Relevance: GS-2 (Governance, Health Regulation, Ethical Issues)
Source: The Hindu; MoHFW; NOTTO Annual Report

Despite medical advances and rising transplant needs, India’s deceased organ donation rate remains extremely low—around 0.5 per million population (NOTTO Report, 2023). This is far below global leaders like Spain (35 PMP) and USA (26 PMP). The existing regulatory framework—the Transplantation of Human Organs and Tissues Act (THOTA), 1994 and amendments—provides ethical safeguards but suffers from procedural gaps. Recent debates highlight how legal ambiguity, bureaucratic delays and weak hospital preparedness continue to obstruct organ donation.

Key Legal and Procedural Bottlenecks

1. Complexity in Brain-Stem Death Certification

Under THOTA, brain-stem death (BSD) is legally equivalent to death.
However:

• BSD must be certified by a four-member medical board, including a neurologist/neurosurgeon—often unavailable in smaller hospitals.
  
• Delays reduce organ viability; the window for heart and liver retrieval is 4–6 hours.
  
• Public misunderstanding of BSD remains widespread, causing families to hesitate.
  

Value Addition: The Supreme Court (Common Cause vs Union of India, 2018) stressed the need for clear end-of-life frameworks, yet BSD communication remains poor.

2. Consent Barriers

Even when an individual has pledged to donate, family consent is mandatory.
Studies show family refusal accounts for over 50% of lost donor opportunities (AIIMS study, 2022).
Counselling is inconsistent due to lack of trained transplant coordinators—a critical weakness identified by the Mashelkar Committee (2020).

3. Uneven Hospital Infrastructure

Only a limited number of hospitals are authorised as retrieval or transplant centres.
Many district hospitals lack:

• ICU beds
  
• Trained staff
  
• Organ retrieval teams
  

This results in underutilisation; for example, Tamil Nadu—India’s most successful cadaver donation model—has shown how hospital readiness strongly correlates with donation rates.

4. Organ Allocation and Governance Gaps

The NOTTO–ROTTO–SOTTO network is improving but still faces:

• Delayed organ transport (especially heart and lungs)
  
• Interstate coordination issues
  
• Limited real-time digital matching outside major metros
  

A CAG Report (2019) noted inconsistencies in data reporting and weak oversight of private hospitals.

5. Ethical and Legal Rigidities

• Strict scrutiny of unrelated living donors—intended to prevent trafficking—often imposes long delays on genuine donations.
  
• Police verification and multiple approval layers increase the burden on poor families.
  

High-profile cases of organ trafficking in the 2000s shaped these rules, but the pendulum has swung too far towards over-regulation.

Way Forward

1. Streamline Brain-Death Procedures

• Allow teleconsultation approval when specialists are unavailable.
  
• Introduce uniform BSD communication protocols (modelled on Spain’s “early family approach”).
  

2. Strengthen Hospital Preparedness

• Expand retrieval centres under the National Organ Transplant Programme.
  
• Mandate trained transplant coordinators in all large hospitals.
  

3. Improve Governance and Transparency

• Develop a national real-time transplant grid for organ allocation.
  
• Make reporting to NOTTO mandatory for all brain-death cases.
  

4. Public Engagement and Ethical Clarity

• Large-scale campaigns to normalise deceased donation, comparable to India’s success with blood donation awareness.
  
• Promote “donor card” systems with digital health IDs (Ayushman Bharat Digital Mission) for easier documentation.
  

Improving organ donation in India requires cutting legal clutter and building a compassionate, clinically robust system.

About NOTTO : The National Organ & Tissue Transplant Organisation (NOTTO) is an apex center under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. It is responsible for coordinating and networking for the procurement and distribution of organs and tissues, and maintaining a national registry for donation and transplantation activities across the country.

Q. “Explain the key legal and institutional challenges in India’s organ donation framework. Suggest reforms to strengthen deceased organ donation.”