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Meenakshi Lekhi
Meenakshi Lekhi

FORTHWRITE

Opt-out is not an option

Is there life after death? Yes, if you are an organ donor. You will continue to enable life, even after your own life has ended. A cadaver donor can give up to 25 organs, saving up to nine lives. Lives saved can go up to 50, if we count tissue donations! Even a live donor can donate a kidney, parts of the liver, pancreas, lung, bone marrow and blood, and still can lead a normal life.

But, organ donation statistics on India are gloomy. Annually, in India, around five lakh people die because of non-availability of organs. Of this, nearly two lakh die for lack of liver donors. Every year, around 1.5 lakh patients need kidneys; only around 5,000 get them. Similarly, more than 10 lakh people suffer from corneal blindness, for want of donors. In a country of 1.3 billion people, the organ donation rate is just 0.08 persons per million population (PMP).

The Transplantation of Human Organs Act, 1994, prohibits organ donation and transplantation without the explicit consent of the donor. The consent process is called ‘opt-in’, as opposed to ‘opt-out’ or ‘presumed consent’, where anyone who has not specifically refused consent to donate is a donor. Opt-out is prevalent in countries such as Spain, Portugal, Belgium, France, Austria, Poland, the Netherlands and New Zealand. Opt-in countries include Germany, Greece, the US and India.

The opt-out system has its benefits. First of all, the donation rate in opt-out countries averages at around 30 to 40 PMP. In opt-in countries it is as low as 0.08-10 PMP. Secondly, the opt-out system overrides procrastination which stops many people from registering as donors, despite positive intentions. Thirdly, in a proper opt-out system, an informed donor may even go for a whole body cadaver donation. And, a regulated process may bring transparency into the organ transplant business, as supply becomes easier and greater.

However, there are challenges. First, an opt-out regime never ensures that the people are adequately informed about making or not making decisions. Second, harvesting organs without the donor’s informed consent is ethically untenable; donation should be an active and wilful process. Third, the system needs to instil trust between the patient’s relatives and the doctors. Fourth, a robust infrastructure for retrieval, storage and supply of organs needs to be put in place. Fifth, with ease of supply under the opt-out regime, adequate regulations would be required to prevent organ trafficking and transplant tourism.

Organ donation and harvesting can have professional, ethical, transparency and governance issues. Possibilities of the rich and powerful manipulating the system stare us in the face. In organ donation, too, rules could be bent to facilitate donations to VIPs, while the poor suffer inside the cobweb of opaque regulations. Hence, it is important to ease the supply side of the market, for which the opt-out system is the best way out.

19-Opt-out Illustration: Jairaj T. G.

India is a country where our ancient traditions glorify personal sacrifices for the common cause. The Gita says the soul is eternal. It goes away at death, leaving behind a useless body given to decay. So, to what better use can we put this body than to use it to give life to others?

Perhaps, the first mention of organ donation in a religious text is in The Bhagavata Purana. Sage Dadhichi gave his body to the gods; they fashioned vajra, a weapon to fight demons, from his spine. Christianity, Judaism and Islam, too, do not prohibit organ donation for the benefit of humanity.

Therefore, it is time to have an impassioned, persistent and unstinting debate about the opt-out system. The gloomy picture of organ transplant in India must brighten to give hope to lakhs of people who are dying waiting for a donor.

Lekhi is a member of Parliament.

forthwrite@gmail.com

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