Organ donation and transplantation in India
A human being has all those organs from birth which are useful to him throughout his life and help in simplifying his life. But many times, such situations arise due to which a human being has to face organ damage or failure, due to which the human being has to face physical problems as well as mental problems. In such a situation, the person needs a transplant so that the person’s problems can be solved. Transplant is actually not as simple as it sounds. To transplant an organ from one person into another person’s body, many things have to be kept in mind, including legal proceedings. Through this article, we will discuss in detail about organ donation and transplantation in India and try to understand these processes.
What is organ donation and transplantation?
Organ donation is a process in which a person (organ donor) whose healthy organs or tissues are all or essential are surgically transplanted into the body of another person (recipient). This process is called transplant.
Transplant is necessary for any person because the organ of that person has failed or has been damaged due to some accident, if this is not done then the risk of death of the person increases. Organ transplantation is one of the great advances in modern medicine. Unfortunately, the need for organ donors far exceeds the number of people who can actually donate. For this reason, human organ trafficking happens on a large scale, which is illegal and for doing so, punishment can be given like fine, jail or both.
Which human organs and tissues can be transplanted?
The organs and tissues that can be transplanted include the following:-
Vascularized composite allografts. This involves the transplantation of multiple structures which may include skin, uterus, bone, muscles, blood vessels, nerves and connective tissue.
Who can be an organ donor?
People of all ages should consider themselves potential donors. When a person dies, they are evaluated for donor suitability based on their medical history and age. The organ procurement organization determines medical suitability for donation. Before donating an organ, it is important to take care of the legal aspects, both the organ donor and the organ recipient can get this procedure done as per the laws of their country.
How many types of organ donation are there?
There are two types of organ donation – living organ donation and deceased organ donation.
Living Organ Donation:- This is when you receive an organ from a healthy living person and transplant it into the body of someone who is suffering from end-stage organ failure. This is usually done in case of liver or kidney failure (because the liver can grow back to its normal size and a donor can survive on one kidney).
Living donors are classified as either close relatives or distant relatives/friends etc.
A close relative is a husband/wife, son/daughter, brother/sister, parents, grandparents and grandchildren.
Apart from close relatives, there may be other distant relatives and friends who will need the permission of the State Authorization Committee to donate organs. If the hospital refuses to consider such cases, the patient can send a legal notice to the hospital for not following the Transplantation Act.
Deceased Organ Donation:- When we talk about pledging your organs for donation or organ donation after death, we are talking about deceased organ donation. It is an organ donation from a person who has been declared brain stem dead by a team of authorized doctors in a hospital. A person is said to be brain stem dead when there is irreversible loss of consciousness, absence of brain stem reflexes and irreversible loss of the ability to breathe.
Many people think that whenever they die, their organs can be donated. That is not true. In India, organ donation after death is possible only in case of brain stem death. Donation after cardiac death is common in the West, but donation after cardiac death is rare in India.
Although organs such as liver and kidneys can be easily donated from a living donor to a recipient, we should work towards an environment where everyone donates their organs after their death (if they can ), then no living person should do this. Others have to donate organs.
What is brain death and how is it related to organ donation?
Brain stem death or brain death results from severe irreversible injury or bleeding to the brain that stops all brain activity. All areas of the brain are damaged and no longer function, due to which a person cannot maintain his or her life, but the vital functions of the body can be maintained by an artificial support system. It maintains circulation to vital organs for a longer period to facilitate organ donation. Patients classified as brain stem dead can have their organs surgically removed for organ donation.
But the truth is that there is no possibility of recovery of a brain dead person. Once a person is declared brain stem death or brain death, the person dies, but their organs are still alive because they have been kept alive by artificial means. This means that if a person dies at home or somewhere else, and his heart stops beating, he cannot donate his vital organs, because the organs of the person who died. Will die within minutes of heart failure. So, the only time you can donate your vital organs is when you are in the hospital and have been declared brain dead.
In case of cardiac death, it is possible to donate your corneas and tissue such as bones, skin. Nerves, blood stem cells, blood and platelets, tendons, ligaments, heart valves, cartilage and even your own body can be donated.
While the incidence of brain death is obviously less common than cardiac death, it is important to remember that organ donation will only take place if everyone is aware of when and how they can donate an organ.
What is the process of brain stem death declaration in India?
Organ donation after brain death is strictly controlled. The protocol for declaration of brain stem death or brain death is defined as per the provisions of the Transplantation of Human Organs & Tissues Act 1994 (THOTA 1994). Any organ donation process must include the following steps before the actual transplant takes place:-
A panel of 4 doctors, 2 of whom must be from a government approved panel, is required to declare brain stem death. As per law this test has to be done twice with a gap of 6 hours between the two tests. This panel needs to be included. It has the following four points –
Registered medical practitioner in charge of the hospital where brain stem death patients are admitted.
A registered medical practitioner nominated from the panel of doctors approved by the appropriate authority
A Neurologist/Neuro-Surgeon. (If a Neurologist/Neurosurgeon is not available to conduct the test, any surgeon or physician and anesthetist or intensivist, nominated by the Medical Administrator in-charge from the panel of names approved by the appropriate authority, may be included .)
Registered doctor treating the deceased. The results of the tests are recorded on Form 10 of the THOT Act 2014. Family consent is obtained on Form 8.
This organ donation process is strictly followed, certifying physicians must have no interest or profit in any way from the transplantation of cadaver donor organs. In these circumstances the legal time of death is taken as a second set of brain stem death tests. The certification should be done on the forms prescribed as per the Act. The Medical Director or Medical Superintendent of the hospital should finally counter check and sign the form. The organs should be retrieved only after completing these formalities.
