Body, Organ & Tissue Donation

A person often tends to assume that body donation, organ donation, eye donation and tissue donation are same. But all these terms have different meanings, different connotations and are governed by different laws in India.

Body Donation
Body donation for educational and scientific use comes under the Anatomical Act of India that was enacted in 1949 and uniformly adopted by all states of republic of India.  The focus of the Anatomical Act of India 1949 is on donation of the whole body after a natural death for scientific or educational purpose. Once a body is donated, neither the body nor its parts are returned to the family. A Body can be donated to any anatomical departments of nearby medical college. There is a great need for body donation in India as medical students in anatomy departments always fall short of cadavers. Medical students learn a lot from the bodies donated by great souls.

Organ Donation
On the other hand, Organ donation is the donation of body’s vital organs for transplantation into people for treatment purposes and has been legalized trough Transplantation of Human Organs Act THOA -1994. An organ is a self-contained part of a human being that performs a specific vital function in the body such as kidney, liver, pancreas, heart, lung and small bowel. Sometimes these organs fail to function in human beings as a result of disease or injury. In such situations the only medical treatment that can save the lives of such people is organ transplants which requires donation of organs from healthy living individuals or Brain Stem Dead donors in India. Organ donation from Brain Stem Dead Donor as well as living donors was made legal in India through THOA in 1994.

Brain Stem Death is a new definition of death; it is death by neurological criteria which was not heard of globally till 1968. Not every doctor in India can diagnose Brain Stem Death. A Brain Stem Dead donor occurs when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe.

When this happens, a ventilator keeps the person’s heart beating, and oxygen circulating through their bloodstream. A person is confirmed as being dead once their brain stem function is permanently lost.
A person can never be diagnosed as Brain Stem Dead at home. Diagnosis and certification of Brain Stem Death is a team effort of four designated doctors only in those hospitals that are registered organ retrieval or/and transplant hospitals in India. After diagnosis of this kind of death it is the willingness of the family that matters in giving consent for donation of organs/tissues.  A Brain Stem Dead donor can give life to seven to eight people by donating two kidneys, liver, two lungs, heart, pancreas and small bowel.  Organs cannot be stored once retrieved from a Brain Stem Dead donor and are required to be transported to various hospitals for transplantation into patients within a short span of time ranging from 4 hours for heart and 48 hours for kidney.

Tissue Donation
Tissue means an aggregate of analogous cells and cell product that forms a definite kind of structural material within body and has a specific function in the body.  Examples are corneas from eyes, heart valves, bones, skin, ligaments, cartilages etc. Tissues improve the quality of life of people who need tissue transplants. Tissues can be donated after natural death within a period of 6 hours usually. Tissues can also be donated after Brain Stem Death, however a person does not need to be Brain Stem Dead as is required by organ donation. THO amendment Act 2011 permits retrieval of tissues for transplantation purposes.
Unlike organs, tissues are not transplanted immediately and can be stored in biomaterial centres for as long as five years for skin and bones.
However in both these situations of organ and tissue donation, the body is returned to the family in dignified way after retrieval of organs or tissues or both.

Organ Donation System in India & Other Countries
India follows the Opt-in system of organ /tissue donation wherein people opt-in during life to be an organ/tissue donor or families opt-in to donate their Brain Stem Dead relative’s organs. The National Organ and Tissue Transplant Organization (NOTTO) is in the process of establishing a National Organ and Tissue Donor Register.  A person who has attained 18 years age can pledge to donate organs/tissues during life in the centralized register at NOTTO website either by online or offline filling and submission of pledge form (Form -7) of THOT Rules. However, if the person has not pledged to donate organs in their lifetime, the family can still give consent to donate organs at the time of Brain Stem Death.

In some States people are supposed to give their option for organ donation in a driving license. If a person has said “yes” to organ donation, the family still has the option to say “no” to organ donation.

However, the opt-in option requires persuading people through awareness programmes to take a pledge during life so that their organs could be donated after Brain Stem Death. It requires motivating people to register their will in driving license or organ donor register of the country, maintaining a centralized register, tracing the will of the person at the time of death and then persuading the families to honour the will of the person which does not always end with a positive outcome.

The Opt-out system, which is the law in many countires, is presumed consent. This means that the state does not need direct consent from the donor or the next of kin in order to carry out organ donation. Presumed consent assumes that donation would have been permitted by the potential donor if permission was pursued. It makes it incumbent upon people to register their unwillingness to be organ donors. So unless the donor had specified in their lifetime that they do not want to be organ donors, it will be presumed that they were willing.

Therefore in the absence of registered unwillingness it is presumed that individual has consented to donate and persuading families at the time of Brain Stem Death declaration is not required to retrieve organs. Some of the countries who have adopted presumed consent legislation are Austria, Belgium, Columbia, France, Italy, Norway, Singapore, Sweden, and Spain.

Organ donation, body donation and tissue donation are not same. One needs to understand the nuances of these donations before making a choice. However, all these altruistic acts of donation have great meaning for the society. A great soul is the one that gives back to the society even at the time of death be it body, organs or tissues. India is a country that believes in respecting the wish of its people. India also believes in persuading people to donate organs, tissues and bodies. India is also a country where people believe in giving be it their bodies, tissues or organs for the welfare of mankind.

Rajkumari Ajita & Y. Ibochouba Singh (2007).Body Donation and Its Relevance in Anatomy Learning – A Review. J. Anat. Soc. India 56 (1) 44-47; Retrieved May 25, 2014, from http://medind.nic.in/jae/t07/i1/jaet07i1p44.pdf
THOA (1994).Transplantation of Human Organs 1994 THOA .Transplantation of Human Organs Act 1994. Central Act 42 of1994. The Gazette of India, part II; section 3; sub section (i); July 8, 1994
-1968, ‘Ad hoc committee of the Harvard Medical School to examine the definition of brain death. A definition of irreversible coma’, Journal of American Medical Association, vol. 205, no. 5, pp.85-88
National Organ and Tissue Transplant Organization (NOTTO: National Organ and Tissue Transplant Registry (NOTTR). [Online] Retrieved on November 29, 2015 from http://www.notto.nic.in/organreport.htm
Dar Reeta Khashu and Sunil Kumar Dar (2014). National organ and tissue donor register: an initiative of National Organ and Tissue Transplant Organization (NOTTO).  Express, an International Journal of Multi-Disciplinary Research, 1(9) [Online]  Retrieved on Jan 16, 2015 from www.express‐journal.com

Courtesy: Organ India