My brother in law has a second chance at life because of the generosity of complete strangers. A chronic diabetic, there had been a rapid decline in his kidney function necessitating dialysis awaiting a renal transplant. With no compatible donors in the family we were contemplating an ABO incompatible transplantation with my sister donating her kidney. That is when we got a call from PGIMER, Chandigarh, where we were on the waiting list, for a possible cadaveric transplant. As we rushed to the hospital and later, while the operation was in progress, I couldn’t stop thinking about the donor and his family. For the parents of the deceased it must have been the ultimate test of selflessness. To think about others when their own world was falling apart. To make a timely decision in the midst of anguish over an untimely death. And yet they did it. They overcame the grief of losing a teenaged son in a freak accident, and donated his organs to ameliorate the suffering of others. Their decision helped save three lives through two kidney and a liver transplant.

The thought itself, is as fascinating as it is riveting. To come as close to immortality as humans can dare. To live on, at least in parts, after your natural death. Your heart beating for someone else, long after you are gone. The ability to be able to give after you cease to live. A parting gift to humanity without a twinge of pain, at no extra cost. One last magnanimous act before you bid adieu to the world…..ashes to ashes…..dust to dust……

One would think that there would be many takers for this noble deed but there aren’t. The donation rate in USA, UK, Germany and Netherlands is a deplorable 10-30 per million population (PMP), where ‘family consent’ is required when people sign up as donors. This makes it faster and easier to harvest organs at the time of the donor’s demise. Countries like Singapore, Belgium, Spain have a marginally better rate of 20-40 donations PMP. This is because of their aggressive approach of ‘presumed consent’, which permits organ donation by default unless the deceased has explicitly ‘opted out’ during his lifetime. India with a population of 1.2 billion has only 0.08 organ donors per million population. One reason for the abysmally low donation rates is because legally, even when registered, the prerogative of the consent lies with the next of kin of the deceased. There are other reasons too which fall in three broad categories, legal, logistical and lack of awareness.

This is an attempt to dispel that ignorance. Cadaveric or Deceased Organ donation is the harvesting of an individual’s organs after death for the purpose of transplanting them into a patient. Anyone, irrespective of age can be an organ donor after registering with the appropriate local organisation ( http://pgimer.edu.in ) A single altruistic act can save upto seven lives through organ donation and improve the lives of scores of others through tissue transplant. Vital Organs like heart, liver, kidneys, intestines, lungs, and pancreas can be harvested only in case of ‘brain death’ when the heart is still beating. However tissues like cornea of the eyes, heart valves, skin, bones etc can be donated within six hours of natural death.

The Government of India passed the Transplantation of Human Organs Act in 1994 which legalised the concept of brain death and facilitated organ procurement from ‘heart beating, brain dead’ donors. Brain death is the irreversible cessation of all brain functions, making sustenance of life impossible. The vitality of organs is artificially maintained by life support equipment until they are harvested.

And now the answer to questions which bother everyone but no one dares to ask. The efforts of doctors to save life is not diluted by the fact that the patient is a donor. A panel of four doctors, none of which are from the transplant team, is needed to declare brain death which has to be done twice, six hours apart. So misdiagnosis is unlikely and the interest of the patient is safe guarded. The deceased body is given back to the family in a dignified way. There is no disfigurement because of organ retrieval (even after eye donation), and the body can be viewed as in any case of death. Funeral arrangements do not get delayed. There is neither charge nor payment made on account of organ donation and all major religions support it.

The need for organs is rising and in the absence of a thriving ‘ Cadaveric donor programme’ patients have to either die of organ failure or choose between live donors from family and illegally bought organs. On an average, each year, five lac Indians die because of non-availability of organs, out of which two lacs suffer from liver failure, fifty thousand people die from heart disease and 1.5 lac people await kidney transplant. Apart from this 4.6 million Indians suffer from blindness which can be reversed with a corneal transplant.

Patients diagnosed as brain dead account for approximately 10% of intensive care unit deaths and are good potential donors. Most of the families who agreed to donate organs viewed it as the only positive outcome from their misfortune and said it helped overcome their grief. Yet the biggest logistical difficulty is to get the living to fulfil this last wish of the dead. This is not a problem with the ignorant masses alone but is met in the upper sections of society too. Hundreds of celebrities have pledged their organs but the Kannada film star Dr Rajkumar is the only one whose corneas were retrieved. Dr Abdul Kalam, had pledged his organs to Armed Forces Retrieval and Transplantation Authority (AORTA) but his wish was not honoured when he died recently. The famous gazal singer Jagjit Singh was on life support for a fortnight before he died but no effort was made to harvest his organs. Similar is the case of Sh Gopinath Munde who died in a car crash early this year. It is easy to understand this, keeping in mind the predicament of the next of kin. In those tragic circumstances ‘do good unto others’ would be farthest away from their minds and others will not broach the subject lest they appear insensitive. A central registry of donors that allows doctors and transplant coordinators to check if a brain dead person had pledged his organs makes it easier to approach the family for consent, but presently, India does not have one.

In all arenas of life we tend to follow the rich and famous, so as a final responsibility, celebrities will have to lead us in death too. Till then I will continue to commend the moral strength and resolve of the parents of the teenager, who will forever be in our prayers. And since this is a deed which can only be paid forward, I declare my wish to be recycled and reused before being reduced to ashes. I will need help to honour this commitment, though, since I won’t be around to do it myself!

(an edited version was published in Sunday Tribune ‘Reading the Pulse’ on 29/11/2016)