Addressing the trust gap and income inequality which exists in organ donation and organ transplantation is crucial for organ donation. Comment.

Indian Organ Donation Day is observed by the Government of India on November 30 with the primary objective of promoting organ donation and transplantation so that people suffering from organ failures can get a new lease of life from people who unfortunately lost their lives. 

While the day celebrates the positive aspects of this Noble act, the constantly growing negative perception of people towards the act cannot be ignored. A good example of this is the nosedive of organ donation in Kerala, from 76 to deceased donors in 2015 to a mere 8 in 2018, due to rumours about a scandal that private hospitals were declaring people brain dead when they really weren’t in order to extract their organs and profit from them.

The main problem here is the growing trust gap between people and the health care system in India. The June 2019 strike by doctors in West Bengal was a good example of this distrust. Organs come free, donated by people. However, transplanting it to another person can cost anywhere between ₹5 lakh and ₹25 lakh, including some profit to the hospital. This leads to suspicion by the public that certain unethical practices are at play. 

The wealth gap between donors and receivers is also a major factor. The fact is that the majority of the donors belong to lower middle class or below while the majority of organ recipients are from the small number of wealthy individuals who can afford the cost of an organ transplant surgery and the costly medication which follows it. The high cost is the main reason for the so many donated organs do not get taken. 

A multi-dimensional solution is needed to fix this problem. One way of approaching things can be to regulate hospitals through legalisation, the Transplantation of Human Organs Act, 1994 does exist but time has now arrived to make the legislation more effective by replacement of bureaucratic procedures for transplants by hospitals with approval by self-declaration and mandatory sample verification involving civil society groups. This will lead to improved compliance as has been proven in other countries and encourage more hospitals to be involved. In addition to this complete State autonomy in this area is needed, avoiding the unnecessary interference of the Central government. 

State organ distribution agencies also need to make their operations 100 per cent transparent and take steps such as putting the record of every organ donation and distribution online this will help to heal public confidence in the system. 

The “organs from the downtrodden to rich” argument can easily be rectified by mandating private hospitals to perform every third or fourth organ transplant free of cost for the section of society that donates a majority of organs. The above steps may not fix the system completely but at least they will be a start.