Autonomy, Beneficence, Non-maleficence and Justice are four fundamental pillars of medical ethics.
Organ Donation is a DONATION. In various cultures and religions, donation is seen as a service to society and is considered as a noble act. It’s altruistic — meaning there shouldn’t be any kind of exchange of anything of monetary value in disguise of gifts between the donors and recipients — it would imply commercialisation of organs and it is illegal. The only cost born by the recipient is the cost of transplant surgery of the recipient. The costs of organ retrieval surgery of the deceased donor are covered by the recipient’s institution, government, or other designated parties — not the donor’s family. No additional costs are born by the donor family apart from the clinical treatment costs of the donor prior to death.
The Consent and Counselling
All Non-Transplant Organ Harvesting centres and Transplant centres should employ trained transplant counsellors to help the families of donors in grieving and helping with through out the donation process. This is the most important requirement but not all centres are compliant yet. The main focus should be on helping grieving families who are going through emotional distress. The consent taken from families should not be rushed nor coerced. Family should be disclosed with all the details regarding the organ donation process and what happens to the donor’s body after organ retrieval.
The autonomy of the donor must be respected and to ensure that, consent should be given voluntarily by the donor. If consent taken by coercion, extortion, commercialisation or by forcing the donors is proven legally, the consent is vitiated. In such cases consent will not be valid.
The vulnerable group of people that are systematically marginalized(belonging to lower socio-economic groups), prisoners, homeless people and victims of organ trafficking should be protected.
The consent for organ donation can be revoked at any stage of living organ donation. In deceased organ donation, consent given by the family, due to legal and clinical constraints, cannot be revoked once the organ retrieval surgery begins.
Talking about Organ Donation with Family and Friends
If you are serious about donating your organs in India, it’s important to discuss it with your family and next-of-kin. The ultimate decision of whether the organ donation will take place or not solely depends on the consent of the family. You should let your family and next-of-kin know your wishes regarding organ donation, and make sure to have meaningful discussions regarding organ donation. This article series will serve as a guide to know about organ donation but it can be difficult to understand all the nuances of the organ donation right away. It’s an ongoing process of learn, unlearn and relearn.
1 in 5 registered donors may not be able to donate due to family refusal or clinical unsuitability.
What it means to be a registered organ donor?
Registering as an organ donor is taking up the personal ethical responsibility of maintaining updated information and communication with family till the day of organ donation. As an organ donor it’s your responsibility to stay and maintain a healthy lifestyle, discuss about organ donation with your friends & family and make sure to demystify myths & familiarise the notion of organ donation to your friends and family.
Organ donation can help families with grieving for their loved ones, by offering a sense of meaning and legacy in the face of loss. Knowing that their loved ones donated organs have helped save or improve the lives of others provides many families with emotional comfort, a sense of continuity, and the feeling that their loss was not in vain. It often becomes a source of pride and solace, transforming personal tragedy into a life-affirming act of generosity.
The Demand and Supply Gap
As per NOTTO (2023), approximately 15,000 organ transplants were performed in India, but estimated demand exceeds 200,000 annually. This gap is not compensated even with the numerous live organ donations in India. No country in the world fully meets the demand for organ donation and transplantation. The number of patients on transplant waiting lists far exceeds the number of available organs globally. According to the World Health Organization (WHO), even in countries with established opt-out systems like Spain (the global leader in organ donation rates), the supply still falls short of meeting clinical needs. The gap between the supply and demand can be narrowed down by encouraging people to get registered voluntarily as deceased organ donors by spreading awareness and educating about the organ donation.
A hybrid model of live and deceased organ donations with lower live organ donation rates should be the ideal goal. This model is not yet adopted nor any kind of guidelines for implementation of this model exist yet in India, justifying the higher number of living organ donations over deceased organ donation. The shift from live to deceased organ donation is in progress and we are already seeing strides with successful SOTTO programs of Telangana and Tamil Nadu. Telangana with its flagship Jeevandan Programme has highest deceased donation rate in India.
“I sold my kidney to buy an iPhone” meme implies Organ Trafficking
This is glorification of commoditisation of human body and organs. This blurs the line between altruistic organ donation and organ trafficking. There are instances where NOTTO has issued advisory against the use of organ donation for misleading sensationalism in social media which directly disrespects altruistic organ donors. (7)
This can be a meme for many, but there are real people behind the stories of organ trafficking and commoditisation of organs and tissues of vulnerable and socio-economically marginalised group of people.
This meme is ethically diabolical as it does not respect all the four aspects of the medical ethics.
India has witnessed several disturbing instances of organ trafficking in recent years, exposing systemic vulnerabilities and exploitation of the poor. In Hyderabad, an inter-state kidney racket lured individuals from Tamil Nadu with false job promises, offering them up to ₹5 lakh while brokers profited significantly. (1) In Kolkata, a lawyer was caught facilitating fraudulent kidney transplant affidavits, misusing legal loopholes since 2014. (2) Jaipur reported a case where a woman was abducted and coerced into signing documents to sell her kidney. (3) Transnational trafficking networks have also emerged, with the NIA uncovering a racket that sent Indian donors to Iran under false pretences. (4) In Delhi, a surgeon was arrested for performing illegal transplants for Bangladeshi nationals using forged documents. (5)
These cases highlight how coercion, document forgery, and institutional complicity enable trafficking networks, emphasizing the urgent need for tighter regulation and public awareness.
