1. Organathon Foundation

1.1 Who are the promoters of this organization

Dr Ajay K Sachdev is the Settlor and Chief Managing Trustee of this Trust. They are both senior, highly qualified and experienced surgeons. Their dedication and commitment towards this noble public cause has led to promotion of this "pro bono publico" initiative.

1.2 Where is your office located

The Registered office of the Trust is located at 8/6, T/F, WEST PATEL NAGAR, NEW DELHI-110008. The corporate office of the Trust is at C-604(DU) Parsvnath Green Ville, Sector - 48, Sohna Road Gurgaon - 122018.

1.3 How can I get associated with your organization

It depends on your qualifications, experience and dedication to the cause that this organization stands for. Any person, irrespective of his qualifications & experience can associate with this project as a potential organ donor & pledge his organs. He may also join us as a volunteer. After some training, one can join as a transplant coordinator / counsellor. Doctors, nurses & other care givers can associate themselves by motivating & counselling family members of brain dead patients for gifting of the organs / tissues. They can also help us by training of coordinators & volunteers and also for training the trainers. Any person can donate funds and if he fulfils the eligibility criteria, can apply to become a member trustee.

1.4 What is meant by "pro bono public"

This is a Latin phrase used for professional work undertaken voluntarily and without payment or at a reduced fee, as a public service.

1.5 What does your logo signify

This logo represents two human beings, happily & heartily 'transferring' the organs from one to the other. The Tag line "Be a doer … be a donor", inspires the youth to do something constructive to live beyond their death. An organ donor lives after his death through the lives he had saved by donating his organs.

1.6 How is your NGO different from other NGOs with similar objectives.

A: Our Differentiators are

  • Promoted by reputed Surgeons
  • Systematic, focused & dedicated approach
  • Reputed stalwarts as Board of Trustees
  • High potential & vacuum of cadaver organ transplantation especially in North Zone of the country

2. Organ & Tissues Donation

2.1 What is an organ

An organ is a part of the body that performs a specific function: like Heart, Lungs, Kidneys, Liver etc.

2.2 What are the Organs that can be donated

The organs that can generally be donated are : Liver, Kidney, Pancreas, Heart, Lung, Intestine.

2.3 What is a Tissue?

Tissue means a group of cells of the body, performing a particular function. Examples are bone, skin, cornea of the eye, heart valves, blood vessels, nerves and tendon.

2.4 What are the tissues that can be donated

The tissues that can be donated are: Cornea, Bone, Skin, Heart Valve, blood vessels, nerves and tendon.

2.5 What is Organ Donation

Organ Donation is the gift of an organ to a person with end stage organ failure waiting for a transplant.

2.6 What are the different types of Organ Donations?

A: There are two types of organ donation:-

  • 'Living Donor' Organ Donation: A person during his life, can donate whole or part of an organ without risking his own life. One can safely donate one kidney (as the other kidney is capable of maintaining the body functions adequately for the donor), a portion of pancreas (half of the pancreas is adequate for sustaining pancreatic functions) and a part of the liver (the segments of liver will regenerate after a period of time in both recipient and donor).
  • 'Cadaver Donor or ‘Deceased Donor’ Organ Donation: A person can donate multiple organs and tissues after (brain-stem / cardiac) death. His / her organs, will then continue to live in another person’s body, unless it is rejected by his immune system.
2.7 Is there any age limit for Organ Donation

Age limit for Organ Donation varies, depending upon whether it is living donation or cadaver donation. For example, in living donation, person should be above 18 years of age, and for most of the organs, the deciding factor is the person’s physical & medical condition and not the age. Healthcare professionals decide which organs are suitable, from case to case. Organs and tissues from people in their 70s and 80s have been transplanted successfully all over the world. In the case of tissues and eyes, age usually does not matter.

Kidneys, Liver : Upto 70 Years
Heart, Lungs : Upto 50 Years
Pancreas, Intestine : Upto 60-65 Years
Corneas, Skin : Upto 100 Years
Heart valves : Upto 50 Years
Bone : Upto 70 Years
2.8 Who can be a Donor

Living Donor: Any person not less than 18 years of age, who voluntarily authorizes the removal of any of his organ and / or tissue, during his or her lifetime, as per prevalent medical practices & legal requirements, for therapeutic purposes.

Cadaver Donor: Anyone, regardless of age, race or gender can become an organ and tissue donor, after his or her Brain-stem / Cardiac death. Consent of the family or a person in lawful possession of the dead body is required for removal of his organs. If the cadaver donor is under the age of 18 years, then the consent is mandatorily required from atleast one of the parent or any near relative authorized by the parents. Medical suitability for donation is determined at the time of death.

2.9 What is Brain death, Brain stem death and cardiac death

Brain, Heart & Lungs are not only vital for life but are dependent on each other for their function. When brain ceases to function, heart is bound to stop functioning after a while. Similarly, when heart has permanently ceased to function, brain has to stop functioning, as a necessary consequence.

A person whose brain no longer works is brain dead. A brain dead individual who is warm and pink with heart beating and lungs ventilating is just as dead, legally, as an individual whose body has turned cold after the heart has permanently stopped beating.

There are 2 ways of determination of death.

  • irreversible cessation of circulatory and respiratory functions (cardiac death)
  • complete and irreversible loss of brain function (including involuntary activity necessary to sustain life). This is brain death. Brain has the Cerebrum and the Brain stem. It is the brain stem which controls the cardiac & respiratory function. Therefore a person with dead cerebrum but living brain stem (Brain death), cardiac & respiratory function may continue unaided. On the other hand, in cases where cerebrum as well as brain stem are dead (Brain stem death), the heart beat & respiration can be continued only through the life support equipment. There is a very minor theoretical difference between brain death & brain stem death and therefore these terms are often used interchangeably. Whereas cardiac death can be easily determined by cessation of heart beat & ECG, determination of brain death requires a set of clinical & investigative criteria, by experts to confirm it.
    Organs recovered from a donor after cardiac death have some degree of oxygen deprivation during the time after the heart stops beating. This may make kidneys from this type of donor “slow to start”. After brain death, the heart continues to pump blood & respiration can be sustained (with life support system). Therefore brain dead patient is better suited for organ donation as compared to cardiac death patient.
2.10 How can I become a Donor ? What is the process for taking donor pledge

