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EDITORIAL 11 : “Not as you say, but as you do”


Dr. J. Amalorpavanathan


Getting organ donation to tick again

Addressing the trust gap and inequality that are impacting family consent for organ donation is crucial

Organ donation is bane and boon in our country . Comment -(GS 3)

GS 3:Systems biology and medicine:Recent initiatives in Health & Biotechnology

This is a potential editorial where you will have an insights of organ trade , and this article is one of its kind !


Organ donation day is observed with the primary objective of promoting organ donation and transplantation so that a number of persons suffering from organ failure, such as the kidneys and liver, can get a new lease of life using organs gifted by others who have lost their lives (such as in road accidents or other reasons).



Undermining altruism
Altruism: disinterested and selfless concern for the well-being of others.


  • Indian Organ Donation Day : As the country honours the donation process, and distributes awards to donor families — Indian Organ Donation Day is observed by the Government of India on November 30 — it also needs to reflect on certain negative perceptions that appear to be growing and undermining the altruistic donation mindset of donor families.
  • A classic example of this is the steep drop seen in Kerala — from 76 deceased donors in 2015 to eight in 2018 — due to a perceived, however unfounded, scandal that private hospitals were declaring persons brain dead when they were not really so, in order to harvest their organs and profit from them.
  • Trust deficit : The underlying factor is the highly privatised health-care system in India and the growing trust gap between patients and doctors trapped in the profit-seeking business of tertiary care;
  • Cost Analysis : While an organ comes free, as donated to society, transplanting it to another person costs anywhere between ₹5 lakh and ₹25 lakh, including profit to the hospital.
  • Healers or Predators : Hence the unavoidable suspicion that unethical practices may take place — as highlighted in a recently published book, Healers or Predators? Healthcare Corruption in India.
Reality of organ transplant 
  • Middle class factor : The reality that a majority of accident victims who become donors are lower middle class and below, while the majority of organ recipients are from the small number of persons who can afford transplant surgery and costly lifetime medication thereafter.
  • Maximum wastage : The cost factor is the key reason why more than three quarters of donated hearts and lungs do not get taken.
Public hospitals cannot help
  • Favourable treatment : A common solution to this, advocated by many, is that public hospitals should chip in and help the poor. Very few public hospitals in the country do kidney transplants and less than five do liver and heart transplants.
  • Health care spending : In a country where public spend on health care remains an abysmal 1.2% of GDP — less than a third of what even some developing countries spend — priority should be on spending the limited allocation on areas that would benefit the greatest number of persons.


  • Are there any solutions to these issues of trust gap and inequality?
  • Only steps to moderate are possible in these deep-rooted societal fault lines.


  • Amendment : One usual approach is to regulate hospitals through acts and rules. In the 25th year of the Transplantation of Human Organs Act, 1994 , it is time to revisit its effectiveness.
  • Role of civil society : Substitution of bureaucratic procedures for hospital and transplant approval by self-declaration and mandatory sample verification involving civil society will improve compliance — as proved in other countries — and will also help get more hospitals involved.
  • Minimising interference : Further amendment is needed to ensure full State autonomy in this area, avoiding the Central government’s interference in organ distribution, which is now demotivating many hospitals.
  • Online regime : Apart from this, all State organ distribution agencies need to make their operations fully transparent. Steps such as making online organ distribution norms and the full details on every organ donation will help build public confidence in the system.
  • Poor to rich : As for “organs from poor to rich” some moderation of the inequality in our country is called for, especially as India figures in the top 10% of unequal countries in the world and among the top 10% of high proportion population spending more than a tenth of their income on health.
  • Throwing lights on : This must also be considered in light of the fact that the organ comes totally free to a hospital from a donor.
  • Regulation : One approach could be to mandate that every third or fourth transplant done in a private hospital should be done free of cost to a public hospital patient.


       IASbhai  Windup:  

This will amount to cross-subsidisation, with the hospital, the doctor and the recipient footing the bill for free surgery to the section of the population that donates a majority of organs.

This may not please present stakeholders in this field but they need to avoid the tendency to sweep inconvenient issues under the carpet and discuss seriously how to address the trust gap and inequality that are factors impacting family consent for organ donation.

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