Central Idea: The National Organ and Tissue Transplant Organisation (NOTTO) is working on a transplant manual as a step-by-step guide for the implementation of organ donation and transplantation programmes in hospitals and a standard course for training transplant coordinators.

Organ transplant in India: Key statistics

• According to data accessed from the Health Ministry, the number of organ transplants has increased by over three times from 4,990 in 2013 to 15,561 in 2022.
• Of the 15,561 transplants, a majority — 12,791 (82%) — are from live donors and 2,765 (18%) are from cadavers (the dead).
• Up to 11,423 of the 15,561 organ transplants are for the kidney, followed by liver (766), heart (250), lung (138), pancreas (24) and small bowel transplants (3).
• Most of these transplants occur in private hospitals, the numbers in government hospitals are relatively lower.

About National Organ Transplant Programme (NOTP)

• In 2019, the GoI implemented the NOTP for promoting deceased organ donation.
• Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994.

Types of Organ Donations

• The law allows both deceased and living donors to donate their organs.
• It also identifies brain death as a form of death.
• Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives or, in some special cases, out of affection and attachment towards the recipient.

(1) Deceased donors:

• They may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine.
• Uterus transplant is also performed, but it is not regarded as a life-saving organ.
• Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained.
• Brainstem death is also recognized as a form of death in India, as in many other countries.
• After a natural cardiac death, organs that can be donated are cornea, bone, skin, and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs

(2) Living donors:

They are permitted to donate the following:

• one of their kidneys
• portion of pancreas
• part of the liver

Features of the NOTP

• Under the NOTP a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organization (NOTTO), New Delhi.
• Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio-material centre.
• As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organization (ROTTO), Chennai, Tamil Nadu.

More moves for facilitation:  Green Corridors

• Studies have suggested that the chances of transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.
• Therefore, the transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of India.
• A “green corridor” refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.

Recent amendments

(1) No Age Bar

• Now an individual of any age can register for organ transplant.
• People beyond 65 years in need of an organ donation will also be eligible to get one.
• The government has decided to do away with a clause in the National Organ and Tissue Transplant Organisation (NOTTO) guidelines as the clause violates the Right to Life.

(2) Doing away with domicile compulsion

• Earlier an organ recipient could register for a prospective transplant in domicile State.
• States like Gujarat had made it mandatory for registered patients to furnish a domicile certificate to be eligible for a transplant.
• In November last year, the Gujarat High Court quashed the discriminatory policy of the State government.

About NOTTO

National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.

1. National Human Organ and Tissue Removal and Storage Network
2. National Biomaterial Centre (National Tissue Bank)

[I] National Human Organ and Tissue Removal and Storage Network

• This has been mandated as per the Transplantation of Human Organs (Amendment) Act 2011.
• The network will be established initially for Delhi and gradually expanded to include other States and Regions of the country.
• Thus, this division of the NOTTO is the nodal networking agency for Delhi and shall network for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
• It functions as apex centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country.

[II] National Biomaterial Centre (National Tissue Bank)

• The Transplantation of Human Organs (Amendment) Act 2011 has included the component of tissue donation and registration of tissue Banks.
• It becomes imperative under the changed circumstances to establish National level Tissue Bank to fulfill the demands of tissue transplantation including activities for procurement, storage and fulfil distribution of biomaterials.
• The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues.

The centre will take care of the following Tissue allografts:

1. Bone and bone products
2. Skin graft
3. Cornea
4. Heart valves and vessels

Various issues involved

• Lack of awareness: Lack of awareness leads to myths and misconceptions about organ donation, which further discourages people from donating organs.
• Religious and cultural beliefs: Some religious and cultural beliefs view organ donation as a desecration of the body, which hinders organ donation.
• Lack of infrastructure: India faces a shortage of medical infrastructure and facilities for organ donation.
• Legal and regulatory challenges: India’s organ donation system is heavily regulated by the Transplantation of Human Organs and Tissues Act, 1994.
• Socioeconomic factors: Poverty and lack of education can lead to reduced access to information and medical services, making it difficult for people to donate organs.
• Organized crime: Organized criminal networks involved in organ trafficking and commercialization also create challenges for organ donation in India.
• Stigma and Discrimination: Stigma against organ recipients, particularly those who receive transplants from other communities or castes, is also a challenge in promoting organ donation in India.

Way forward

• Developing a National Organ and Tissue Donation Registry: The registry could maintain a database of donors and recipients, along with their medical history and compatibility information.
• Setting up Mobile Organ Donation Units: These units could be equipped with medical personnel and equipment to conduct donation procedures in remote areas.
• Crowdfunding for Organ Transplant Surgeries: This could be used as a means to raise funds for organ transplant surgeries, especially for underprivileged individuals who cannot afford the cost of treatment.
• Promoting Living Donor Transplants: Living donor transplants can help increase the number of organs available for transplantation.
• Incentivizing for Organ Donation: Incentives could be introduced to encourage more people to donate organs. This could include tax breaks, priority access to medical treatment, and other benefits.
• Leveraging Technology: Technology could be used to develop better donor and recipient matching algorithms, create virtual waiting lists, and streamline the donation and transplantation process.
• International Collaboration: India could collaborate with other countries to share best practices, leverage technology, and develop new approaches to organ donation and transplantation.

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