What are the laws and regulations governing organ transplantation in India?
Primary legislation relating to organ donation and transplantation in India. The Transplantation of Human Organs Act, was passed in 1994 and its purpose is to regulate the removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial transactions in human organs.
In India, health-related matters are governed by each state. The Act was introduced at the request of Maharashtra, Himachal Pradesh and Goa (who had adopted it by default) and was later adopted by all states except Andhra Pradesh and Jammu and Kashmir. Despite a regulatory framework. Cases of commercial trading of human organs came to light in the media. An amendment to the Act was proposed by the states of Goa, Himachal Pradesh and West Bengal in 2009 to address the deficiencies in the effectiveness, relevance and impact of the Act. Amendments to the Act were passed by Parliament in 2011, and rules were notified in 2014. It is adopted by default by the proposing states and union territories and can be adopted by other states by passing a resolution.
The main provisions of the Act (including the 2014 amendments and rules) are as follows:
A. Brain death is recognized as death. Procedure and criteria defined for brain death certification (Form 10)
B. Allows transplantation of human organs and tissues from living donors and cadavers (after heart or brain death).
C. Regulatory and advisory bodies to monitor transplant activity and their constitution defined
(i) Appropriate Authority (AA): Inspects and grants grants to hospitals for transplants, enforces required standards for hospitals, conducts regular inspections to check the quality of transplants. It can investigate complaints regarding violations of the provisions of the Act, and has the powers of a civil court to summon any person, request documents and issue search warrants.
(ii) Advisory Committee: Consisting of experts in the domain who will advise the appropriate authority.
(iii) Authorization Committee (AC): Regulates living donor transplantation by reviewing each case to ensure that the living donor is not exploited for monetary considerations and commercial transactions in transplantation. to stop. Video recording of proceedings and decisions to be notified within 24 hours. Their decision can be appealed to the state or central government.
(iv) Medical board (Brain Death Committee): Panel of doctors responsible for brain death certification. In case of non-availability of a neurologist or neurosurgeon, any surgeon, physician, anesthetist or intensivist nominated by the medical administrator in-charge of the hospital can certify brain death.
D. Living donors are classified as either close related or non-related donors.
(i) A close relative (spouse, child, grandchild, sibling, parent and grandparent) requires the permission of the doctor in-charge of the transplant center to donate his or her organ.
(ii) A non-related donor requires the permission of an authorization committee established by the State to donate his organs.
E. Swap transplant: When a closely related living donor is medically incompatible with the recipient. The pair is allowed to perform a swap transplant with any other related unmatched donor/recipient pair.
F. Authorization for organ donation after brain death
(i) may be given by the person himself before his death or
(ii) By a person in legal possession of the body. A doctor will ask the patient or relative of each person admitted to the ICU whether any prior authorization was made. If not, the patient or his or her next of kin should be made aware of the option to authorize such donation.
(ii) Authorization procedure for organ or tissue donation from unclaimed bodies has been outlined.
G. Organ retrieval is permitted from any hospital having ICU facility after being registered with the appropriate authority. Any hospital with intensive care unit (ICU) facilities with the manpower, infrastructure and equipment necessary for the diagnosis and maintenance of a brain-stem deceased person, including facilities for their temporary storage to retrieve and transport organs and tissues , the center can register as a recovery.
H. The cost of donor handling, recovery, transportation and preservation shall be borne by the recipient, institution, government, NGO or society and not by the donor family.
I. The process of organ donation has been defined in medico-legal cases so as to avoid jeopardizing the determination of cause of death and delaying the retrieval of organs.
J. Manpower and facilities required for registration of the hospital as a transplant centre.
K. Outline the infrastructure, equipment requirements and guidelines and standard operating procedures for tissue banks.
L. Defines the qualifications of transplant surgeons, cornea and tissue recovery technicians.
M. Appointment of transplant coordinators (with defined qualifications) has been made mandatory in all transplant centres.
N. Non-governmental organizations, registered societies and trusts working in the field of organ or tissue removal, storage or transplantation will require registration.
O.The Central Government is setting up a National Human Organs and Tissues Removal and Storage Network i.e. NOTTO (National Organ & Tissue Transplant Organisation), ROTTO (Regional Organ & Tissue Transplant Organisation) and Will establish SOTTO (State Organ & Tissue Transplant Organization). The website for this is www.notto.nic.in. The manner in which national or regional or State removal and storage networks of human organs and tissues are established and their functions are clearly spelled out.
P. The Central Government shall maintain a registry of donors and recipients of human organs and tissues.
Q. The punishment for removing an organ without authority, making or receiving payment for the supply of human organs or violating any other provision of the Act is too stringent to act as a deterrent to such activities has been made.
The various forms mentioned in the rules are as follows:
Form 1: Next of kin consent
Form 2: Consent of spouse
Form 3: Consent of donor other than next of kin Form 4: Psychiatric assessment of donor
Form 5: HLA DNA Profiling Report
Form 7: Self-Consent for Deceased Donation
Form 8: Consent for organ donation from family (applicable to minors also)
Form 9: Consent for organ donation from unclaimed bodies Form 10: Brain death declaration form
Form 11: Joint Transplant Application by Donor/Recipient
Form 12: Registration of Hospital for Organ Transplantation
Form 13: Registration of Hospital for Organ Retrieval
Form 16: Grant of Registration
Form 17. renewal of registration
Form 18: Decision by Hospital Authority Committee
Form 19: Decision by District Authority Committee
Form 20: Verification of Domicile for Non-Close-Relatives
Form 21: Letter from Embassy