You can become a potential donor by expressing your wish in the authorized organ and tissue donation form (Form-7 as per THOA). You may pledge to donate your organs by signing up with our website and registering yourself as donor. For offline registration you may download the Form 7 from our website. You are requested to fill the form 7 and send signed copy to our office at below mentioned address:

151, First floor, Vipul Trade Centre, Sector- 48, Sohna road, Gurgaon

2.11 Do I need to register my pledge and can I register with more than one Organisation

No, it is not mandatory to register your pledge. However, it helps the Central Registry to analyze data. If you have already pledged with one Organization & received a Donor Card, you need not enroll with any other organization. Through the linkage with the NOTTO central registry, your pledge will be registered with the Government registry as well.

2.12 Do I need to carry my donor card always

Yes, you should try to carry it with you like you carry your ID cards & credit cards etc. It will be helpful for the health professionals and your family, to know (and remember) your wish & desire on the subject, when you are not in a position to communicate.

2.13 Can a person, without a family, enroll for pledging his organs

Yes, you can pledge, but you need to preferably inform the person closest to you in life, a friend of long standing or a close colleague, about your decision of pledging. This is only to ensure that somebody close to you is aware of your wish & desire at a time when you are not in a position to do anything. To fulfill your organ donation wishes, healthcare professionals will need to speak to someone else at the time of your death for the consent.

2.14 What is the benefit to my family or me after donation of organs

Donation of an organ or tissue provides an unparalleled opportunity to give someone a second chance of life. You might have been helped during your life by so many people in different ways. You also might have helped so many people in your own ways. This, however, provides a unique opportunity for you to give a ‘gift of life’ to several persons at the time of your death, without incurring any risk yourself. You will be fondly remembered by so many people for this noble gesture. Your donation is not only going to impact the life of one person or family, but it is of immense overall help for the society as a whole. Your family and the society will feel proud of you.

2.15 If I had pledged my organs, can I change my mind to un-pledge

Yes, you can un-pledge at any time, by making a call to Organathon Foundation office or directly to the NOTTO office or write or visit NOTTO website and avail of the un-pledge option by logging into your account. Also, let your family know that you have changed your mind regarding organ donation pledge.

2.16 Are there any religious objections to donate Organs and Tissues

None of our major religions object to donate organs and tissues. Rather they all are promoting and supporting this noble cause. If you have any doubts, you may discuss with your spiritual or religious leaders or advisors. Also read FAQs under ‘Religious issues’ section at the end.

2.17 How many patients need organ transplant in India on an average

In India there is a growing demand for Organ and tissue transplant due to large number of organ failure patients, with improved healthcare life outcomes. The quality of life (in addition to length of life) of these patients can improve with a transplant. As there is no organized data available for the required organs, the number is only an estimate. Every year, following number of persons (organ wise) are waiting for organ/tissue transplant :

Kidneys 2,50,000
Liver 80,000
Heart 50,000
Cornea 1,00,000
2.18 The people who have pledged for Organ donation in life, will they definitely become organ donors

No, Only a few people die in the circumstances where they are able to actually donate their organs. That is the reason why we need large number of people to take pledge for Organ Donation and register themselves as potential Donors.

2.19 Are donors screened to identify if they have a transmissible disease

Yes, blood is taken from all potential donors and tested to rule out transmissible diseases and viruses such as HIV and hepatitis. The family of the potential donor is made aware about the details.

2.20 Can I still become a donor if I have an existing medical condition

Yes, in most circumstances you can be a donor. Having a medical condition does not necessarily prevent a person from becoming an organ or tissue donor. It is only in some medical conditions that your organ / tissue may not be appropriate for transplantation. The decision about whether some or all of your organs or tissues are suitable for transplant is made by a healthcare professional, taking into account your medical history and investigations.

In very rare cases, the organs of donors with HIV or hepatitis-C have been used to help others with the same conditions. This is only ever carried out when both parties have that condition and with the informed consent of the family of the recipient. All donors have rigorous checks, to guard against such infections

2.21 Can I be an organ donor, if I have been rejected to donate blood

Yes, The decision about whether some or all organs or tissue are suitable for transplant is always made by a specialist, taking into account your medical history. There may be specific reasons why it has not been possible to donate blood, such as having anemia or had a recent blood transfusion or had hepatitis in the past or there may be reasons why you could not donate blood because of your health at that time - sometimes a simple thing like a cold or medication that you are taking can prevent you from donating blood. Therefore, rejection for blood donation may not be a rejection for organ donation.

2.22 How does whole body donation differ from organ donation

Organ donation for therapeutic purposes is covered under the Transplantation of Human Organs Act (THOA 1994).Whole body donation is covered by the Anatomy Act 1984.

Organ and Tissue donation is defined as the act of giving life to others after death by donating his/her organs to the needy patient suffering from end stage organ failure.

Body donation, on the other hand, is defined as the act of giving one’s body after death for medical research and education. Those donated cadavers remain a principal teaching tool for anatomists and medical educators teaching gross anatomy.

2.23 Can a dead body be left for medical education or research after the organs have been retrieved for donation

No, Bodies are not accepted for teaching purposes if organs have been donated or if there has been a post-mortem examination. However, if only the corneas have been donated, the body can be left for research.

2.24 How can I contribute in the field of organ donation

You can help by:

  • Pledging as an organ donor,
  • Talking to your family members about your decision of saving lives of others by gifting your organs if & when declared brain dead.
  • Participating in campaigns & events of Organathon for spreading the message.
  • Promoting organ donation by motivating people at your work place, in your community, at your place of worship, and in your civic organizations
  • You can join us as volunteer or as grief counsellor or transplant coordinator (after some training)

3. Donor Card

3.1 What is a Donor card

This is a document which indicates the person’s desire & wish to donate his organs & tissues when he has been declared brain dead. This is usually in the form of a small card which can be (and should be) kept in the pocket.

