Organ transplantation has not been able to achieve its full potential due to an absolute shortage of organs. The National Organ and Tissue Transplant Organization (NOTTO) has been set up in India with the main objectives of promoting deceased organ donation thus preventing commercial trade and creating a national registry. The deceased organ donation rate (DODR) in India is less than 1 and the goal of NOTTO is to take this higher by increasing the actual number of people consenting for donation in principle and in actuality. Nation-wide and year-round awareness activities are conducted by NOTTO along with regional organizations (ROTTOs) and state organizations (SOTTOs) under it to improve the number of donor pledges. To promote brainstem death declarations and to achieve a higher donor conversion rate (i.e. from eligible to actual donor), training of intensivists and anesthetists is being undertaken to educate the medical community about the medical and legal provisions of brainstem death declaration. To integrate organ donation in the process of end-of-life care, the Transplantation of Human Organs and Tissues Act 1994 has made “Required Request” mandatory, whereby patients and their families are offered the opportunity to donate organs and tissues of their next of kin as part of the standard ICU care.

Yet, the ODR remains proportionately low due to a plethora of reasons. Brainstem death (BSD) declaration by neurological criteria is not a routine or popular practice amongst the medical professionals. Donation after cardiac death (DCD) is performed in only one center in the country. Issuance of government orders making declaration of BSD mandatory in all hospitals might prove helpful. The use of the term ‘Potential Donors’, so that the full potential of patients who have a high probability of becoming deceased donors is tapped, is also being encouraged. Another strategy is the use of “marginal donors/organs” and split grafting techniques (in case of liver).

The geographical differences in ODRs across a single nation are also noteworthy. Literacy rate, duration of establishment of sub-specialties, cultural and religious practices, socio-economic factors, access to healthcare and ease of organ transport are just a few of many responsible factors.

The Hindus and the Muslims believe that the human body should not be desecrated or tampered with after death. There is scarcity of faith in the healthcare system; public also believes that if you consent to be an organ donor, the doctors will not make enough effort to save you and let you die. These religious practices and misconceptions further lower an already plummeting deceased organ donation rate.

Despite the continuing doubts in peoples’ minds, the universal concept of “If we can save the lives of others, why not? It is a beautiful thing”, prevails. This is in keeping with teachings of Lord Krishna to Arjuna in the Bhagawada Gita, “yad yad ācharati śhreṣhṭhas tat tad evetaro janaḥ sa yat pramāṇaṁ kurute lokas tad anuvartate”,which means “The common people emulate the good actions of great leaders.”