Organ donation is the entire practice of retrieving a human organ from a living or deceased person, who is referred to as a Donor, and transplanting it into a recipient. The recipient will be a patient who is suffering from organ failure and who will not survive unless she/he receives an organ replacement. The process of recovering organs is called Retrieval.

There are two types of organ donations – Living Organ Donations & Deceased Organ Donations.

Living Organ Donation: This is when you retrieve 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 commonly done in the case of a liver or a 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 a near relative or a distant relative/friends etc.

A near-relative is spouse, son/daughter, brother/sister, parents, grandparents and grandchildren.

Those other than near-relative can be distant relatives and friends who will need the permission of the State Authorization Committee to donate organs. If the hospital refuses to entertain such cases, the patient may send a legal notice to the hospital for not following the Transplant Act.

Deceased Organ Donation: When we talk about pledging your organs for donation or about organ donation after death, we are talking about Deceased Organ Donation. This is an organ donation from a person who has been declared brain stem dead by a team of authorized doctors at a hospital. A person is said to be brain stem dead when there is an irreversible loss of consciousness, absence of brain stem reflexes and irreversible loss of the capacity to breathe.

A lot of people think that whenever and however they die, their organs can be donated. That is not true. In India, organ donation after death is only possible in the case of Brain stem death.

Donation after cardiac death is common in the West, but in India it is rare for donations to take place after cardiac death.

Although it is possible for organs such as the liver and the kidney to be easily donated from a living donor to a recipient, we should work towards an environment where everyone donates their organs after their deaths (if they can), so no living person should have to donate an organ to another.

The Living Donation Process
The living donor needs to undergo some medical tests and evaluations to check and confirm her/his her medical compatibility with the recipient.
The living donor’s medical compatibility is confirmed by a doctor. Only after all the tests have positively confirmed that the donor is compatible with the recipient, can the transplant take place.
The living donor’s organs are retrieved surgically by doctors. They will be stored in special chemical solutions briefly until they are transplanted into the recipient.
The living donor will need to remain under medical care for a few days or weeks after organ retrieval until she/he is fit to go home.
The Deceased Donation Process
A deceased donor is often someone who has suffered a fatal injury to the head or had Brain Haemorrhage. She/He is declared brain stem dead by a group of medical experts in a hospital.
The donor’s family has to give consent for the donation before the process of organ retrieval can be carried out. Meanwhile, the donor is kept on life-support with Doctors looking after all her/his needs until the retrieval of the organs is allowed to move forward.
Suitable recipients for all the organs are identified from a waiting list. They are notified and asked to reach their respective hospitals.
After retrieval, the body of the donor is respectfully handed over to the family.

The primary legislation related to organ donation and transplantation in India, Transplantation of Human Organs & Tissues Act, was passed in 1994 and is aimed at regulation of removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs.

Some of the main provisions of the Act are as follows:

Brain stem death identified as a form of death. Process and criteria for brain stem death certification defined
Allows transplantation of human organs and tissues from living donors and cadavers (after cardiac or brain stem death).
Regulatory and advisory bodies for monitoring transplantation activity and their constitution defined.
For more information on the Transplant Law in India read our Organ Transplant Laws Made Easy section.

What is Brain Death and how is it related to organ donation? A brain stem death or brain death results from a severe irreversible injury to the brain or haemorrhage which causes all the brain activity to stop. All areas of the brain are damaged and no longer function, due to which a person cannot sustain his/her own life, but vital body functions may be maintained by an artificial support system. This maintains circulation to vital organs long enough to facilitate organ donation. Patients classified as brain stem dead can have their organs surgically removed for organ donation.

A Brain Dead person has absolutely no chance of recovering. Brain death is a form of death and is irreversible. To know more about Brain Death, please visit the following link to a short clip and an easy to understand movie giving insights on what is brain stem death. Click here

Once brain stem death or brain death has been declared, the person is dead, but their organs are still alive because they have been kept alive through artificial means. This means that if a person dies at home or anywhere else, and their heart stops beating, they cannot donate their vital organs, because the organs of a person who has died a cardiac death will die within minutes of the heart stopping. Therefore, the only time you can donate your vital organs is if you are in hospital and have been declared brain dead.

In case of a cardiac death it is possible to donate your corneas and tissues such as bones, skin, veins, blood stem cells, blood and platelets, tendons, ligaments, heart valves, cartilage and even your body.

While the incidence of brain death is obviously less common than cardiac death, it is important to remember that organ donations will take place only if everyone is aware about when and how they can donate organs.

Procedures for Brain Stem Death Declaration in India
Organ donation after Brain Death is strictly regulated. According to the provisions of the Transplantation of Human Organs & Tissues Act, THOTA 1994 the protocol for declaration of brain stem death or brain death has been defined. Any organ donation process must involve the following steps before the actual transplant can occur:

A Panel of 4 doctors, 2 of whom must be from a panel approved by the government need to declare the brain stem death. This test as per law has to be done twice, with a gap of 6 hours between the two tests. This panel needs to include:

A Registered Medical Practitioner in charge of the Hospital where the brain stem death patient is admitted.
A Registered Medical Practitioner nominated from the panel of Doctors who have been approved by the Appropriate Authority.
A Neurologist/Neuro-Surgeon. (If a Neurologist/Neurosurgeon is not available to carry out the tests, then any Surgeon or Physician and Anaesthetist or Intensivist who is nominated by Medical Administrator In-charge from the panel of names who have been approved by the Appropriate Authority can be included in the panel).
The Registered medical practitioner treating the deceased. Results of the tests are recorded on Form 10 of the THOT Act 2014. The family’s consent is obtained on Form 8.
This Organ Donation Procedure is strictly followed. The certifying clinicians must have no interest or benefit in any way from transplantation of cadaver donor organs. The legal time of death in these circumstances is taken as the second set of brain stem death tests. The certification should be done on laid out forms as per the act. The medical director or medical superintendent of the hospital should finally counter-check and sign the form. It is only after these formalities have been completed, should organs be retrieved.