India, one of the world’s most populous countries, has comparatively fewer organ donors compared to other developed or developing countries across the globe. The organ donation rate in India is just 0.26 per million population compared to 26 in the US, 35 in Spain and 36.5 in Croatia. The need for organ donors has always been a big burden in India with more than half a million Indians estimated to be in dire need of an organ transplant. Yet, less than a thousand transplants from deceased donors are performed each year – an incredibly small and insignificant number.

Where are we?

A research done by leading organ donation NGO says that the number of brain deaths in India is close to 1,00,000 a year and that at any given time, every major city has 8 to 10 brain deaths registered in various ICUs. According to a study published by the All India Institute of Medical Sciences, Delhi in 2008, road traffic accidents amount to approximately 1,40,000 deaths a year, of which almost 67% sustain severe head injuries resulting in brain death. These statistics reveal an unpleasant image of the deaths in our country by raising questions on the emergency care available to save such casualties. However, the bigger question remains, even with such tragic brain deaths and availability of organs that can be donated, why is there a huge list of people waiting for an organ transplant?

According to the research, every year in India, about:

· 500,000 people die because of non-availability of organs for transplantation

· Union Health Ministry says there is a demand for 2 lakh kidneys against the availability of 6,000

· There is a demand for 30,000 livers, only 1,500 are available

· Demand for the heart is 50,000 while the supply is 15

What is holding us back?

Even though we talk about the social stigma associated with organ donation, lack of awareness about the need for organ donation and transplantation among people is the biggest concern that has been holding back many from pledging their organs. Most of us are not aware of the procedures pertaining to organ donation even today due to lack of proper resources on whom and how to reach out to. In addition to this, consent from the family members, superstitious beliefs, fear about fraudulent practices and unauthorized entities running organ transplant rackets are few of the other bigger challenges that India is still fighting with.

Institutional Challenges

In India, the majority of the population are in rural areas where poor healthcare facilities have always posed the biggest challenge in comparison to the urban areas. Most of the brain death cases do not get registered in rural hospitals. Secondly, even after registering the case, hospitals must offer good ventilator support to preserve the organs and the intensive care staffs must be competent enough to handle them. Unfortunately, these facilities are not available in many of the government as well as private hospitals. To reach a well-equipped

hospital in tier II & III cities within a stipulated time with the organs is also preventing the doctors in the smaller nursing homes or primary healthcare centres to talk about organ donation.

Next steps

To save the lives of millions waiting for an organ transplant is in our hand. Creating awareness among people on the necessity to pledge and donate organs is the need of the hour today. The act of raising awareness and educating people should start at an early age by including organ donation in academics. Secondly, measures should be taken to improve the infrastructure of the hospitals in the rural areas and train doctors and other staff to handle brain death situations competently. All hospitals should have counsellors who can convince the patient’s family to provide consent for cadaveric organ donation.

If all hospitals declare brain death cases and register them, it will help in improving and implementing the state-wise centralized donors' list and solve the problem of people waiting for an organ transplant.

Brain death is the irreversible and permanent cessation of all brain functions. Although with the help of ventilator support, all the vital body functions work, however, the person cannot sustain his own life. This artificial support can give hope for a shorter period. However, deciding to donate the organs at the right time can give hope to the recipients family for their lifetime.