3.2 What is meant by Pledging of organs

Pledging of organs means that you take a pledge that you will donate your organs at the time of your death. Since you will not be in a position to do anything at that time, this desire or wish is documented in the form of an Organ Donor Card and disclosed to the family & friends.

3.3 Do I need to get it registered with the National or State Registry

It is not mandatory to get it registered in the National or State Registry. However, registration is helpful for the authorities because it enables them to analyze the data for policy decisions. If you pledge your organs through the Organathon Foundation, our networking will automatically get you registered with the State & National Registry.

3.4 How is your donor card different from other Donor Cards

As soon as you enrol with us, an acknowledgment card with useful information is delivered to you. Within a few days, an Organ Donation Pledge Card is issued to you. This is a smart card like any other ID card or credit card.

3.5 Can I get the Donor card by online enrolment

Yes, you can enrol online at our website, On completing the Pledge Form, you will get the acknowledgment card and some useful information, which you can download. Within a few days, an Organ Donation Pledge Card is issued to you. If you so desire, you can fill the pledge form & submit it in our office or call us to get it collected. The same thing can also be done at the events organized by us from time to time.

3.6 Do I need to pay something for it

No, there are no charges whatsoever for pledging your organs. In fact the society in general and Organathon Foundation in particular will appreciate your noble gesture.

3.7 Do I need to always keep it in my pocket

It is preferable to do so, in the same manner as you keep your ID cards & Credit cards

3.8 Should I disclose this card to my family, relatives & friends

Yes, it should be disclosed to your family & friends not only to inspire them to follow your footsteps but also to enable them to realize your wish & desire at a time when you yourself will not be able to do anything.

3.9 Can I get it re-issued in case it is lost or mutilated

Yes, it can be re-issued, in case it is lost or mutilated

4. Organs & Tissues Transplant

4.1 What is Transplantation

Transplantation is the act of surgical removal of an organ from one person and placing it surgically into another person. Transplantation is needed when the recipient's organ has failed or has been damaged permanently, due to illness or injury.

4.2 What are the end stage organ failure diseases

The end stage illnesses that need transplantation as the final treatment option are :

End stage Kidney Failure (Kidney Transplant)
End stage Heart Failure (Heart Transplant)
Terminal stage Lung Failure (Lung Transplant)
Some types of Diabetes Mellitus (Pancreas or Islet Cell Transplant)
Corneal Blindness (Corneal Transplant)
Valvular Disease of Heart (Heart Valve Transplant)
Severe Burns (Skin Transplant)
4.3 Who will tell me about the Transplant process

Transplant Coordinator and Treating Physician will explain to you about the process of Transplant.

4.4 Who is transplant coordinator

Transplant Coordinator means a person appointed by the hospital for coordinating all matters relating to removal of organs / tissues or transplantation of Human Organs or Tissues or both and for assisting the hospital management and the regulatory authorities at different stages.

Though their work is more related to deceased organ donation, they are responsible for living organ donation also. The current Transplantation of Human Organ Act envisages that every hospital doing transplant activity, whether retrieval or organ transplantation, must have a transplant coordinator in the hospital before the centre is registered for transplantation under the Act. Transplant coordinator is a pivot of the organ donation and transplantation program.

4.5 What is the role of a transplant coordinator in cadaver Organ & Tissue Transplant

The transplant coordinator has to counsel the grieving family, make them comfortable and approach the subject in a very sensitive manner. It is customary to initiate the discussion with eye donation and later, depending upon their response, discuss about multi-organ donation.

If the family gives consent for organ retrieval, then the coordinator has to inform the Nodal Officer and coordinate with the ICU staff to maintain the patient on ventilator and organize organ retrieval. The coordinator has to ensure that all paperwork is correctly done and that the family is respectfully handed over the body, as soon as possible, without any hassles. The coordinator has to ensure that the family of the deceased does not suffer any hassles or costs during their stay.

4.6 Is there any insurance cover for organ transplant costs

Till few years back, transplant cost both for donor as well as recipient was not covered by most of the insurance companies. Nowadays many insurance companies are covering cost related to transplant. It will be better to discuss the details with the insurer, when you are going for health insurance.

4.7 Is there any age criteria for organ transplant

Yes, patient should be medically fit for the operation of transplant and age is one of the several criteria for assessing fitness of patient for transplant. This fitness is assessed by the concerned medical specialists trained in the field.

4.8 What is the waiting list for Organ Transplant

A list of people waiting for receiving an organ, is prepared by all hospitals dealing with end stage organ failure and waiting for organ transplant. This list is shared with the National Registry (NOTTO) directly or through the regional (ROTTO) or State (SOTTO) divisions. Whenever, Cadaver organs become available, which recipients will get it depends largely on the waiting list besides other medical criteria.

4.9 How does someone get on the waiting list

The patient can register for inclusion in the waiting list through a registered transplant hospital. The treating physician of the hospital shall make an evaluation (based on medical history, current condition of health, and other factors) and decide if the patient needs a transplant and meets the criteria to be listed. Like for kidney transplant, other than blood group, main criteria is time since patient is on regular dialysis. Similarly, for other organs, criteria are different, based on medical history, current condition of health, and other factors.

4.10 How can I know that I am fit to be listed for organ transplant

Every patient who has developed end stage organ failure may not be fit for organ transplant. Basic principle is that the patient must be screened on medical grounds (based on medical history, current condition of health, and other factors) for the development of end stage organ failure. Your treating doctor will decide whether you need a transplant surgery and whether you are medically fit for transplant and other issues before listing in the wait list.

4.11 How long will I have to wait

Once you are added to the national organ transplant waiting list, you may receive an organ on the same day, or you may have to wait many years. Factors affecting are how well you match with the donor, how sick you are, and how many donors are available in your local area compared to the number of patients waiting.

4.12 Why waiting list is so long

There is a huge disparity between demand and supply for organ transplant. There are more numbers of patients requiring different organs for transplantation as compared to number of organs available for the same. That is why there is urgent need to create awareness about organ donation. As more persons decide to take the pledge and donate organs, the waiting list will go down.

