Organ Donation In Brain Death

Organ donation is the donation of body’s vital organs for transplantation into people for treatment purposes and has been legalized trough Transplantation of Human Organs Act THOA -1994. An organ is a self-contained part of a human being that performs a specific vital function in the body such as kidney, liver, pancreas, heart, lung and small bowel. Sometimes these organs fail to function in human beings as a result of disease or injury. In such situations the only medical treatment that can save the lives of such people is organ transplants which requires donation of organs from healthy living individuals or Brain Stem Dead donors in India. Organ donation from Brain Stem Dead Donor as well as living donors was made legal in India through THOA in 1994.

Brain Stem Death is a new definition of death; it is death by neurological criteria which was not heard of globally till 1968. Not every doctor in India can diagnose Brain Stem Death. A Brain Stem Dead donor occurs when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe.

When this happens, a ventilator keeps the person’s heart beating, and oxygen circulating through their bloodstream. A person is confirmed as being dead once their brain stem function is permanently lost. A person can never be diagnosed as Brain Stem Dead at home. Diagnosis and certification of Brain Stem Death is a team effort of four designated doctors only in those hospitals that are registered organ retrieval or/and transplant hospitals in India. After diagnosis of this kind of death it is the willingness of the family that matters in giving consent for donation of organs/tissues. A Brain Stem Dead donor can give life to seven to eight people by donating two kidneys, liver, two lungs, heart, pancreas and small bowel. Organs cannot be stored once retrieved from a Brain Stem Dead donor and are required to be transported to various hospitals for transplantation into patients within a short span of time ranging from 4 hours for heart and 48 hours for kidney.

Organ Donation System in India & Other Countries
India follows the Opt-in system of organ /tissue donation wherein people opt-in during life to be an organ/tissue donor or families opt-in to donate their Brain Stem Dead relative’s organs. The National Organ and Tissue Transplant Organization (NOTTO) is in the process of establishing a National Organ and Tissue Donor Register.  A person who has attained 18 years age can pledge to donate organs/tissues during life in the centralized register at NOTTO website either by online or offline filling and submission of pledge form (Form -7) of THOT Rules. However, if the person has not pledged to donate organs in their lifetime, the family can still give consent to donate organs at the time of Brain Stem Death.

In some States people are supposed to give their option for organ donation in a driving license. If a person has said “yes” to organ donation, the family still has the option to say “no” to organ donation.

However, the opt-in option requires persuading people through awareness programmes to take a pledge during life so that their organs could be donated after Brain Stem Death. It requires motivating people to register their will in driving license or organ donor register of the country, maintaining a centralized register, tracing the will of the person at the time of death and then persuading the families to honour the will of the person which does not always end with a positive outcome.

The Opt-out system, which is the law in many countires, is presumed consent. This means that the state does not need direct consent from the donor or the next of kin in order to carry out organ donation. Presumed consent assumes that donation would have been permitted by the potential donor if permission was pursued. It makes it incumbent upon people to register their unwillingness to be organ donors. So unless the donor had specified in their lifetime that they do not want to be organ donors, it will be presumed that they were willing.

Therefore in the absence of registered unwillingness it is presumed that individual has consented to donate and persuading families at the time of Brain Stem Death declaration is not required to retrieve organs. Some of the countries who have adopted presumed consent legislation are Austria, Belgium, Columbia, France, Italy, Norway, Singapore, Sweden, and Spain.