Cultural Acceptance of Organ Donation in India

There are two aspects to the cultural acceptance of organ donation in India: public acceptance and professional acceptance. Both are current impediments to widespread knowledge about organ donation and deceased donor transplantation in India today, but these impediments are surmountable. There are many advantages of organ donation after death. Organs that can be donated include the heart, lungs, liver, kidneys, pancreas and small bowel. Tissues that can be donated include corneas, heart valves, blood vessels, bone, tendon and skin. A single deceased donor can save or vastly improve the lives of more than 50 people. Hundreds of thousands of Indians suffer from end stage organ failure of the heart, liver or kidneys due to chronic diseases such as hypertension, diabetes and fatty liver disease. The potential benefit to the transplant recipients is obvious. Perhaps less obvious is the benefit to the deceased donor and the donor’s family. The miraculous act of organ and tissue donation brings profound meaning to the memory of the donor’s life and gives great comfort and closure to the family members in an otherwise tragic situation. The donor lives on in others. This is reincarnation in it’s most literal sense, isn’t it?

So what really are the barriers to cultural acceptance of organ donation in India?

Many argue that religious beliefs constitute the toughest barrier to overcome for cultural acceptance of organ donation in India, but there is much evidence to the contrary and all major religious traditions (Hindu, Muslim, Jain, Sikh, Christian, Zoroastrian and Buddhist) support an individual’s decision to pledge and/or become an organ donor. There remain, however, various levels of acceptance based on one’s religious affiliation. Most Muslims, Orthodox Jews, and Confucian/Shinto Asians are unlikely to consent to organ donation, whereas most Christians accept organ donation freely. Hindus, despite their strong beliefs in reincarnation, often accept the idea of organ donation out of their belief in Daan, or helping those who suffer. Jains and Sikhs are even more welcoming of organ donation because of Daan.

“Religious objections” to organ donation often have more to do with one’s education on the subject rather than one’s personal religious views. For example, organ and tissue donation and transplantation are allowed according to the Supreme Council of Ulama in Riyadh’s resolution (no.99 dated 6 Dhul Qa'dah 1402). A recent review of 70 fatwas by C van den Branden and Broeckaerton all supported organ donation. Muslim families often consult with their Imams when confronted with a need for organ donation and the Imams themselves may or may not be familiar with all fatwas and impart only their personal opinions (which are, of course, duly followed by the family). This lack of awareness can and does happen in any religion, so focused and informed educational efforts must be undertaken for each individual religious tradition.

Brain death is medically and legally recognized in India as constituting actual death, despite the fact that the heart continues to beat for a period of time even though the brain is dead. Declaration of brain death can be difficult for lay people to understand and there even exists widespread misunderstanding of brain death among physicians.

As in the West, cultural acceptance of organ donation is age dependent in that young people are far more likely than older people to embrace the idea of organ donation, especially when presented with accurate education focused on youth. There is a natural tendency for young people to want to help others and make the world a better place. Organ donation, when explained properly, resonates with youth as a just cause. Studies show that even those as young as 16 years respond positively to organ donation efforts. If youth-focused education campaigns are properly and systematically implemented, it is quite possible that organ donation could become culturally accepted in India within one generation.

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The professional acceptance of organ donation in India, especially among medical professionals, is at present a more severe barrier to a general cultural acceptance. Non-transplant medical professionals generally look upon transplant with suspicion and tempered disdain. This is because transplant is currently an economically driven affair in which recipients pay entirely for their transplants and for their donors’ surgeries. Because of this suspicion, neurosurgeons, neurologists and critical care doctors are reluctant to declare brain death, the absolute prerequisite to considering organ donation.

There is even a curious reluctance among many transplant professionals in India to embrace deceased donor transplantation and organ donation. Whether this is due to their satisfaction with the current economic state of living organ donation transplant, a reluctance to take on more work or a fear of legal retribution is unclear and likely unknowable.

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What needs to be made clear to everyone are the benefits of organ donation and the donor transplant program in India. First, transplant volumes would greatly increase, allowing more people with end stage organ failure to be transplanted. Second, transplant in India could become “democratized” if sufficient deceased donor activity took place in the government hospital setting. Here, even the poorest of Indians would have access to this life saving endeavor. Finally, the possibility exists to cease, or at least greatly temper, the illegal organ trade in India. If enough organs became available from family consented brain dead individuals, then there would be no need for a recipient to seek out a donor through illegal means.