4.13 What is the process to find a right donor

When a transplant hospital adds an individual to the waiting list, it is placed in a pool of names. When any deceased organ donor becomes available, all the patients in the pool are compared to that donor. Factors such as medical urgency, time spent on the waiting list, organ size, blood group, tissue typing, and genetic makeup are all considered.

4.14 How long it will take to get a cadaver's organ

There is no time line on how long one will have to wait for an organ that the individual requires. This depends on his / her medical situation and how frequently organs are becoming available in a city or state

4.15 Do I have option other than organ transplant

This query can only be answered by your treating doctor, depending upon your medical condition and stage of damage of the organ. For example in a case of kidney failure, dialysis is an alternative treatment and for kidney failure patient transplant is usually not an emergency. Also, for a heart failure patient, some patients can be maintained on artificial cardiac assistive devices. Similarly for other organs, criteria for maintaining, on medical therapies for the time being, are different.

4.16 Is it possible to know my status in the waiting list

Yes, you may know your status in the waiting list as this is quite a transparent system. But this will not help you significantly, as getting an organ depends on many factors other than just waiting list number.

4.17 Do I need to be always prepared to receive call for transplant

Yes, it may be better to be mentally prepared and have some funds for an urgent organ transplant, ready. Cadaver transplant is mostly on urgent basis. That is why it is better that your investigations for cadaver transplant are updated all the time so that whenever you receive a call, you can get the organ. Getting a cadaver organ is a unique life saving gift and one should not miss it.

4.18 If I get a call for transplant, will I definitely get the organ

No, getting a call for transplant does not mean that you will definitely receive an organ. The transplant team will examine your immediate fitness for transplant. There is possibility that the tests done just before the possible transplant may not be normal to make you fit for transplant. Further, more than one patient is called for possible transplant and it may be a chance that someone else might be considered more fit & appropriate than you, for that particular organ transplant, on that particular day.

4.19 Would a donor's or recipient's family ever know each other

No, in Cadaver Organ Donation Programme confidentiality is always maintained, unlike in the case of living donors, where the donor & recipient usually already know each other.

If the family wishes, they will be given some brief details such as the age and sex of the person or persons who have benefited from the donation. Patients who receive organs can obtain similar details about their donors. It is not always possible to provide recipient information to donor families for some types of tissue transplant.

Those who wish to exchange anonymous letters of thanks or good wishes they can do it through the transplant coordinator. In some instances donor families and recipients have arranged to meet but this is not encouraged.

4.20 What is the protocol for maintaining waiting list

As per protocol, patients who require cadaver organs are put in the waiting list. But in India, number of patients requiring organs are much more as compared to number of organs available.

There are two types of waiting list; one is urgent waiting list and another one is regular waiting list. Urgent listing of patients for cadaver organ transplant is primarily based on medical criteria, i.e. patient needs organ on urgent basis otherwise he / she may not survive.

Regular waiting list is based on the date of being listed and also based on some medical criteria. These criteria are different for different organs. Like for kidney transplant, main criteria is time spent on regular dialysis. Similarly, for other organs, criteria are different.

4.21 What is the protocol for organ distribution

The organs would be distributed locally within the State first, and if no match is found, they are then offered regionally, and then nationally, until a recipient is found. Every attempt would be made to utilize donor organs in an optimum manner.

4.22 How are donated organs matched with patients

Many medical factors need to match to ensure a successful organ transplant. Blood group is one of the major factors taken into account. Organ size of the donor & recipient is also considered. For kidneys another important factor is tissue matching which is more complex than blood group matching and also takes more time. The best results can be achieved if there is a perfect kidney match.

There is a local, regional and national computerized list of patients waiting for an organ transplant. Most of the time, computer will identify the best matched patient for a particular organ and organ is offered to the transplant unit who is treating that patient. Also, priority is given to patients who most urgently need a transplant, for medical reasons. NOTTO operates the waiting list and organ allocation system. It works round the clock, every day of the year. In case of tissues, matching is usually not required.

4.23 Can my Organs be given to a foreigner also

As per the Transplantation of Human Organs Act 1994, sequence of allocation of organs shall be in the following order: State List - Regional list - National List - Person of Indian Origin - Foreigner.

5. 'Living Donor' Transplant

5.1 What is ‘living donor’ organ donation

Means a person during his life donates his organ to another person. This can put his own life to risk. So there are some restrictions. A person, during his life can donate one of the two kidneys (one kidney is capable for maintaining the body functions fully), a portion of pancreas (half of the pancreas is adequate for sustaining pancreatic functions) and a part of the liver (the segments of liver will regenerate after a period of time).

5.2 Can I donate organ while I am still alive

Yes, but not all organs and tissues, only few organs can be donated during life. The most common organ donated by a living person is a kidney, as a healthy person can lead a completely normal life with only one functional kidney. Kidneys transplanted from living donors have a better chance of long-term survival than those transplanted from cadaver donor. Nearly 90% of all kidney transplants currently in India are from living donor.

In addition to kidney, part of a liver can be transplanted and it may also be possible to donate a segment of a lung and, in a very small number of cases, part of the small bowel. For all forms of living donor transplants, the risk to the donor must be considered very carefully. Before a living donor transplant can go ahead there are strict regulations to meet and a thorough process of assessment, discussion and ethics committee approval has to take place. This is to ensure that the organ donation is not involving buying / selling of organs.

5.3 What are the different types of living organ donations

Living ‘Near Relative’ Donors: Only immediate blood relations are accepted usually as donors viz., parents, siblings, children, grandparents and grand children (THOA Rules 2014). Spouse is also accepted as a living donor in the category of near relatives group and is permitted to be a donor.

Living Non-near relative Donors: These are other than near relatives of recipient or patient. They can donate only for the reason of affection and attachment towards the recipient or for any other special reason, which should be convincing enough to the ethics committee for approval.

SWAP Donors: In those cases where the living near-relative donor is incompatible with the recipient, provision for swapping of donors between two such pairs exists, when donor of first pair matches with the second recipient and donor of second pair matches with the first recipient. This is permissible only for near relatives as donors.

