. 

So, Can it Be Made Compulsory? 

One thing is clear- no, organ donation cannot be “compulsory” literally. It will be unethical to pass a law forcing everyone to donate organs after death and disregard or disrespect their wishes. I do not even want to imagine the political repercussions of this and the pandemonium it would create. 

There could be a law that permits organ donation by default unless the donor explicitly opposed it during his lifetime- known as the opt-out system. Countries like Singapore, Belgium, and Spain, the unchallenged world leader in this area, have oodles of organ donors only because of this aggressive approach, which is entirely sensible. Even the UK recently passed this same law, taking a step towards a better future for transplants. I believe this is the need of the hour. People explicitly opposing organ donation can be put in the refusal registry, and hence their consent will not be presumed. Such a system will not only increase the number of available donors but also alter the dynamics of public view in the long run, as found in a study. The next best thing would be to devise a policy that makes it compulsory for people to have an opinion and a stand. Ignorance will not be appreciated anymore, and people would no longer be able to brush it off, saying, “I’ll think about it when the day comes”- it never comes. It will be mandatory for everyone, regardless of their ethnicity and financial status, to decide to be or not to be an organ donor. Just like your national identity card, there could be a system to identify every person’s decision, accessible from anywhere in the country. 

Must Go Hand-in-Hand 

An opt-out system will be utterly useless if it is not simultaneously complemented by high-end medical facilities, personnel and, of course, awareness, somewhere India is gravely lacking. Furthermore, as Dr Avinash Seth mentioned in an interview with the Economic Times, 95% do not even list themselves for a transplant because they cannot afford it, heart-wrenching. He also rightly pointed out that with an expenditure of our GDP being so low on health, we will never have enough facilities. Impecuniousness should not be the reason holding back someone in dire need of a transplant. We need to make our public sector of hospitals strong enough so even the common man can benefit. Many hospitals do not even have an organ retrieval system in place; hence an up-gradation in the government hospitals and others is imperative, without which even if one wanted to donate organs, will not be able to save any life, a genuinely dismal reality. A reality for which we much come together to change. 

To end it on a hopeful note and to make a difference- now if you want to pledge to become a donor and change the ending to someone’s story.  



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About the author

A self-proclaimed tea connoisseur and an aspiring gynaecologist, Dr Upali is as much of an avid writer as a reader. She likes to acquaint herself with new experiences and journeys. She believes that "A person often meets his destiny on the road he took to avoid it.”



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