How the authorities eliminate distribution bias of deceased organ donor organs?
In India, the distribution of deceased donor organs is overseen by NOTTO (National Organ and Tissue Transplant Organisation) along with SOTTOs at the state level. To eliminate bias, a centralized computerized registry maintains a waiting list based on objective medical criteria like urgency, tissue compatibility, and time on the list. Allocation follows a defined priority protocol — first within the same hospital, then city, state, and finally across India if no match is found locally. The process is transparent, regulated under the Transplantation of Human Organs and Tissues Act (THOA), and monitored to prevent favouritism, ensuring equitable access regardless of socioeconomic status.
Steve Jobs reportedly received a liver transplant in 2009 in Memphis, Tennessee. Although he was a California resident, he got listed in multiple states (a legal but controversial practice called multiple listing) to increase his chances. Tennessee had a shorter waiting time and higher organ availability, which made him eligible sooner.
This led to ethical debates about fairness in the U.S. organ allocation system, as wealthier individuals can afford to register in multiple states, travel quickly, and receive organs faster—raising concerns about equity in access to transplants. (6)
Debunking Myths
Spreading awareness
Awareness campaigns must be held to promote and spread the word about organ donation. In UK as part of a Behavioural Insights Team (UK) trial, to help boost the number of driver license applicants registering as organ donors, they added a moral-hypothetical conditional statement, “If you needed an organ transplant would you have one? If so, please help others” to the organ donor registration section of driver license application forms. The narrative of using, “If you needed an organ transplant would you have one? If so, please help others.” was more effective than using, “1 organ donation can save 7 lives”.
Making the “Decision”
Making the decision to register as an organ donor was not easy for me. Thoughts like, “What if I end up with no organs in after life?” and “What if the organ donation process is too complex for my family to handle in tough times?” made me hesitant.
After learning how organ donation has more pros than cons when viewed from the grieving family and friends perspective, and how medical institutions and counsellors deal with the entire organ donation process with utmost empathy and dignity while taking family’s emotional wellbeing into account, I was convinced to take the final step and get myself registered as an organ donor.
Now we are familiar with the ethical concerns related to organ donation. This article concludes this comprehensive 3 part series on Why it took me a month to get registered as a Deceased Organ Donor?
I hope you will take your time in discussing about organ donation and register as an organ donor.
How to register as an organ donor in India?
Enter your Aadhar number to login.
Enter your details and your next-of-kin details — mentioned as emergency contact.
Select the organs and tissues you want to donate.
Click submit.
You will receive a organ donor registration certificate as a confirmation of your registration.
AI Disclosure
This article series is the original work of the author. AI tools such as ChatGPT were used only to identify and correct factual inaccuracies.
Postscript
This article is for educational purpose only. This is an effort to raise awareness about organ donation and the potential of 1 organ donation in saving 7 lives and improving quality of life of many more. Do not take this decision impulsively. Discuss about organ donation with your family and friends before registering yourself as an organ donor.
If you needed an organ transplant would you have one? If so, please help others.
Register as an organ donor here https://notto.abdm.gov.in/register
References and Resources
2 more accused held from Chennai in inter-state organ trafficking case | TimesOfIndia
Lawyer held in kidney racket case | TimesOfIndia
Woman alleges attempt to force organ sale in city | TimesOfIndia
NIA chargesheets four in international organ trade racket case | TheHindu
Surgeon at 'cash for kidneys' hospital linked to new organ trafficking claims | TheTelegraph
How To Get A Liver When You Need One | Forbes
NOTTO urges everyone not to use noble cause of organ or cornea donation for creating misleading content on social media | NOTTO
On the Way to Self-sufficiency: Improving Deceased Organ Donation in India | TheTransplantationSociety
Uniform Determination of Death Act (1981, USA) | UniformLaws.org
Modified Maastricht classification of DCD | ScienceDirect
Data of Organ Donation and Transplantation 2013-2023 | MohfwReport
Organ Donation: from Death to Life | Coursera
Timeline of perception of death | DeekshithVodelaSubstack
Supreme Court simplifies procedure to withhold life support of a terminally ill patient; Modifies guidelines given in 2018 Euthanasia Judgment | SCConline
The Current Scenario Of Kidney Transplants In India | NarayanaHealth.org
Management of the brain dead organ donor in the operation theatre (OT) | MoHFW
National Organ and Tissue Transplant Organisation | NOTTO
Jeevandan portal | Jeevandan
Jeevandan Transplantation Guidelines of Telangana state | DMETelangana
The Transplantation of Human Organs and Tissues Act, 1994 | IndiaCode
NOTTO organ donation statistics information | NOTTO
Data of Organ Donation and Transplantation 2013-2023 | MohfwReport
Standard Operative Procedure | MoHFW
Management of the brain dead organ donor in the operation theatre (OT) | MoHFW
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