5.4 Is there age limit for living donor

Yes, there is an age-limit bar for living organ donation. Living donation can be done only after 18 year of age.

5.5 What is Swap donation

Sometimes in the family, there is a potential related donor who is otherwise willing but due to blood group mis-matching criteria or due to some other medical reasons, is not fit to donate the organ to that particular recipient in the family. Further, in another family similar situation exists. However, in these two families, donor of one family may become medically compatible with the recipient of the other family and vice versa. These two families then make a pair and make organ transplant possible for these two recipients of different families. This is called swap donation transplantation. Swap transplant is legally permitted in THOA (Amended) act 2012.

5.6 Will I become medically unfit after living organ donation

No, It is the basic principle of living organ donation program that person remains absolutely healthy for the rest of his / her life after donation. Thus, donor is not medically unfit for any purpose. However, in certain situations, living organ donor is treated differently. Like in the Armed Forces, an organ donor is not taken as normal and donor faces issues related to difficult areas and difficult duties.

5.7 Is it possible to receive organs from a friend or other than near relative

As per Transplantation of Human Organs Act, any living person other than near relative can also donate organ for the reason of affection and attachment towards recipient or for any other special reason. Such cases have to be approved by the Authorization Committee of the Hospital, where the transplant is going to take place. Approval of authorization Committee is mandatory in all cases involving other than near relatives.

If such authorization committee is not existing in the Hospital then it can be approved by the respective district or state level Authorization committee of the district or state (if no committee at district level), where the transplant hospital is located.

6. 'Cadaver / Deceased Donor' Transplant

6.1 What is Cadaver / Deceased

The Oxford Dictionary defines 'Cadaver' as 'a dead human body'. Medically a 'Cadaver' is a corpse used for dissection and study. In the area of Organ Transplantation, 'cadaver' refers to a brain-dead person with a beating heart, on life support system. ‘Deceased’ is a synonym often used in preference to the word ‘cadaver’.

6.2 What Organs and Tissues can a Deceased donor donate

If different organs and tissues are in medically fit conditions, following organs and tissues can be donated:

Organs : Two Kidneys; Liver; Heart; Two Lungs; Pancreas; Intestines

Tissues : Two Corneas; Heart Valves; Skin; Cartilage / Ligaments; Bones / Tendons; Vessels

6.3 What is Brain-stem Death

Brain stem death is cessation of function of the brain stem due to irreversible damage. It is an irreversible condition and the person has practically died. It is also called Brain Death in India.

A brain stem dead person cannot breathe on his own; however the heart has an inbuilt mechanism for pumping as long as it has a supply of oxygen and blood. A ventilator continues to blow air into lungs of brain stem dead persons, their heart continues to receive oxygenated blood and medicines may be given to maintain the circulation of blood. The heart will continue to beat for a period of time after brain stem death - this does not mean that the person is alive, or that there is any chance of recovery.

The declaration of brain stem death is made with accepted medical standards. The parameters emphasize the 3 clinical findings necessary to confirm irreversible cessation of all functions of the entire brain, including the brain stem: coma (loss of consciousness) with a known cause, absence of brainstem reflexes, and apnea (absence of spontaneous breathing). These tests are carried out twice at the interval of at-least 6-12 hours by the team of Medical Experts. Brain-stem Death is accepted under the Transplant of Human Organ Act since 1994.

6.4 Is Brain-stem Death legally accepted as death

Yes, as per the Transplantation of Human Organs Act 1994, Brain Stem Death is legally accepted as death.

6.5 Who will certify the Brain-stem Death

As per THOA, Board of Medical Experts Consisting of the following, will certify Brain-stem Death:

  • Doctor in charge of the hospital (medical superintendent)
  • Doctor nominated from a panel of Doctors appointed by the Appropriate Authority
  • Neurologist / neurosurgeon / intensivist nominated from a panel appointed by the Appropriate Authority.
  • Doctor treating the patient.

The panel of four doctors carries out the tests together to certify brain death.

6.6 Who explains to the family about the brain-stem death

The doctor (Intensivist / neurologist / neurosurgeon) who is treating the patient will explain to the family about brain-stem death.

6.7 If the family is willing to donate organs of the potential donor, how can they proceed for more information in terms of brain-stem death

The family can approach the counselor of the hospital, the transplant coordinator or the doctors and nursing staff of the ICU.

6.8 What are the reasons for time delays in cadaver organ donation


  • Confirmatory tests for brain death have to be done twice within an interval of 6-12 hours between the tests.
  • Once consent for organ donation has been obtained, coordinating the process of organ retrieval takes time.
  • Organ retrieval from deceased donors involves many hospitals and transplant teams should ensure that the donated organs match as perfectly as possible with the recipient.
  • If it is a medico-legal case, a post-mortem has to be performed and this involves both the police as well as the Forensic Medicine department.
6.9 How quickly should the donated Organs by a deceased donor, be transplanted

Healthy organs should be transplanted as soon as possible, for good functioning. During the period from retrieval of the organ from the donor to its transplantation, the organ is preserved in a standard manner to prevent / minimize chances of ischemia. However, in cardiac death cases (as opposed to brain death cases), organ retrieval has to be done immediately to prevent prolonged ischemia. Different organs can generally be transplanted within time frame as mentioned below:

Heart 4-6 Hours
Lungs 4-8 Hours
Intestine 6-10 Hours
Liver 12-15 Hours
Pancreas 12-24 Hours
Kidneys 24-48 Hours
6.10 Who will receive my organs

Your vital organs will be transplanted into those individuals who need them most urgently. These are the unique gifts of life and so they should be transplanted into the most suited recipients. They (Organs) are matched to the waiting recipients on the basis of medical suitability, urgency of transplant, duration on the waiting list and geographical location. NOTTO and its regional and state units (ROTTO & SOTTO) will work round the clock, every day of the year and cover the whole of the country. Tissue is very occasionally matched, e.g. for size and tissue type, but otherwise is freely available to any patient in need of a transplant.

