Organ Donation in India: Laws, Altruistic Donation and the Transplantation System

Why in News?

• The Karnataka High Court recently allowed a 52-year-old bachelor to donate a kidney voluntarily to an unrelated person. 

• The case has highlighted the legal framework governing altruistic organ donation and safeguards against commercial organ trading. 

Legal Framework

• Organ donation is mainly governed by the Transplantation of Human Organs and Tissues Act (THOTA), 1994, amended in 2011 and supplemented by rules in 2014. 

• The law regulates the removal, storage and transplantation of human organs and tissues and prohibits commercial dealings. 

Who Can Donate?

• Living donors may be near relatives or unrelated persons. 

• Near relatives include spouses, children, grandchildren, siblings, parents and grandparents. 

• Donations by unrelated persons require approval from an Authorisation Committee, which checks whether the donation is voluntary and free from financial motives. 

Altruistic Donation

• Altruistic donation means donating an organ without expecting money or another prohibited benefit. 

• Section 9(3) of THOTA permits donations to non-relatives when motivated by affection, attachment or other special reasons, provided there is no commercial transaction. 

• Donors must establish that the decision was made without pressure, inducement or financial influence. 

• False documents used to disguise commercial organ trading as genuine donation are punishable. 

Organ Donation System

• India follows a three-tier institutional structure: 

  • National Organ and Tissue Transplant Organisation(NOTTO): National-level coordination, registry and organ allocation. 

  • Regional Organ and Tissue Transplant Organisation(ROTTOs): Regional coordination. 

  • State Organ and Tissue Transplant Organisation(SOTTOs): State-level coordination and waiting lists. 

• These institutions work together to create a national waiting-list system. 

Types of Donation

• Living donation: An organ is donated by a healthy living person, commonly involving a kidney or part of the liver. 

• Deceased donation: Organs are retrieved after legally recognised brain-stem death, subject to prescribed procedures. 

Government Measures

• The National Organ Transplant Programme (NOTP) seeks to expand transplant infrastructure, train medical personnel and promote deceased organ donation. 

• The One Nation, One Policy approach has removed the domicile requirement for registration for deceased-donor organs and removed the upper age limit for registration. 

• The government has also promoted awareness through Indian Organ Donation Day and Angdaan Mahotsav. 

Key Challenges

• India faces a major gap between the demand for and availability of organs. 

• Deceased donation remains relatively low compared with living donation. 

• Other challenges include inadequate infrastructure, shortage of transplant facilities in rural areas, cultural hesitation and difficulties in identifying and certifying brain-stem death. 

• Most transplants take place in private hospitals, raising concerns about accessibility and affordability. 

• Xenotransplantation also presents potential risks of transmitting infectious agents. 

About Xenotransplantation

• Xenotransplantation involves transplanting or introducing living cells, tissues or organs from non-human animals into humans. 

• It is being explored because the demand for human organs far exceeds their supply. 

• It may also help treat diseases such as diabetes and neurodegenerative disorders. 

• However, it carries risks of cross-species infections, including unknown pathogens. 

• Retroviruses are a particular concern as they may remain dormant and cause disease years later. 

• Such infections could potentially spread to close contacts and the wider population.

Practice Question 

Q. Consider the following statements regarding organ donation and transplantation in India:

1. Under THOTA, donation by an unrelated living donor is permissible only after approval by an Authorisation Committee and must be free from commercial considerations. 

2. NOTTO, ROTTOs and SOTTOs constitute a three-tier institutional framework for coordinating organ transplantation and allocation in India. 

3. Deceased organ donation in India is permitted only after legally recognised brain-stem death, subject to prescribed procedures. 

4. Xenotransplantation is free from the risk of transmission of infectious agents because the transplanted biological material originates from non-human animals. 

Which of the statements given above are correct?

(a) 1 and 2 only
(b) 1, 2 and 3 only
(c) 2, 3 and 4 only
(d) 1, 2, 3 and 4

Answer: (b) 1, 2 and 3 only

Explanation

• Statement 1 is correct. THOTA permits altruistic donation by unrelated living donors subject to the approval of an Authorisation Committee and the absence of commercial motives. Hence, Statement 1 is Correct. 

• Statement 2 is correct. NOTTO functions at the national level, ROTTOs at the regional level and SOTTOs at the state level for coordination, registration and organ allocation. Hence, Statement 2 is Correct. 

• Statement 3 is correct. In India, deceased organ donation is permitted after legally recognised brain-stem death, subject to the prescribed procedures. Hence, Statement 3 is Correct. 

• Statement 4 is incorrect. Xenotransplantation carries a risk of cross-species transmission of recognised as well as unknown infectious agents, including potentially dormant retroviruses. Hence, Statement 4 is Incorrect.