"New Law to Boost Organ Donation in India" : Dr. Avnish Seth, Director, FORT

The Transplantation of Human Organs and Tissues Rules 2014 (THOTR 2014) are likely to provide a fresh impetus to organ donation in the country. Twenty years after the landmark Transplantation of Human Organs Act of 1994 (THOA 1994) was published, several changes have been instituted to promote and streamline the process of declaration of brain death and organ retrieval.

Firstly, declaration of brain death and organ retrieval, earlier permitted only in hospitals approved for organ transplantation, is now allowed from any hospital having intensive care facility equipped with ventilators. However, such hospitals need to apply for sanction, free of cost, as non-transplant organ retrieval centers (NTORCs).

Secondly, the presence of neurologist or neurosurgeon was mandatory in the 4-member team for declaration of brain death. With the new rules, when a neurologist or neurosurgeon is not available in a hospital, any physician, anesthetist or intensivist, nominated by the medical administrator in charge of the hospital, and approved by the appropriate state authority, can be the member of the board of medical experts for certification of brain death.

Thirdly, families of patients with brain death were not being approached for organ donation, as there was no mandate. It is now mandatory for the treating doctor to ascertain whether the potential donor had pledged to donate organs during lifetime and to approach the relatives for organ donation, irrespective of previous pledge.

Fourthly, in patients with medico-legal requirements, like in all patients with head injury due to road traffic accidents, the procedure for clearance from police and postmortem authorities has been simplified. After the consent to donate organs from a brain-stem dead donor is obtained from the family, the registered medical practitioner of the hospital is required to make a request to the police to facilitate timely retrieval of organs or tissue from the donor and a copy of such a request is simultaneously sent to the designated post mortem authority. Following retrieval of organs, the surgeon issues a certificate listing out the organs retrieved to the postmortem authorities, who are required to carry out the autopsy expeditiously, even beyond office hours.

Fifthly, there was no clarity on who would pay for the donor maintenance or organ retrieval charges. It has now been clarified that the cost of donor maintenance, retrieval of organs and tissues, their transportation and preservation, may be borne by the recipient or institution or government or non-government organization as decided by respective state or union territory.

Sixthly, it is now essential for hospitals carrying out organ transplantation to employ trained transplant coordinators and their qualifications have been specified. The salient differences between THOTR-2014 and THOA-1994, as applicable to deceased organ donation, are summarized below:

Table: Summary of changes related to deceased organ donation in THOTR 2014 as compared to THOA 1994.

This path breaking new legislation, coupled with increasing awareness on socially relevant and altruistic issues, is ready to launch organ donation in India to the next level.

(Dr. Avnish Seth, Director, Fortis Organ Retrieval & Transplant (FORT), Director, Gastroenterology & Hepatobiliary Sciences)