6.11 Who can give consent for organ donation after brain-stem death

A person legally in possession of the deceased person can sign the consent form. This is usually done by a parent, spouse, son / daughter or brother / sister. It becomes easier for the family members to take the decision if they are themselves aware & sensitized or have been properly counselled or if the person concerned had already pledged his organs & is carrying his donor card. By signing a consent form the family says that they do not have any objection to the removal of organs from the body of their loved one. It is a legal document. This form is kept with the hospital.

6.12 If my family refused cadaver organ donation, will my treatment be affected

No. Even though your family refuses for organ donation, the treatment will be carried out as per the clinical condition. As a matter of fact the discussion about the cadaver organ donation is initiated only when brain stem death has occurred. Organ donation process is never linked with your appropriate treatment. In fact, the organ donation team works independent of the treating team. The Transplant team is different from the treating team as well as from the organ donation team.

6.13 Will the doctors try to save me if I am registered as a potential organ donor

Yes, it is the medical professional’s duty to try his best to save life of his patient first. Despite of all efforts, if the patient dies, organ and tissue donation can then be considered and a completely different team of retrieval and transplant specialists would be called in. The organ donation is considered only when the patient is declared brain stem dead. The brain death declaration protocol under the THOA has to be followed where 4 experts examine & evaluate by way of the objective criteria and the same is repeated after a gap of 6-12 hours to declare brain death and to permit retrieval of the organs for transplantation.

6.14 If I carry a donor card, will my organ be taken out without my family being asked

No. Even if you have pledged your organs and are carrying a donor card, your immediate family members and close relatives will be asked for the informed consent for the donation of organs and tissues. The consent is mandatory from the person lawfully in possession of the dead body, before donation can be carried out. If they refuse, then organ donation will not take place.

6.15 Is it possible that I can express my wish, to donate organs to some people and not to others

No. Organs and tissues cannot be accepted unless they are freely donated. No such conditions can be accepted in terms of potential recipients. You can express your wish to donate specifically which Organ & / or Tissue, you want to donate but you cannot select any recipient or category of recipients

6.16 Is there any financial burden to my family for cadaver organ / tissue donation

No. There is no additional charge to family of the potential cadaver organ donor. Potential donor needs to be medically maintained in ICU till the time of donation. From the time family agrees to donate organs and tissues, all charges are borne by the treating hospital and the donor family is not charged any further. Coordination will be done by the Organathon Foundation workers to ensure the same. In case the hospital refuses to waive off these charges, our organization will bear these charges

6.17 Does organ / tissue removal affect cremation / burial arrangements and does it disfigure the body

No. The removal of organs or tissues will not interfere with customary funeral or burial arrangements. The appearance of the body is not altered. A highly skilled surgical transplant team removes the organs and tissues which can be transplanted in other patients. Surgeons stitch the body carefully, as is done after routine surgery. Hence no disfigurement occurs. The body can be viewed as in any case of death and funeral arrangements are not unduly delayed.

6.18 Can organs be removed, after death, at home

No. It can only be removed when a person is declared as brain stem dead in the hospital and is immediately put on a ventilator and other life support systems so that circulation and oxygenation is maintained artificially. After death at home, only corneas and some tissues can be removed for transplantation.

6.19 What, if I had pledged to donate Organs, but my family refuses

In most situations, families agree for donation if they know that their loved one had pledged or wanted to pledge his organs. If the family, or those closest to the person who has died, object to the donation even though the person who has died had given his explicit permission, either by telling relatives, close friends or clinical staff, or by carrying a donor card or registering his wishes on the organ donation website, healthcare professionals will discuss the matter sensitively with them. They will be encouraged to accept the dead person’s wishes. However, if families still object, then donation process will be abandoned & not go further and organ donation will not materialize.

6.20 Is there any difference in organs between heart beating donor and donor after cardiac death

Yes. Heart beating donor means the patient has been declared as Brain-stem Dead, and his / her organs can be retrieved when heart is still beating & the ventilator is still oxygenating the organs, with the assistive devices. Beating heart keeps the blood supply intact to organs and there is no damaging affect of low blood supply to organs. Organs from beating heart brain dead patients therefore do much better than those retrieved from cardiac death patients.

6.21 Why can organs of a brain dead patient be used for transplantation and not those of a patient who has died of a cardiac arrest

Solid organ donation (heart, lungs, liver, pancreas, kidneys) requires blood circulation to be maintained in these organs until retrieval. This is possible in brain-stem death where the functioning of these organs can be supported for some time by assisting devices.

However organs after cardiac death will soon become useless for transplantation in the absence of blood supply. However, they can still be harvested, if the decision is taken immediately and the time gap between death and organ retrieval is minimal.

7. Legal & Ethical Issues

7.1 What is National Human Organs and Tissues Removal & Storage Network

The Central Government has established a National Human Organs and Tissues Removal & Storage Network named NOTTO, which stands for National Organ and Tissue Transplant Organisation. NOTTO will have five ‘Regional’ Networks ROTTO (Regional Organ & Tissue Transplant Organization) and each Region of the country will develop SOTTO (State Organ and Tissue Transplant Organisation) in every State / UT.

Each hospital of the country related to transplant activity, whether as retrieval or transplant centre, has to link with NOTTO, through ROTTO / SOTTO as a part of National Networking.

7.2 What is National Registry

I - Organ Transplant Registry:

The Organ Transplant Registry shall include demographic data about the patients waiting for transplant (Organ / hospital wise waiting list), donor (Living Donor including Related Donor, Other than Near Related Donor, Swap Donors and Deceased Donor), hospitals, follow up details of recipient and donor etc., and the data shall be collected from all retrieval and transplant centres.

Data collection may preferably be through a web-based interface or paper submission and the information shall be maintained both specific organ wise and also in consolidated formats.

The hospital or Institution shall update its website regularly in respect of the total number of the transplantations done in that hospital or institution along with reasonable detail of each transplant and the same data should be accessible for compilation, analysis and further use by authorised persons of respective State Governments and Central Government.

