Union Health Minister Dr Mansukh Mandaviya reviews Organ Donation Policy; directs for imbibing learnings from International Standards

Context: Hon’ble Prime Minister Shri Narendra Modi called upon the countrymen to come forward for the noble cause of organ donation for saving the lives of fellow human beings in the 99th episode of the “Man Ki Baat” Programme. This has given a fresh impetus to organ donation in the country.  The number of total organ transplants in the country has substantially increased from less than 5000 in the year 2013 to more than 15000 in the year 2022.

Transplantation of Human Organs and Tissues (THOT) Rules, 2014.

  • The Transplantation of Human Organs Act (THOA) was enacted by the Government of India in 1994.
  • This act was amended in 2011 and the same was notified as Transplantation of Human Organs and Tissues (THOT) Rules 2014. 
  • It provides guidelines regarding the removal, storage and transplantation of human organs for therapeutic purposes and prevents the commercial dealings of human organs.
  •  According to THOT, the concept of transplantation is the grafting of human organs from a living or dead person to a living person for a therapeutic process.
  •  Further, the deceased person is a person who does not have any symptoms of life such cases that is of brain stem death or cardio-pulmonary sense after live birth.
  •  Brain-stem death is a stage at which all the functions of the brain-stem have permanently and irreversibly ceased.

Authority for removal of human organs or tissues

  •  As per the current medical practice of the land, a living person can be an organ donor and can permit the removal of any is/her organs or tissue during his or her lifetime for therapeutic purposes by the provisions of Section 3 of the THOT Act 2014.
  • The organ also can be removed from the human body after the declaration of brain stem death subject to the consent and authorization of the near and dear ones and permission of competent authority as per the THOT Act 2014.
  • The brain stem death of a person is declared by a panel of experts.
    The panel of experts shall be framed by provisions in the said act and they should be fully operational at all levels of the need.
  • The authorization authority for organ removal and transplantation is available at three tier stages, State level, District Level and Institutional Level.
  • The Institution refers to the authorized hospitals or health care centres for organ removal, storage and transplantation.

Procedure for Organ Donation & Transplant. 

According to NOTTO (National Organ and Tissue Transplant Organisation) about THOT Rules 2014.

Living donors

  • It refers to any living person who is ready to donate his/her organ.
  • It can be related donors (parents, siblings etc.), spousal donors, or other related donors.
  • There should be valid documentary evidence of the relationship in the case of related donors by provisions of 8the THOT Act.

Spousal donor

Here the proposed transplant is between a married couple, documents such as marriage certificate and marriage photograph are kept for records along with the information on the number and age of children and a family photograph depicting the entire family and birth certificate of children containing the particulars of parents.

Swap donation

  • Swap donation is the transplantation of organs within the family between persons who are related but whose blood group is incompatible.
  •  Swap transplant should be carried out simultaneously, so there is no donor reneging.
  • Donor reneging means that one of the donors backs out from the donation. 
  • Furthermore, the donor and recipient pair in a family should be near related.

Other than near-related donors

  • It is a controversial category of organ donation as the possibility of illegal, forceful and monetary-based transplantations are involved in it.
  • If the donor–recipient pair is non-related then permission is granted by the authorization committee.

The THOT Act 2014 has made several provisions to avoid organ trade.

1.      Donor or recipient from another state: When the living donor is unrelated and if the donor or recipient belongs to a state, other than the state where the transplantation is to be undertaken, verification of residential status by Tehsildar, or any other authorized officer for the purpose with a copy marked to the appropriate authority of the state of domicile of donor or recipient is 8required.

2.      Foreign donors: In the case of foreign donors donating to their relatives in India, transplantation is permitted only in near-related donors. Indian living donors wanting to donate to a foreigner other than a near relative shall not be considered. In the case of foreigners coming for transplantation in India, the transplant is permitted in India with permission from a senior embassy official of the country of origin who certifies the relationship 8between the donor and the recipient.

3.      A deceased (cadaver) donor/transplant is another source of organs:  The deceased donation can be either after brain stem death or after cardiac death. People can pledge their organs during their lifetime if they want their organs to be used after death. After certification of the brain stem death of the person, it’s now mandatory for the medical practitioner to ask him near relative or person for lawful possession of the body of a person admitted to the Intensive Care Unit (ICU) regarding the plan of organ donation. Even if the donor has pledged his organs before death, the consent of a near relative or person in lawful possession of the body is also required. In case of Medico-Legal Case is involved in the organ donor then the Medical Practitioner after obtaining necessary permissions and consent may intimate the proceeding to a nearby Station   Officer or Superintendent of Police in the limit for the retrieval of organs or tissue from the donor and a copy of such a request should also be sent to the designated post mortem doctor of area simultaneously. Commercialization of Organ Transplantation.

Mains Practice question.

Critically evaluate the Transplantation of Human Organs and Tissues (THOT) Rules, 2014. (150 words 10 marks)

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