By clicking Submit, I agree to have read & understood the Terms & Conditions and Privacy Policy of Narayana Health.

Organ Allocation process in India

Health is a State subject in India, and owing to the importance of organ donation, each state has its own Nodal Agency in charge of the allocation of human organs. Each Nodal Agency is connected to all the Transplant Hospitals in the State. All hospitals are required to have their own website linked to the State Nodal Agency so that the hospital waiting list for all organs is automatically linked to the State Nodal Agency. State Nodal Agency needs to be linked to the concerned Regional Organ & Tissue Transplant Organisation (ROTTO) and that ROTTO lists in turn are to be linked to the National Organ & Tissue Transplant Organisation (NOTTO). This will form the National Waiting-List Registry.

In the event of a brain stem death, once the family has agreed to organ donation, the hospital informs its own Nodal Officer in charge of organ donation about the death and the willingness of the family to donate. Of the paired organs such as kidney and lungs, one of each is used by the hospital fora patient on its waiting list and the other is offered to the common pool which will be allocated by the Nodal Agency to one of the patients in another hospital.

The rest of the organs (heart, liver, intestines and pancreas) can be used by the donor hospital if the hospital is registered to perform the transplant of the particular organ and if they have patients on the waiting list. If they do not have patients on their waiting list, then the organs are offered to the common pool and the Nodal Agency will decide their distribution. It is rare to have all recipients in the same hospital.

As per the government’s allocation policy, if organs are retrieved from a government hospital and offered to the common pool, then they will be offered to a government hospital first and if there are no takers in any government hospital, they are then offered to private hospitals. Likewise, if the organs are retrieved in a private hospital, then they will be offered to a private hospital first.

In the event of a trans-state allocation, the concerned ROTTO as well as NOTTO will be informed and they will oversee the allocation of the organs.

What is organ donation?

Organ donation is a process of retrieving an organ from a living or deceased person, who is referred to as a Donor and transplanting it into a recipient. The recipient is a patient who is suffering from organ failure and will not survive unless he or she undergoes replacement of the diseased organ. The process of recovering organs from a living or deceased donor is called Retrieval.

Types of organ donations?

There are two types of organ donations – Living Organ Donation and Deceased Organ Donation.

Living Organ Donation

In the process of living organ donation an organ is retrieved from a healthy person and transplanted into the body of someone who is suffering from end-stage organ failure. This is usually done in the case of liver or kidney failure because the liver can grow back to its normal size and a donor can survive on one kidney (Nature has given us an extra kidney!).

Living donors are classified as either - near relative or a distant relative/friends etc.

A near-relative is spouse or a blood relative like son/daughter, brother/sister, parents, grandparents and grandchildren.

Those other than near-relative can be distant relatives and friends. They will need the permission of the State Authorization Committee to donate organs.

Deceased Organ Donation

Deceased Organ Donation is donation of organs after death of the person. This is the process of organ donation from a person who has been declared brain-dead by a team of doctors at a hospital. A person is said to be brain-dead when there is an irreversible loss of consciousness, absence of brain stem reflexes and irreversible loss of the capacity to breathe. In India, organ donation after death is only possible after the person has been declared brain dead.

Although organ donation after cardiac death is common in western countries, it is uncommon in India.

The process of organ donation from a living person has been standardized in India and is performed routinely in several centres. However, if deceased organ donation can be increased in India, this could benefit a large number of sick patients and give them a fresh lease of life.

What organs can be donated after death?

All organs and tissues that are viable can be donated after a person dies.

What is the process of organ donation?

Living Donation Process

The donor will have to undergo medical tests and evaluations to confirm that he or she is compatible with the recipient for organ donation.

The donor’s medical compatibility is confirmed by a doctor. Only after all the tests have confirmed that the donor is compatible with the recipient, the transplant can take place.

The donor’s organs are retrieved (removed) surgically by doctors. They are stored in a special solution briefly until they are transplanted into the recipient.

After the operation, the donor usually remains under medical care for 5-7 days or until he or she is fit to go home.

Deceased Donation Process

A deceased donor is usually someone who has suffered a fatal injury to the head and has been declared brain stem dead by a group of medical experts in a hospital.

Only after the donor’s family has provided consent for organ donation, the process of organ retrieval(removal) can be carried out. The donor is kept on life-support by doctors until the operation is performed.

Alongside this process, suitable recipients for the organs are identified from a waiting list of patients. They are notified and asked to reach their respective hospital.

After retrieval of organs, the donor’s body is respectfully handed over to the family.

Brain Death and Organ Donation:

What is Brain stem death and how is it related to organ donation?

Brain stem death or brain death results from a severe irreversible injury to the brain or hemorrhage within the brain which causes all brain activity to stop. All areas of the brain are damaged and can no longer function due to which the person can no longer sustain his or her own life. However, vital bodily functions like oxygenation, heart beat and blood pressure can be maintained by doctors with the help of artificial support system using medicines and machines. This maintains blood circulation to vital organs. Patients classified as brain stem dead can have their organs surgically removed for organ donation.

Procedures for Brain Stem Death Declaration in India

In India, organ donation after Brain death is strictly regulated. According to the provisions of the Transplantation of Human Organs & Tissues Act (THOTA), 1994 the protocol for declaration of brain stem death or brain death has been defined. Any organ donation process must involve the following steps before the actual transplant can occur:

A panel of four doctors of which two are approved by the government, need to declare brain stem death. This test has to be done twice, with a gap of 6 hours between the first and second test.

