Organ transplantation has been a life-saving medical procedure for many individuals around the globe. Despite its medical benefits, it often raises ethical concerns related to consent, human rights violation, and organ trafficking. Recently, a man from Odisha, declared brain dead following a severe head injury, brought renewed life to four individuals from three different states. This raises pertinent questions about organ donation and transplantation practices, particularly within the context of India.
An Overview of Organ Donation and Transplantation in India
India ranks third globally in performing organ transplants. The nation saw a significant increase in transplants from deceased donors, accounting for approximately 17.8% of all transplants in 2022. Over the past decade, the total number of deceased organ transplants rose from 837 in 2013 to 2,765 in 2022. Combined with living donor transplants, this number went up from 4,990 in 2013 to 15,561 in 2022.
Regulation of Organ Donation in India
The Transplantation of Human Organs Act, 1994 safeguards organ donation and transplantation operations in India. It regulates the removal, storage, and transplantation of human organs for therapeutic purposes and aims to prevent commercial dealings in human organs. In 2023, the Ministry of Health and Family Welfare introduced the National Organ Transplantation Guidelines. These guidelines removed age restrictions for recipients, abolished domicile requirements, and eliminated registration fees charged by some states.
Ethical Concerns Related to Organ Donation and Transplantation
Organ transplantation triggers a host of ethical concerns. Kidney donors, while capable of leading healthy lives post-donation, are susceptible to urinary and chest infections. These complications contravene the foundational principle of medical ethics, primum non nocere, which emphasizes not harming the patient. Furthermore, organ donation is susceptible to illegal and unethical activity, notably trafficking. Emotional coercion also plays a role, particularly when donors are genetically related to recipients and feel obliged to donate due to familial and emotional bonds.
Ethical Issues Regarding Deceased Organ Transplantation
Key ethical issues surrounding deceased organ donation include consent and autonomy, allocation and fairness, and transparency and public trust. Ensuring the deceased had expressed their consent for organ donation while alive is crucial. Fair and equitable organ allocation is another important factor. Additionally, maintaining transparency in organ procurement and transplantation procedures and handling organ donation registries is vital for public trust.
While deceased and living organ transplantations bring unique ethical considerations, deceased organ transplantation is generally considered more ethically preferable as it ensures no harm to living donors, respects their autonomy, and maintains fairness in organ allocation.
WHO’s Guiding Principles on Organ Donation
The World Health Organisation (WHO) has laid out eleven guiding principles for organ donation. These include adherence to the deceased’s wishes, ensuring physicians declaring a patient’s death are not directly involved in organ removal or transplantation, restrictions on donations from living minors barring certain legal exceptions, and prohibition of organ sale or purchase. The guidelines also emphasize that organ donation should be voluntary and devoid of monetary incentives. However, compensation for reasonable and verifiable expenses incurred by the donor or costs of recovery, processing, preservation, and supply of organs are permitted.
The Way Forward
Surveys across the world reveal people’s acknowledgment and support for the ethical need for organ donation. However, this altruism hinges on the understanding that organs will be distributed fairly among those in need. Regulations in organ transplant policy are integral to upholding ethical principles, protecting donor and recipient rights, preventing organ trafficking, and maintaining public trust. These policies provide a framework for a transparent, effective, and ethically sound organ donation and allocation system.