II - Organ Donation Registry:

The Organ Donation Registry shall include demographic information of donors (both living and deceased), hospital, height and weight, occupation, primary cause of death in case of deceased donor, associated medical illnesses, relevant laboratory tests, donor maintenance details, driving license or any other document of pledging donation, donation requested by whom, transplant coordinator, organs or tissues retrieved, outcome of donated organ or tissue, details of recipient, etc.

III - Tissue Registry:

The Tissue Registry shall include demographic information on the tissue donor, site of tissue retrieval or donation, primary cause of death in case of deceased donor, donor maintenance details in case of brain stem dead donor, associated medical illnesses, relevant laboratory tests, driving license or any other document pledging donation, donation requested by whom, identity of counsellors, tissue(s) or organ(s) retrieved, demographic data about the tissue recipient, hospital conducting transplantation, transplant waiting list and priority list for critical patients, if these exist, indication(s) for transplant, outcome of transplanted tissue, etc.

IV - Organ Donor Pledge Registry:

The National Organ Donor Register is a computerized database which records the wishes of people who have pledged their organs and tissues for donation. Person during their life can pledge to donate their organ(s) or tissue(s) after their death through Form 7 and submit it in paper or online to the respective networking organization and pledger has the option to withdraw the pledge through intimation, at any time he chooses.

There are many hospitals and organizations which are also maintaining the list of persons who have pledged organ donation with them. This will be passed to National Organ & Tissue Transplant Organisation for entry in the National Register.

7.3 What is legal position on Organ Donation

Organ Donation is legally permitted in India, under THOA. However there are conditions & restrictions to prevent misuse of the provisions of the law – both for Live organ donation and Cadaver organ donation.

7.4 Can people buy / sell organs

No. As per Transplant of Human Organs Act (THOA), buying / selling of human organs in any way is strictly illegal and has significant financial as well judicial punishment for those who violate this law. Not only in India, but in any part of world, selling of human organs is not permissible.

7.5 Whom do I report, in case, I find that there is a sale of organs

In case, anybody submitting false records or any other delinquency is noted, it should be reported to the Appropriate Authority of the State Government, Department of Health & Family Welfare. Any hospital, Authorization Committee, or a person can approach the State Appropriate Authority. The Appropriate Authority can file a case against the party.

7.6 What are the ethical concerns with living unrelated donations

Doctors are concerned with the possible emotional / financial exploitation of donors, by recipients’ families, and by transplant hospitals. They are worried that, with the increasing demand of organs, the rights of the poor donor to live with dignity may be abused. Middlemen tend to crop up and exploit the poor / illiterate people with some money and expose them to the risks, howsoever small they may be.

The amendments in the Act and strict enforcement of the same has almost eliminated trading of human organs. Transplant hospitals have become more careful with a good system of screening in place, and an Authorization Committee of Hospital / District / State scrutinizes all the applications. Today, Living Unrelated organ donations, supposedly out of affection have become rare and the procedure has become more transparent & streamlined.

7.7 What is "Required Request"

Required request is a way of getting consent of the person for the cadaver donor transplantation. Any person, who wishes to donate his / her organ and tissue after his death, has to affirmatively make a pledge that his / her organs after death may be used for transplantation and saving life of other persons.

At the time of death, Hospital staff approaches the family of the deceased person for donating their loved ones’ organs and tissues to save life of others. This approach is also called as ‘opting in’ approach, which means that the family needs to express their consent for organ donation. In some countries they follow the ‘opting out’ approach where there is presumption of consent for organ donation in all brain dead patients. If the family does not want to donate the organs of their patient then they have to expressly negate the consent and opt out of the program.

7.8 What is "Presumed Consent"

In the presumed consent approach, every person is supposed to be agreeing for organ donation at the time of death, unless the person has decided during his / her life time that he / she is not willing for organ and tissue donation after death. This system is also called "opting out” system. There are countries in the world who have presumed consent approach for organ donation and they believe that presumed consent approach usually increases the organ donation rate. However, all do not agree for the same. India does not follow this approach, largely because of the fear of exploitation.

7.9 What is "Informed Consent"

Informed consent is a process, which is not specific to organ and tissue donation. This is a process of reaching an agreement based on a full understanding of what will take place, in the form of medical treatment. Informed consent involves information sharing as well as the ability to understand and freely make an independent choice in relation to an operative procedure.

7.10 What is NOTTO Organ Donor Register

The NOTTO Organ Donor Register is a computerized database which records the wishes of people who have pledged their organs and tissues for donation and decided that, after their death, they want to leave a legacy of life for others. There are many hospitals and organizations like ours, which are also maintaining the list of persons who have pledged their organs for donation with them. They have the coordination with NOTTO and the data will be passed on to NOTTO website for entry in the National Register.

7.11 Who can join the NOTTO Organ Donor Register

Everyone irrespective of age or health can join the organ donation program by pledging his organs. Through the NOTTO network system, the data passes on to the NOTTO Organ Donor Register. Joining the Organ pledging program expresses a wish to help others by donating organs or tissues after death but importantly, pledging the organs, is also a way to give legal consent or authorization for organ donation to take place, though with the endorsement consent of the family / friends present at the time of death.

7.12 What is the importance of a donor registry

This registry is an essential part of understanding who and where potential donors are. A registry gives the planners enough information to devise strategies to get more public cooperation and commitment towards organ donation. Having a registry in place allows doctors and transplant coordinators to check if a brain dead person wished to donate and then approaching the family for consent becomes easier. It helps in saving crucial time in the process of organ donation.

7.13 What are MLC cases

When an accident / poisoning / assault victim is brought to a hospital for emergency treatment, an FIR is filed in the nearest Police Station through an official Police Intimation sent by the hospital concerned. Such cases are usually called medico-legal cases (MLC cases). Also, any medical treatment (for suicide, assault, poisoning or fall) or any case which arouses some suspicion, needs the police to be notified for investigations. Such cases are also medico-legal cases.

The police will conduct an inquest about the incident and take charge of the case for investigations. A forensic doctor will examine the patient and will allow or deny organ retrieval.

7.14 Is the police department involved in any way for the declaration of brain-stem death

The police department has to be informed that a patient is brain dead if it is a medico-legal case, but the declaration of brain-stem death is only done by a panel of doctors. Police has no role in that.