This panel of doctors include:

1) A Registered Medical Practitioner who is in charge of the hospital where the brain stem dead patient is admitted.

2) A Registered Medical Practitioner who have been approved by the Appropriate Government Authority.

3) A Neurologist or Neurosurgeon. (If a Neurologist/Neurosurgeon is not available to carry out the tests, then a Surgeon or Physician and an Anaesthetist or Intensivist is nominated by the medical administrator in-charge from the panel who have been pre-approved by the Appropriate Authority).

4)The Registered Medical Practitioner treating the deceased. Results of the tests are recorded on Form 10 of the THOTA Act 2014. The family’s consent is obtained on Form 8.

This Organ Donation Procedure is followed strictly. The certifying clinicians should have no interest or benefit from the transplantation. The legal time of death is taken as the second set of brain stem death tests. The certification is done on forms as per the THOTA Act. The medical director or medical superintendent of the hospital should finally counter check and sign the form. Only after these formalities have been completed, the organs can be retrieved.

Should Organ Donors Talk to Their Families?

Yes, it is important to talk to your family about your decision to become an organ donor. Under Indian law, organ and tissue donation cannot take place without the written consent of the donor’s family. Therefore, discussing the reasons behind the decision to be an organ donor can help the family understand their desire to do so. For example, if they have been inspired by a story of organ donation, they could narrate this story to their family so that they understand the sentiment behind their decision. This will make the family more likely to go along with the donor’s decision, when the time arises.

In India, it is the the next of kin of the donor who makes the final decision to donate the organs. Even if you have pledged your organs for donation, no donation can take place unless the next of kin signs the forms. Therefore, when you register to be an organ donor, it is very important that you discuss your wish to donate with your family. This is to enable your family to carry out your wishes when the time arises.

Can anyone donate organs? Are there any conditions under which organ donation is not possible?

Generally, there is no bar to organ donation and organs or tissues can be donated at any age. The only people who cannot donate organs are those who have cancer, HIV or infection in the bloodstream or body. However this is not a hard and fast rule. There have been instances where one HIV positive person has donated to another HIV positive patient.

However, it is important to do some essential virology screening before accepting the donor. All potential donors will require a virology screen to prevent transmission of diseases to the recipient. The next of kin should be made aware that this is necessary. If there are any objections to the donation by doctors, these should be respected.

Decisions about the usability of an organ is made at the time of death of the donor, or, in the case of living donors, during the pre-transplant screening stage.

Current situation in India

Unfortunately, mostly due to unawareness and prejudices, there is a huge shortage of organs that are needed for transplants. It has been seen in umpteen situations that relatives are hesitant and unwilling to donate the organs of their loved ones who have been declared brain dead.

Normally the transplant coordinator will approach the relatives with information about organ donation and explain that even in their time of loss, they can help another person to live. It is tough for the relatives at this point to come to a decision especially if they are not familiar with the concept of organ donation. This is the main reason why it is important for the public to know about organ donation, before they are suddenly faced with the possibility at some point in their lives.

It is estimated that the total number of brain stem deaths due to accidents in India is nearly 1.5 lakhs annually. Other causes of brain stem death would potentially add many more numbers. However, our organ donation rate is 0.86 per million population.

Contrast that to the demand for human organ donation, there is a need of approximately 5 lakh organs annually. Barely 2-3 percent of the demand is met, and many people die of organ failure every year across India.


Myth: What if I recover from brain death ?

Fact: It is impossible to recover from brain death - it is not the same as coma. In coma there’s activity in brain. In brain death, the person is dead. There is no activity in the brain.

Myth: : If the family agrees to organ donation, doctors will not try hard to save the patient.

Fact: When a patient is declared brain dead, doctors focus on saving your life - not somebody’s life. The option to donate organ is offered only after the person declared medically dead.

Myth: The donors family have to pay more money to the hospital.

Fact: After declaration of brain death, if you agree to donate organs, the hospital bears all expenses of artificially supporting the donor.

Myth: Religions forbid organ donation and transplantation

Fact: All major faiths support organ donation as a humanitarian act. All religious leaders have also endorsed organ donation.

Myth: Organ donation means my body will be mutilated badly

Fact: Donated organs are removed surgically with one incision from the top of the chest to the navel, which does not disfigure the body. Also since the donor’s body is clothed for cremation, there are no visible signs of donation.

Myth: Once I become an organ donor, I can never change my mind

Fact: This is not true, you always have the option to change your mind and withdraw your registration. It is always your next of kin who will ultimately decide, if you donate your organs after brain dead.

Myth: I’m too old to be a donor

Fact: Nobody is ever too old or too young to give the gift of life. Once consent is give, it is purely based on specific medical criteria not age.

Myth: My health is not very good. Nobody would want my organs or tissues.

Fact: Anyone can be considered for organ and tissue donation. At the time of death, medical professionals will determine a person’s eligibility to become an organ and/or tissue donor.

Myth: Celebrities and rich people on the waiting list are on priority for receiving an organ.

Fact: To be placed on the national/regional organ transplant waiting list, medical data must be presented documenting the individual’s need for a transplant. Organs are then allocated to those on the national/regional waiting list according to medical need, blood and tissue type matching, height and weight. Celebrity status and wealth are not considered.

About Narayana Health

Founded in 2000 by renowned cardiac surgeon Dr. Devi Shetty, Narayana Health is one of India’s largest hospital networks with hospitals and heart centres across the country and an international hospital in the Cayman Islands. The group’s facilities provide advanced medical care in over 30 medical specialities for all ages.