Dear Editor:

India is a country of varied religious beliefs and faiths. It is even more so in the context of life and birth. The organ donation rate in India is at a staggering low of 0.65 per million population,1 and continual efforts are being done to raise awareness and improve its rate. The government of India has actively supported this cause by setting up of the National Organ & Tissue Transplant Organization (NOTTO), which carries out promotion of organ donation, setting up of systems, and training of workers.

However, what hospitals in India still lack is spiritual support to the patient’s family. The mention of brain death is quite overwhelming, and only a few can think rationally when asked to consent for donation of organs. Beyond doubt, the treating physician should be empathetic; however, the physician is not the right person to provide spiritual support. The myths and beliefs associated with organ donation are many and vary among different religions. Although there is mention about involvement of religious leaders in raising awareness about this noble cause, we still have not been able to achieve this involvement. In many countries outside India, there are posts for hospital chaplains who provide emotional and spiritual support to anyone who needs it, in both recovery and ill health for patients and their families during hospitalization. A significant number of chaplains have been involved in organ procurement issues with patients and/or their families in some way.¹ Their tacit experience and spiritual support at end of life can significantly affect decisions involving organ donation.

In India, we do not have trained chaplains in hospitals to provide holistic support to patients and families. There is need for someone who can patiently hear their concerns, respect their beliefs, and even clarify myths around organ donation. The trust built with chaplains can facilitate decision making, keeping in mind the ethical and spiritual needs. The incorporation of trained hospital chaplains in India can be a step forward in organ procurement. In an online survey conducted at 5 chaplain institutions in the United States, the authors observed that 56% of the respondents had encountered religious objections to brain death, and they needed to receive additional education to make them more prepared for such kinds of situations.² Training of hospital chaplains should include continuing education on the medical aspects of organ donation in addition to providing religious support in times of need. Hospital chaplains can be a link between the physician/medical staff and the patient’s family,³ not only for effective communication but also for respectful organ procurement. For this, we need dedicated personnel catering to the needs of different religious sects who can be educated and involved in communication with families of patients after brain death. This can be a challenge in India where we need personnel who can identify with separate religious sects. While we request the government of India to initiate steps in this direction, the local hospital authorities can seek help from nonprofit organizations to involve people educated in theology for this noble cause.

References:

1. Carey LB, Robinson P, Cohen J. Organ procurement and health care chaplaincy in Australia. J Relig Health. 2011;50(3):743-759. doi:10.1007/s10943-009-9279-1
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2. Lewis A, Kitamura E. The intersection of neurology and religion: a survey of hospital chaplains on death by neurologic criteria. Neurocrit Care. 2021;35(2):322-334. doi:10.1007/s12028-021-01252-x
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3. Carey LB, Cohen J. Chaplain–physician consultancy: when chaplains and doctors meet in the clinical context. J Relig Health. 2009;48(3):353-367. doi:10.1007/s10943-008-9206-x.
   CrossRef - PubMed