Organ Donations

Death will be no more…Pain will be no more.
See, I am making all things new.”

Revelations 21:4-5

The sombre moment brings home the eternal truth of Death
I leap out of my body refusing to be laid to be rest

To become a part of you here and a he or a she there
And Death stands bewildered – left with an empty Stare

  • Today, advancement in science and medical facilities make it possible for us to distribute our organs after death. This way, we are more fortunate than our ancestors.
  • A Living Will records your wish to donate your organs after your death and brings the possibility of organ donation closer to reality.
  • It is also possible for living persons to donate certain organs.


Facts on Organ Donation

What does the law of the land (India) say about donating organs?

“The Transplantation of Human Organs Act” (See Appendix A) was enacted by the Government of India in 1994. This Act makes it possible for persons who have suffered “brain-stem death” to donate their organs.

(a) Where a person has already signed a living will* in order to donate his or her organs, transplantable organs may be harvested from such person.

(b) Where a person has not already signed a living will in order to donate his or her organs, it is possible to harvest organs from such person with the due consent and authority of the next of kin of such person.

The law by recognizing brain-stem death allows for organs becoming available for harvest and transplant.

What is Brain-Stem?

The brain-stem connects the brain and the spinal cord. It is responsible for basic vital life functions such as breathing, heartbeat, and blood pressure. The function in this region is crucial for the whole of the brain.

What is Brain-Stem Death?

Total irreversible cessation of all brain functions, including the brain-stem, demonstrated by lack of responsiveness to stimuli, absence of all reflexes and an absence of spontaneous breathing.

Traditionally, it has been believed that death occurs only when the heart stopped beating.1 However, we have to understand that death can occur when either the heart or the brain stops working.

Organs for transplantation purposes are removed only after brain-stem death has occurred.

How does brain-stem death occur?

When the brain is injured, it swells – just as an injury like a twisted ankle. Unlike the muscles and tissue of the ankle, however, the brain is in a confined space – the skull – and has no room to swell.

Brain-stem death usually results occurs when a person suffers a severe brain injury or brain haemorrhage which causes all the brain activity to stop. This can happen after a major road accident or a bleeding in the brain due to stroke. Any of these injuries can deprive the brain of oxygen, causing it to swell. The action of the brain swelling inside a closed space and the build-up of pressure is what can ultimately lead to brain death. As the brain swells inside the skull, it pushes downward toward the brain stem blocking all upward flow of blood.

Does the law permit organ retrieval only upon brain-stem death?

The 1994 law on human organ transplantation has recognized brain-stem death as a form of death. The rationale behind organ retrieval upon brain-stem death is a matter of medical viability and not a legal requirement.

It is important to understand the difference between Cardiac Death (the usual form of death where breathing and heartbeat stops) and Brain-Stem Death.

How is brain-stem death confirmed?

In order to make organs harvestable upon occurrence of brainstem death, the Transplantation of Human Organs Act, 1994 makes it mandatory for brain death to be certified after independent evaluation by 4 different physicians who form the Board of Medical Experts (or the Brain Death Committee). This declaration is legal.

The following process is followed:

(a) A Brain Death Committee is formed with the following medical experts:

1. Medical Administrator In-charge of the hospital
2. Authorized Specialist
3. Neurologist/ Neuro Surgeon
4. Medical officer treating patient.

(b) Of the above, Nos.2 and No.3 are co-opted by the administrator in-charge of the hospital from the panel of experts approved by the Appropriate Authority.

(c) Such co-opted doctors must not be working with the hospital or medical institution where the patient is being treated

(d) Such two doctors can certify brain-stem death only upon performing the following 7 tests:

Each member of the Brain Death Committee performs simple yet conclusive tests to check for brain-stem reflexes. The certification of brain-stem death is given as per Form No.8 under the Transplantation of Human Organs Rules (see Appendix B).

The tests to confirm brain-stem death first consists of ruling out any reversible coma. Thereafter, the following normal responses are looked for. For a person to be certified brainstem dead, ALL responses have to be absent on at least two occasions with an interval of 6 hours between them:

1. Pupillary light reflexes – The eyes constrict in response to light
2. Corneal reflexes (both sides) – The eyes blink in response to stimulation of the cornea
3. Grimacing in response to painful stimuli in the form of firm pressure applied just above the eye socket
4. Cough or gag reflex – There is coughing or gagging in response to a suction catheter being passed down the lungs.
5. Movements of the eyes in response to the ears being flushed with ice water.
6. Doll’s eye movement or movement in the eyes when the head is turned from right to left or up and down.
7. Apnoea test – to test whether the patient breathes spontaneously the ventilator being withdrawn. This test is conducted by administering 100% oxygen for 10 minutes to ensure that the patient will not suffer serious oxygen deprivation while being disconnected from the ventilator.

The above tests that are undertaken in order to confirm brainstem death. These tests are accepted medically, legally and ethically the world over.

Who can sign a Living Will?

It is practically possible for anyone to make a Living Will – regardless of age and sex – simply because one may meet with death anywhere, anytime.
It is possible even for diseased persons to donate their organs.

What do the religions say about organ donation?

Buddhism: Leaves organ donation to each individual’s choice. At the same time, it considers organ donation as the highest form of compassion.

Hindu Religious Tradition: Hindu texts record instances where parts of the human body are used for the benefit of other humans and society. Such examples of “noble giving” are noteworthy given that in those days of old, scientific advancements such as today were yet to take place.

