Introduction:
Life is a gift. Its preservation is of utmost significance. Indian Constitution ensures “Right to Life” as a fundamental right under Article 21. It not only focuses on the mere physical existence of an individual but also on the quality of life of that individual. Right to life likewise acknowledges Right to health. Sometimes, when this quality of life is in peril certain steps are taken to save that life. Organ transplant is one such process which can save lives.
Organ transplant is a process when a donor permits the elimination of his/her own organ and given to another person, lawfully, either by his/her consent (if the donor is alive) or with the consent of the next of kin (if the donor is dead). Around 5 lakh people die every year in India because of deficiency or inaccessibility of the organs.[1]
An organ can be donated either by a living individual or a brain dead individual. The organs that are most transplanted are kidneys, liver, pancreas, heart, lungs, intestines, bones, bone marrow, skin and cornea. Some of the essential organs that are in pairs like kidneys, cornea and lungs can be donated during the lifetime of a healthy donor without affecting his/her life while the others can only be donated after the demise of that donor because of the lack of discontinuation of blood supply those organs fail as well.
One person can save up to 8 lives by organ donation and additionally can improve the quality of life of more than 50 people. That’s the reason behind calling organ donation a “gift of life”.
Historical Background
During 3rd CE, St. Cosmas and St. Damian amputated a cancerous leg and replaced it with another, taken from Moor who just died.
Also, the unmarked era of Hindu mythology has shown us the possibility of transplantation as Lord Ganesha had his head transplanted. Ashwini Kumara is also known as Dev Vaidya, the chief surgeon of Vedic periods performed both homo and hetero transplantations during the time of Rigveda which was around 5000 years ago.[2]
Approximately 2000 years ago, Sushruta, also known as “the father of surgery” was doing rhinoplasty on the soldiers injured during the war by using skin from their chin.
So, is it so easy to perform such surgeries? The appropriate answer would be no. Organ transplantation has various biological, legal and political barriers that a surgeon has to overcome before performing such critical surgeries as it is a matter of life and death.
What is the Organ Transplantation Process?
Organ transplant is a lengthy procedure. If a person needs an organ transplant he/she has to go through a procedure of health check-up, medical history check-up, etc. in the transplantation centre. If the transplantation centre thinks that the recipient is suitable then his/her name will be registered and will be listed on the National Transplantation Waiting List. For organ transplant, the surgeons consider the blood type, tissue type, distance from the donor etc.
If any hospital receives a patient who is brain dead or is critical then it informs the Organ Procurement Organisation. The organisation checks the name of the patient in the National Organ Donation List. If the patient’s name is there then they contact the family regarding the organ donation and if the name isn’t present then that organisation tries to convince the family for organ donation.
If the donor’s blood group or tissues etc. match the recipient then the organization contacts that recipient for the organ transplant. And further, the transplantation process is carried.
Laws In India
With the advancement in the clinical field, there is an increase in organ transplantation as a curative remedy to improve the quality of life. Because of this, there was unrestrained sale and purchase of human organs. This prompted the exploitation of the idea of the dignity of a human. So, to facilitate such transplants and to secure the interests of the donor, the Government of India passed the Transplantation of Human Organs and Tissues Act in 1994. The Act contemplates two sorts of organ donations:
- donation by a living person
- donation by a brain dead person or Cadaver.
It also focuses on providing the regulations of removal, storage and transplantation of human organs for therapeutic purpose and for safeguarding the commercial dealings in human organs and for issues connected with it.[3]
Section 3-8 of the Act regulates living donation. It allows any donor or his/her next kin or representative to donate or authorise the removal of any of his organs or tissues from his/her body, before his death for therapeutic purposes only.
Section 9 of the Act regulates the living donation. Living donors are classified as either a near relative or a non-related donor. A near-relative could be parents, spouse, children, grandparents etc. He/she will have to take permission from the doctor accountable to the transplant centre to donate his/her organs. A non-related donor will have to take the permission of an Authorization Committee established by the state to donate his/her organs. The Committee reviews each case to ensure that the living donor isn’t being exploited for monetary considerations. Likewise, it also prevents commercial dealings in organ transplantation.
In 2011, the then Health Minister Ghulam Nabi Azad moved the Transplantation of Human Organs (Amendment) Bill which was introduced in 2009 in the House of the Parliament. The altered legislation was to check the illicit exchange of human organs and stop the exploitation of poor people.
The Government also launched a National Organ Transplant Programme in 2019, to promote the cadaver donor’s organ and to improve the accessibility to the organs for the transplantation in needy patients.