7.15 Does Government of India financially support organ transplant

Yes. Government of India has started National Organ Transplant Program (NOTP), under which patients below poverty line are supported for the cost of transplant as well as cost of immunosuppressant after transplant for one year. Other than this, renal transplant in all public hospitals is subsidized as per Government of India policy.

7.16 Is it possible to jump the waiting list if you are rich, well connected and influential

No. In India, the allocation of organs to recipients on the waiting list is based on predetermined criteria which include date of registration and medical criteria, besides urgency on medical grounds.

The wealth, race, or gender of a person on the waiting list has no effect on when and whether a person will receive a donated organ. The Transplantation of Human Organs Act of 1994 makes it illegal to buy or sell human organs in India and prohibits any commercial transaction for organ donation – directly or indirectly.

7.17 If someone desperately needs an organ, is there any point in making a special appeal through the media

Any special appeal through the media, usually results in more people agreeing to become donors and can increase the number of organs pledging.

However, family appeals through the newspapers and television will not result in an organ immediately becoming available for the person on whose behalf the appeal was made. The patient will still be on the waiting list, just like everyone else, and the rules that govern the matching and allocation of donor organs to recipients still apply.

7.18 Is it right to remove a healthy organ from a living person and give it to another

Organ transplantation is undertaken only as a lifesaving treatment. It is best for the transplant team to decide whether to go ahead with a live organ donation, keeping in mind the two issues of doing no harm to the donor, and doing good for the recipient. Only the transplant team can decide whether the benefit to the patient is worth the risk faced by the donor. The transplant team takes into account the mortality and morbidity of the donor, though this can’t be accurately predicted. The Government has laid down rules & procedures which have to be followed strictly. This not only removes the possibility of organ trading but also ensures the safety of the donor.

8. Religious / Spiritual Issues

8.1 Does religion debar a person’s body to be disfigured / mutilated before the final rites

All major religions either accept organ donation or accept the right of individual members to make their own decision. Organ donation does not cause any disfigurement / mutilation of the body.

8.2 Will the re-incarnation happen without the organs which had been removed

Reincarnation (for those who believe in this theory) is related to the soul which passes from one body (costume) to another after death. So removal of organs do not affect this process.

8.3 Will my organ donation, in any way, affect my karmic account

Karmic account is related to the good & bad karmas and has nothing to do with the body. So removal of the organs does not affect the Karmic account of the person. Since this removal of organs is done for saving several lives, if at all, this will positively enhance the karmic account of the person concerned, in view of the good deed done.

8.4 Being a Muslim, my religion does not permit me to donate my organs because this involves violating the human body.

Despite the orthodox position by some Islamic religious leaders, Muslims are often times uncertain about whether or not Islamic tradition considers organ donation to be forbidden. This uncertainty is due to the erroneous ambiguity caused by conflicting opinions among some Islamic leaders. Such negativity towards organ donation has resulted in low rates of participation in organ donation by practicing Muslims, even in cases where donation would be considered permissible by religious leaders.

However, in actuality, there is nothing in the Muslim faith that prohibits organ donation. As a matter of fact, one of the basic aims of the Muslim Faith is ‘saving of life’. This is the fundamental aim of the Shariah and the Allah greatly rewards those who save others from death. The Shariah waives the prohibition of violation of human body, in cases of necessity and in situations of saving another’s life. The Islamic legal maxim, al-darurattubih al-mahzurat means necessities overrule prohibition. (Holy Qur’an chapter 5 vs 32)

8.5 As a Buddhist, organ donation cannot be done by me

As a matter of fact, helping others is central to Buddhism. Moreover, charity forms an integral part of a spiritual way of life, as per Buddhist belief. There are examples in Buddhist scriptures of the compassion shown by Buddha in giving his life & body to help others. The Sutra of Golden Light, chapter 18 shows how Buddha gave his body to save a starving tigress and her cubs, who were later born as his disciples. Dhammarati, Western Buddhist Order states, "I would be happy if I was able to help someone else live after my own death". Phramaha Laow Panyasiri, Abbot, The Buddhavihara Temple states, "Organ Donation is acceptable in Theravada Buddhism. It is a Buddhist virtue to generously extend help to other sentient beings and this covers the case of organ donation". Sogyal Rinpoche – The Tibetan Book of Living & Dying, published by Rider, mentions, "Organ Donation is an extremely positive action. As long as it is truly the wish of the dying person, it will not harm in any way the consciousness that is leaving the body. On the contrary, this final act of generosity accumulates good karma"

8.6 As a Christian, my religion does not permit me to donate my organs.

The Lord demonstrated with his own life how, even in sorrow, love enables us to embrace the needs of others. We can choose to donate our organs to save lives of many people. In Revelation, chapter 21:4,5, it mentions, "In eternity we will neither have nor need our earthly bodies : former things will pass away, all things will be made new". David Ebor, Archbishop of York has said, "I hope that Christian people will seriously and positively consider organ donation. The ready willingness to donate an organ is a clear sign of that sacrificial self giving for others patterned by Jesus Christ". His Holiness Pope John Paul II has stated, "Every organ transplant has its source in a decision of great ethical value ….. Here lies the nobility of a gesture which is a genuine act of love. There is a need to instill in people’s hearts a genuine and deep love that can find expression in the decision to become an organ donor". Methodist Church UK states, "The Methodist Church has consistently supported organ donation and transplantation in appropriate circumstances, as a means through which healing and health may be made possible".

8.7 The Sikh religion may not permit me to donate my organs

As a matter of fact, the Sikh philosophy and teachings place great emphasis on the importance of giving and putting others before oneself. Guru Nanak, Guru Granth Sahib states, "The dead sustain their bond with the living through virtuous deeds". Dr Indarjit Singh OBE, Director of the Network of Sikh organizations UK, endorsed by Sikh authorities in Amritsar, Punjab, has stated, "The Sikh religion teaches that life continues after death in the soul, and not in the physical body. The last act of giving and helping others through organ donation is both consistent with and in the spirit of Sikh teachings"

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