NOTTO Annual Report 2023-24 | 06 Aug 2024

Source: IE

The National Organ and Tissue Transplant Organisation (NOTTO) released its annual report for the year 2023-24 on Indian Organ Donation Day (IODD) on August 3, 2024.

• According to NOTTO, in 2023, India reached a significant milestone by surpassing 1,000 deceased organ donors in a single year for the first time, breaking the record set in 2022.

What are Key Highlights of the Report?

What are the Regulatory Framework Related to the Organ Transplantation in India?

• Transplantation of Human Organs and Tissues Act, 1994 (THOTA):
  • Organ donation and transplantation in India are regulated under the THOTA (amended in 2011) having the following provisions:
    • A transplant can come from organs donated by deceased individuals or from a living donor who is known to the recipient.
    • Altruistic donations from distant relatives, in-laws, or long-time friends are permitted, but they undergo extra checks to ensure no financial exchange has occurred.
    • Unrelated donors must provide documents and photos to show a long-term connection or friendship with the recipient.
    • Offering or paying for organs, arranging or advertising such deals, seeking organ suppliers, or helping to make false documents can result in up to 10 years in jail and a fine of up to Rs 1 crore.
    • Brain stem death is legally recognised as death under THOTA since 1994.
  • The Transplantation of Human Organs and Tissues Rules 2014 were notified for promoting organ donation from deceased donors.
• National Organ and Tissue Transplant Organisation (NOTTO):
  • NOTTO, an apex organisation at the national level, was established to provide a national system for organ procurement and distribution.
• National Organ Transplantation Guidelines:
  • Removed Age Cap: The upper age limit has been removed as people are now living longer.
    • Earlier, according to the NOTTO guidelines, an end-stage organ failure patient above 65 years of age was prohibited from registering to receive the organ.
  • No Domicile Requirement: The domicile requirement to register as an organ recipient in a particular state has been removed under a ‘One Nation, One Policy’ move.
    • Now a needy patient can register to receive an organ in any state of his or her choice and will also be able to get the surgery done there.
  • No Fees for Registration: The Centre has instructed states to discontinue the registration fee that was previously charged for this purpose.
• Organ Transport Policy:
  • Recently, the Union government has finalised a uniform policy to speed up the process of transporting a live organ between hospitals or cities.
    • It was created by Niti Aayog with input from several ministries like civil aviation, railways, transport and highways etc.

What are the Ethical Concerns Related to Organ Donation and Transplantation?

• Living Persons:
  • Violates the Traditional Rule of Medicine: Kidney donors are vulnerable to urinary and chest infections, which violates the first traditional rule of medicine, primum non nocere (above all, do no harm). One person becomes a patient to benefit another person who is already a patient.
  • Donation is Prone to Trafficking: Organ donation is susceptible to trafficking when there is illegal and unethical activity involved in the acquisition, transportation, or transplantation of organs. In its 1991 document, the World Health Organisation (WHO) expressed worry about the increase in illegal trade of human organs, especially from living donors who are not related to the recipients.
  • Emotional Coercion: The relationship between the donor and recipient influences the donor's motivation for organ donation. Living related donors are genetically related to the recipient and often feel obligated due to family ties and emotional bonds. Ethical concerns include the potential for undue influence, emotional pressure and coercion.
• Deceased Person:
  • Consent and Autonomy: It is important to determine whether the person had expressed their consent or refusal for organ donation while they were alive. If the person's wishes are unknown, it can be ethically challenging to make decisions on their behalf.
  • Allocation and Fairness: Ethical concerns can emerge when there are disparities in access to transplantation based on factors such as wealth, social status or geographical location.
  • Transparency and Public Trust: The ethical concerns related to disclosure of information, the handling of organ procurement and transplantation procedures, and the management of organ donation registries are important considerations.

What are the Challenges in Organ Transplantation?

• Donor Organ Supply: In India, the demand for organ donations far exceeds the available supply. An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only. The organ donation rate is still less than 1 per million.The need is for 65 organs per one million population.
• Peri-Transplant Donor Tissue Damage: Aging and diseases reduce donor organ quality, leading to Ischemia-Reperfusion Injury (IRI). Many organs are discarded due to inferior quality, impacting transplant success rates.
• Outdated Preservation Techniques: Many hospitals still rely on traditional static cold storage methods, which may not be as effective as newer technologies. Not all transplant centres in India have access to advanced preservation technologies like hypothermic or normothermic machine perfusion.
• Chronic Rejection in Organ Transplantation: Long-term survival rates for transplanted organs have not significantly improved over the past 20 years. Current anti-rejection therapies have remained unchanged, with only modest improvements in survival rates.
• Lack of awareness: There is a lack of awareness among people about the importance of organ donation and transplantation. E.g., lack of Awareness of concept of Brain Stem Death among stakeholders

Way Forward

• Strengthen Organ Donation and Awareness Programs: Launch comprehensive public awareness campaigns to educate the public about the importance of organ donation and how it saves lives.
  • Integrate organ donation education into school curricula and community programs to foster a culture of donation from a young age.
• Enhance Infrastructure and Facilities: Adopt advanced organ preservation techniques, including hypothermic and normothermic machine perfusion systems. Implement standardised protocols for organ procurement, preservation, and transport across all transplant centres.
• Advance Research and Innovation: Investigate and implement emerging technologies such as bioengineered organs, xenotransplantation, and nanotechnology in transplantation.
• Foster Ethical and Regulatory Frameworks: Create and promote ethical guidelines for organ donation, transplantation, and research, addressing issues such as consent and equitable access.