By Dr Mukul Pai Raiturkar
01 August 2013 19:27 IST

Since Vedic times, humans have always asked whether it is possible to live after death. Immortality and afterlife have occupied the minds of many of our philosophers.

While philosophy may provide afterlife to a man or a woman, science is not yet so advanced. However modern medicine can give afterlife to many of our organs and tissues.

Typical examples are: Kidney, cornea of the eye, liver, pancreas, heart, lungs, intestines, heart valves, skin, bones,veins, tendons and ligaments.

Some of these organs can be donated where the donor is alive, others only after brain death of the donor.

Kidneys, a part of the liver, a part of the pancreas, skin and venous graft can be donated by a living donor.

All the other organs can be donated by the just brain dead donor.

How many just brain dead people are there in India who can donate organs? Anybody's guess but mine is that there are around one lakh every year all over India. At any given time Indian metros would have 15 - 20 brain deaths in their Intensive Care Units. The heart of these patients is still beating and the respiration is maintained by mechanical ventilation in the ICU. The organs of these patients are therefore technically alive although their brain has stopped functioning irreversibly. The best example would be those healthy people whose brain death has occurred due to head injury.

And yet one finds that in India we have had only 200 transplants last year, nowhere close to even 1 per million population. USA has 22 transplants per million people and Spain 35.

There are many reasons why the culture of organ donation has not managed to pick up in India. Other than religious taboos, to me the most important is that brain death alone is not accepted as diagnostic of death in India. We want the heart stop as well. Once the heart stops organs die quickly. So for organ transplantation to pick up in a big way brain death has to be taken as the diagnostic criterion of death. In other words brain death has to be certified.

The only Indian state to make brain death certification mandatory is Tamil Nadu, via an order passed in 2008. Otherwise the certification of brain death is mandatory only in transplant hospitals and in non transplant organ retrieval centers registered under the Human Organ Transplant Act 1994. No wonder Tamil Nadu's organ donation rate is 10 times the national average.
Simplification of the legal procedure of organ transplantation is also necessary.

According to the Transplantation of Human Organs Act 1994, one kidney, one part of liver, and one part of pancreas can be donated to blood relatives by living donor. In case of unrelated persons or for a dead donor, prior approval of the Authorization Committee, in each state, is mandated.

In 1995, this Act was amended and The Transplantation of Human Organs Rules, 1995, came into existence. According to these Rules, any person can authorize the removal, before his death, of any human organ of his body for therapeutic purposes in the manner and under such conditions as specified.

These Rules also specify the duties of the Medical Practitioner. These include:

--Taking the Form 1 (A) or (B) or (C) of authorization from the donor.

--ensuring that the donor is in proper state of health and fit to donate.

--That donor is a near relative of the recipient.

--If the donor is dead the Medical Practitioner must ensure that:

1. That the donor had in the presence of two or more witnesses (at least one of whom is a near relative) unequivocally authorized as specified in Form 5 before his/her death, the removal of the said organ.

2. That the person lawfully in possession of the dead body has signed a certificate as specified in Form 6

The Medical Practitioner is also responsible for getting the brain death certified by all the members of the Board of medical Experts in the State Authorization Committee.

These Rules mandate one State level Authorization Committee. In Goa this Committee includes the Dean, Goa Medical College, the Head of Department of Nephrology and the Head of Department of Surgery, GMC.

So please do not hesitate to give afterlife to your organs. Go ahead and make someone else's day!

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Dr Mukul Pai Raiturkar

Dr Mukul R Pai Raiturkar is a consultant pediatrician & neonatologist practicing in Margao. He is the co-convener of Ami Goenkar, an organisation of secular young Goans working towards a novel approach to religious-political issues of Goa. Son of veteran Goan freedom fighter Mr Ravindranath Pai Raiturkar, he exudes unshakable faith in a liberal, secular and free spirited democracy of India.

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