On Organ Donation

 

Frequently we come across news items of how organs donated from brain dead people has given a fresh lease of life to several persons. While kidney donation is quite common, the list of organs which can be transplanted from human cadavers include cornea, lungs, heart, etc. Living humans quite often donate blood and bone marrow without any ill effects to the donor.

Over the years with development of techniques of tissue matching, and better immuno-suppressant drugs, the quality and length of life after transplantation is not only increasing but is also quite comfortable.

The situation in India is that potential recipients of human organs far outstrip the supply. This situation results in many people living on life support for years at end with the faint hope of getting a donated organ. The quality of life with a donated organ is very often much better than being linked to a life support system such as a dialysis machine on a permanent basis.

The supply / demand imbalance in harvested human organs has also led to a thriving black market for organs with all its concomitant pathologies – hapless donors getting tricked into donating their organs, some black sheep from the medical establishment making loads of money from human misery, bureaucrats who turn a blind eye to this illegal trade etc.

The main supply source for human organs in India continues to be close relatives. But many a time there are no close relatives whose organs are suitable or available for harvesting. A good source for human organs in that case is harvesting of organs from brain dead people. However, due to low appreciation of the benefits or modalities of donating organs of deceased relatives, and due to the associated complicated red-tape, along with an orthodox mentality of not messing with the organs of a dead person, very few organs of brain-dead people are harvested and are available for donation.

The Nobel Prize winner Daniel Kahneman in his book, Thinking, Fast and Slow, suggests a small policy intervention which could substantially increase the availability of organs for donation from brain dead people. He refers to an article published in 2013 which found wide variation in the rate of organ donation among various culturally similar European countries. It was found that the rate of organ donation was close to 100% in Austria but only 12% in neighbouring Germany. Similarly, it was 86% in Sweden but only 4% in next door Denmark!

On investigation it was found that this miracle was due to a simple difference in the design of the default option in an individual's driving licence application!

In the driving licence application of countries with high organ donation rates, in case of accidental death, the default option was that the individual agrees to donate his organs. There is an opt out option, which just needs to be ticked while applying for a driving licence, in case the individual does not wish to donate his / her organs.  Unless they take this simple action, they are considered willing donors. Kahneman concludes that “the best single predictor of whether or not people will donate their organs is the designation of the default option that will be adopted without having to check the box”!

A similar option in our Aadhar application form could perform a similar miracle in our country. It would not only substantially improve availability of harvested organs from brain-dead persons but also decrease the bureaucratic hassles involved in getting approvals post death. 

There can be no better way of remembering our deceased near and dear ones than to know that they continue to live on in other people’s bodies, which gives much joy and comfort to not just the recipient but also their family members.