Demand of the question
Introduction. Contextual Introduction.
Body. Organ donation scenario in India. Issue of illegal organ trade and reasons for the same.
Conclusion. Way forward.

Organ donation is the donation of biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation. Organ donation is done for a noble cause of saving one’s precious life. Unfortunately, organ donation has turned into a business where poor are being cheated, incentivised, targeted or even trafficked for stealing organs and selling them.

Organ donation in India:

1. Globally, Spain has the highest organ donation rate at about 34 donors per million, while India has nearly 0.03 donors per million. In India, Tamil Nadu has a highest number of organ donations.

2. India needs an estimated 6 lakh kidney donations annually, only 6,000 kidney transplants take place. The number of heart transplants is just inching close to 500.

3. National Organ and Tissue Transplant Organization (NOTTO) under the ministry of health and family welfare was setup in 2014 to oversee the process of Organ transplantation.

4. Under Article 246 of the Constitution, public health and hospitals are within the legislative competence of states which makes every state has its own transplantation laws.

Altruistic organ donation:

1.  It saves a precious life and help many families to sustain.

2. Altruistic organ donation usually involved a conscious and well think decision and thus is a noble way to save other’s lives by donation of sometimes literally dead people.

3. But with rising demand and organ failures and rising accidents altruistic donation is not a sufficient and sustainable way to meet the demand of organ donation. There is need of developing artificial organs and tissues in the lab with technology and stem cell research. 

Illegal organ trade- a threat to the society:

1. Organ trade in India like other problems such as child labor has a societal issue to it. It relates to the exploitation of the poverty-stricken people by alluring them with financial gains.

2. There has been exploitation of the donors from the lower income groups. The usual scenario driving these poverty stricken people is desperation for monetary payments. Some are under pressure from loan sharks and others to pay off for some major family costs (eg. Marriage).

3. Like child labour and prostitution, the ethics of organ donations is much more complex in our country and these are part of the corrupt fabric of our society. The country provides many hamlets of poverty that are fertile area for any kind of exploitation.  

4. The removal of the tissue or organ illegally threatens and impair the health or functional integrity of the donor. Donor many times are left dis-functional, which Impact their productivity and ability to earn.

5. The benefits expected to be given to the recipient bear an acceptable proportion to the harm likely to the donor. There are many issues around compensation for the donor, and benefits given are very less and often insufficient to run a family.

6. Illegal organ trade lead to violation of human rights and is mainly done by coercion, luring and mis-information. There have been at least two deaths of healthy young donors in the Liver programme and many donors have had long-term complications related to the donation process.

7. Further there are health concerns of organ donation and person may die. Person may become disable to carry on a healthy life impacting his life to live with dignity.

Reasons for illegal organ trade:

1. Organ scarcity is growing rapidly in because of increasing life-span and rise in number of organ failures due to lifestyle. A huge gap persists between demand and supply of organs in India. India has a donation rate of 0.5 per million which is one of the lowest in the world. This is leading to ever rising organ demands.

2. The major reasons for poor performance of Organ Transplant program is lack of awareness amongst public which has generally contributed for poor donor pool, but also lack of awareness, positive attitude and motivation amongst medical professionals.

3. Lack of organised systems for organ procurement from deceased donor led to such an illegal trade.

4. The law in India provides that a non-relative donor can be considered only if one is willing to offer an organ out of “affection and attachment” to the donee, or for a special reason, but never out of consideration of money. Such a provision virtually blacks out the possibility of getting a donor.

5. Though the TOHA law was envisaged with good intentions to ensure that the poor are not exploited but some stringent provisions in the law leads to illegal human organ trafficking.

What needs to be done?

1. Bringing law for Voluntary donation of an organ in exchange for a minimum stipulated amount of money.

2. India may adopt system of ‘opt out’ where organ donation will be automatic, unless an explicit request is made before death for organs not to be taken.

3. There should be a uniform legislative policy to increase organ donations. Though there are existing rules for the organ transplant system in the country, stricter implementation is the need of the day.

4. India should adopt the Spanish system of “presumed consent” were everyone, post death, is considered a donor unless one has opted out of the process in his life time.

5. There should be a centralized regulatory authority with jurisdiction to monitor the transplantation procedures as the authority constituted under the Transplantation of Human Organs Act 1994 does not have pan-India jurisdiction. With a proper monitoring mechanism in place that would make the system open and transparent.

Organ commodification is a serious exploitation as there can be endangerment to health. Recently there is a move by some physicians and policy makers in India to look at the possibility of making kidney sale a legal transaction by setting up some mechanism to protect them from the middle man or the brokers. These policy-makers should really re-examine the value of using financial incentives to increase the supply of organs for transplantation. Financial incentives for organ donation is likely to only lead to more exploitation. Without a quick cure for poverty, the transplant brokers will thrive and continue to operate and organs will continue to be bought from the poor and sold to the rich.