Problems Faced During Organ Transplantation
Regardless of the fact that the donor has given his assent, the consent of family is necessary. Retrieval of the organ won’t be possible if the family isn’t ready. In India, religious beliefs are very strong. Donation of assets or doing charity work is different from organ donation. It is very difficult for a grief-stricken family to comprehend the concept of cadaver donation. Also, there is distrust against the medical practitioners whether they’ll use the donated organs for the right purposes or not.
Myths and fears dominate the minds of the family or even a donor if he/she is alive. So, a donor or his/her family becomes reluctant or opts out of donating the organs.
Current Scenario
The World Health Organisation recognizes Columbia, India, Pakistan and the Philippines as four of the leading global hotspots for buying and selling human organs. The sale of organs is illegal in all these countries. Notwithstanding different legislations which have been formulated to prevent the sale of organs in these nations, recipients from all around the globe still continue to purchase organs in these nations.
The advent of anti-rejection drugs and the donor-specific blood transfusion have greatly improved the endurance of the transplanted organs in the recipient body. Furthermore, the absence of awareness and ethical, religious and emotional constraints are the contributing factors for minuscule organ donation in India. The rate of organ donation in India is only 0.16 per 1 million population as compared to Spain with 40 and USA with 35.[4]
One of the brain chilling cases was of “Kidney Kingpin” in 2008. The Gurgaon doctor illegally removed kidneys from people and transplanted them into high-paying patients.[5]
Because of this, recipients are increasing, which is spurring disequilibrium between the demand and supply of transplantable organs resulting in illegal trade in organs.
Currently, only close relatives such as parents and children are legally permitted to donate their organs. As a result, poor people are often lured to donate their organs such as eyes, kidneys, liver etc. for money.
Although these organ donations are relatively safe surgery, these still increase the health risks of young donors.
In a field study on Economic and Health Consequences of selling a kidney in India, it was discovered that 96% of participants sold their kidneys to pay off debts. The average family income declined after kidney donation and the number of participants living below the poverty line increased.[6]
The surgeries are often performed in temporary clinics without licenses and there were various reports of serious post-operative complications. These clinics are ill-equipped and don’t feel obligated to check hepatitis-B or HIV among donors.[7]
According to the National Organ and Tissue Transplantation Organization, in 2019, out of 12,625 organ transplants, 72.4% were male recipients.[8] The reason for such imbalance is that males are considered as bread-earners of the family and women are supposed to sacrifice everything. Many women undergo such procedures due to social and family pressure. Presently, there is a trend that has taken up in our society where the couples get themselves tested to discover whether they are a match or not and then they further move forward in their relationship. There were cases where the marriage was done for the sake of organ donation. [9]
Conclusion
If we analyse the whole situation we can conclude that there is a significant incompatibility between the legal framework and social system. This inconsistency has led to a fake dichotomy between organ donations and organ sales. By creating a perception that all organ donations are done out of affection or compassion totally points out that law neglects the influence of commercial factors which pressurise donors to donate just for earning benefits. Law doesn’t acknowledge the fact that these organ transplants are done in exchange for money as economic transactions. Law additionally disregards the distinction that has been created between the poor donors and rich recipients. It is naive to not consider that there is a fine line between an altruistic donor and incentive-motived donor. Gender disparity in organ donation is also shocking. The laws have been formulated but still, have various loopholes which don’t protect the concept of organ donation is a gift. There is a need to strengthen the whole procedure and laws and speed up the process in the amendments of the law. A visible difference is there in what the government claims they are doing and what is happening in reality.
References:
- https://www.expresshealthcare.in/blogs/guest-blogs-healthcare/the-importance-of-organ-donation/413 659/#:~:text=National%20Organ%20and%20Tissue%20Transplant,Family%20Welfare%2C%20Gove rnment%20of%20India.&text=One%20brain%20dead%20donor%20can,from%20end%20stage%20or gan%20failures.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512402/
- http://ili.ac.in/pdf/paper1017.pdf
- Dr Harsh Vardhan calls for body pledge revolution, National Organ & Tissue Transplantation Organisation coming up in Delhi, “ Press Information Bureau, Government of India, Ministry of Health and Family Welfare, 07-August-2014 11:27 IST, available at: http://pib.nic.in/newsite/PrintRelease.aspx?relid=108215
- https://www.indiatoday.in/india/north/story/lok-sabha-approves-tougher-organ-transplant-bill-139258-2011-08-13
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779960/#:~:text=The%20legislation%20called%20the%20Transplantation,of%20organs%20a%20punishable%20offence
- https://theprint.in/pageturner/excerpt/how-mumbai-became-epicentre-illegal-kidney-trade-with-100-transplants-month/351719/
- https://notto.gov.in/organreport.htm
- https://sites.ndtv.com/moretogive/women-donate-men-receive-lopsided-truth-organ-donations-991/
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