Islam: For a Muslim, the sacredness of life is second only to love of the Creator of life, Allah. Given that it is priority to nurture and save human life, the various schools of Islam welcome and permit organ donation as a means to attain that noble end.

Jainism: Jain religious leaders consider eye donation as a sublime form of charity and stress a powerful link between ‘daan’ (charity) and ‘moksha’ (salvation). Highest eye donation rate in India among Jains of Gujarat.

Judaism: All four branches of Judaism – Orthodox, Conservative, Reform and Reconstructionist – support and encourage organ donation. The Jewish religion considers that if one is in the position to donate an organ to save another's life, it's obligatory to do so.

Sikhism: "Where self exists, there is no God. Where God exists, there is no self," says the Guru Granth Sahib – the sacred scripture of the Sikhs. The Sikh religion places great emphasis on the importance of giving and putting others before oneself. Therefore, the importance of saving a life is considered one of the greatest forms of noble deeds. Therefore organ donation is deemed acceptable to the Sikh religion.

Lutheran Church: In 1984, the Lutheran Church in America passed a resolution stating that donation contributes to the well-being of humanity and can be "an expression of sacrificial love for a neighbor in need." They call on members to consider donating organs and to make any necessary family and legal arrangements, including the use of a signed donor card.

Seventh-Day Adventists: Donation and transplantation are strongly encouraged and propagated by Seventh-Day Adventists. In fact, in some countries, they run transplant hospitals.

Pentecostal: Pentecostals believe that the decision to donate should be left up to the individual.

Baptists: Baptists generally believe that organ and tissue donation is ultimately a matter of personal conscience and call for “voluntarism regarding organ donations in the spirit of stewardship, compassion for the needs of others and alleviating suffering."

Episcopal Church: The Episcopal Church passed a resolution in 1982 that recognizes the life-giving benefits of organ, blood and tissue donation. All Christians are encouraged to become organ, blood and tissue donors "as part of their ministry to others in the name of Christ, who gave His life that we may have life in its fullness."

Greek Orthodox Church: The Greek Orthodox Church is not opposed to organ donation as long as the organs and tissue in question are used to better human life.

Jehovah’s Witnesses: Jehovah’s Witnesses believe organ donation is a matter best left to the individual’s conscience.

Roman Catholic Church: The debate within the Roman Catholic church on the moral propriety of organ donation commenced in 1954 – the year when the world’s first kidney transplantation was conducted.
Theologians were divided on this issue.

One school thought organ donation to be an effective expression of love for others and favoured organ donation as a way of witnessing to Jesus’ words and action in the scripture “love one another as I have loved you (John 13:34).” The dissenting school argued against organ transplantation on the grounds that it could adversely affect the future well-being of the donor. They insisted that a damaged part of one’s body could be removed but not a healthy part.

In 1957, Pope Pius XII declared ("The Prolongation of Life", November 24, 1957) The Pope Speaks 4:4 1958) that death is determined by medical experts and it "does not fall within the competence of the Church." Thereby, ‘brain death’ came to be accepted in Catholic medical ethics – long before the recognition of ‘brain death’ as death!

Pope Pius XII further declared that - based upon the principle of fraternal charity - both living and cadaver donations are acceptable to the Catholic Church. The Pope went on to introduce four basic principles to guide reflection, considering that the end does not justify the means.

i. The donor should be in physical and moral disposition in order to perform the obligation of preserving the recipient’s life. For instance, the donor should not be deprived of a healthy organ, even to delay the death of the recipient.

ii. The physical and psychological risks incurred by the donor must be proportionate to the good sought for the recipient.

iii. The donor must be aware of these risks and the proportionate good. The donation he makes should give him fulfillment.

iv. Informed consent should have been legitimately given by the donor or his duly authorized representative.

The Catechism of the Catholic Church explains that “it is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of the other persons” (no. 2296).

Following this, Pope John Paul II declared concerning donations after death:

  • "The Catholic Church would promote the fact that there is a need for organ donors and
  • That Christians should accept this as a 'challenge to their generosity and fraternal love'
  • So long as ethical principles are followed."

On 29 August 2000, Pope John Paul II in his address to the 18th International Congress of the Transplantation Society stated:

  • "Transplants are a great step forward in science's service of man, and not a few people today owe their lives to an organ transplant.
  • Increasingly, the technique of transplants has proven to be a valid means of attaining the primary goal of all medicine - the service of human life
  • Any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an "object" is to violate the dignity of the human person.

Pope John Paul II sums up the position of the Church in these words:

“The Gospel of life is to be celebrated above all in daily living, which should be filled with self-giving love for others … Over and above such outstanding moments, there is an everyday heroism, made up of gestures of sharing, big or small, which build up an authentic culture of life. A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope (Evangelium Vitae, no. 86).”

Commercial dealing in human organs is illegal –punishable

The Transplantation of Human Organs Act of 1994 allows for donations of organs but outlaws buying and selling of organs.
The law prescribes punishment for those dealing commercially with human organs viz. 2 to 7 years rigorous imprisonment and fine from Rs.10,000/- to Rs.20,000/-.
In the 10 years since the enactment of this law up to 2003, a mere 450 persons made organ donations. Only 18% of these had signed a Living Will to donate organs after death.

Living Related Donor

Spouse (Husband/Wife), son, daughter, father, mother, brother, sister. Such donor should be 18 or above and may donate without any special permission to make such donation.

Living Unrelated Donor

Though living donations may be made by donors unrelated the recipient, the law entails that the donor must be known to the recipient in some way. For instance, the donor could be someone who has been in the service of the recipient or someone who has affection or attachment towards the recipient.