1. What is organ donation?
Organ donation is a gift or an organ to a person who has irreversible permanent damage of that organ. Irreversible damage means that damaged organ cannot recover its function by any other treatment.
2. What all organs can be transplanted?
Many organs in the body can be transplanted. These includes but not limited to, kidney, liver, heart, lung, pancreas, small bowel, uterus etc. Techniques are improving with passage of time and we may soon be able to transplant many other organs of the body to help even more people.
3. Can damaged organ in body not recover?
In the body, various organs have got different capacity of recovery. Some body tissues and organs can recover while others not. Also, usually acute damage of the organs has more chances of recovery. But, long standing, permanently damaged organs often do not recover. So, recovery of damaged organ depends on type of organ, whether damage is recent onset or long standing and whether damage is minor or severe.
4. Who can be a donor?
There are various types of organ donor. Broadly speaking donors are living donor, who donates an organ during life and cadaver (Deceased) donor, where donations take place after death. Criteria or suitability of these different donors are different. Please see respective section for more information.
5. How many patients need organ transplant in India on an average?
Number of persons in India requiring organ or tissue transplant is enormous and is different for different organs. Further, as there is no organized data available for this, the numbers is estimates only. Every year, following number of persons needs organ/tissue transplant as per organ specified:
  • Kidney 2,50,000
  • Liver 80,000
  • Heart 50,000
  • Cornea 1,00,000
6. Are there religious objection to organ donation?
There is practically no religious objection to organ donation. Hindus are not prohibited by religious law from donating their organs. In fact, Hindu mythology includes stories in which parts of the human body are used for the benefit of other humans and society. Lord Ganesh is one of the best examples of organ donation and transplantation. Muslims believe in the principle of saving human lives, and permit organ transplants as a means of achieving that noble end.
7. Is there age limit for organ donation?
Age limitation varies depending upon whether it is living donation or cadaver donation. For example in living donation, person should be major; above 18 year of age. For most of the organs, it is the person’s physical condition and not the age, which is the deciding factor. Specialist healthcare professionals decide in each case which organs are suitable. Organs and tissue from people in their 70s and 80s have been transplanted successfully all over the world. In the case of tissues and eyes, age usually does not matter.
8. If I had pledged before, can I change my mind?
Yes. You can ring the NOTTO office or go to NOTTO website www.notto.nic.in and fill in the form asking for your name to be removed. If you prefer, you can write to NOTTO. If you have an organ donor card, tear it up. Also, let your family know that you have changed your mind regarding pledging.
9. Can a person without family register for pledge?
You can still do the pledge, but to fulfill your donation wishes, healthcare professionals will need to speak to someone else at the time of your death. But it is advisable also to tell the person closest to you in life, a friend of long standing or a close colleague, about your decision of pledging.
10. How donated organs matched with patients?
Many medical factors need to match to ensure a successful organ transplant. Blood group is one of the major factors taken into account. For kidneys another important factor is tissue matching which is more complex than blood grouping matching and also takes more time. The best results can be achieved if there is a perfect kidney match. There is a local, regional and national computerized list of patients waiting for an organ transplant. Most of the time, computer will identify the best matched patient for a particular organ and organ is offered to the transplant unit who is treating that patient. Also, priority is given to patients who most urgently need a transplant. NOTTO operates the transplant list and donor organ allocation system. It works round the clock, every day of the year. In case of tissues, matching is usually not required.
Candidate’s Blood Group Donor’s Blood Group
A A or O
B B or O
11. What is benefit to my family or me after donation of organ?
Donation of an organ or tissue provides an unparalleled opportunity to give someone a second chance at life. Not only do you impact the life of one person or one family, overall you help the society as a whole. As you and your family are part of society, indirectly you are helping yourself. Donation helps by giving mutual benefit to each other.
12. What is value of carrying organ donation card?
If you carry donor card with you, at the time of death, medical team will be able to know your wish by seeing this donor card. Thus, it is important that after pledging, you must tell your family and carry donor card with you all the time.
13. Can I sell my organs?
NO, as per Transplant of Human Organ Act (THOA), selling of organ in any way is punishable under the law and has significant financial as well judicial punishment. Not only in India, but in any part of world, selling of an organ is not permissible.
14. What is “Required Request”?
Required request is a way of getting consent of the person for the cadaver donor transplantation. Any person, who wish to donate his/her organ and tissue after his death has to affirmatively make a pledge that his/her organs after death can be used for transplantation and saving life of other person. Hospital staff at the time of death approach families that their loved one’s organs and tissues can be used for transplant. This approach is also called as ‘opting in’ approach.
15. What is “Presumed Consent”?
In the presumed consent approach, every person is supposed to be agreeing for organ donation at the time of death unless, the person has decided during his/her life time that he/she is not willing for organ and tissue donation after death. This system is also called “opting out” system. There are countries in the world who have presumed consent approach for organ donation and few believe that presumed consent approach usually increase organ donation rate. However, all do not agree for the same.
16. What is “Informed Consent”?
Informed consent is a process, which is not specific to organ and tissue donation. This process is basically a process of reaching an agreement based on a full understanding of what will take place, in the form of medical treatment. Informed consent involves information sharing as well as the ability to understand and freely make a choice in relation to medical treatment.
17. Is there any national register of people willing to donate?
Yes, NOTTO office is maintaining a national register of the persons who have pledged for organ and tissue donation. There are many hospitals and organizations that are also maintaining the list of persons who have pledged organ donation with them. But all those names also then are passed on to NOTTO office ultimately. So, for all-purpose, NOTTO list is the national list of the persons who have pledged for organ and tissue donation.
18. Who is transplant coordinator?
As the name suggests, transplant coordinator is a person who coordinates all the process related to organ and tissue donation in a hospital. Though their work is more related to deceased organ donation, their responsibility is also towards living organ donation. The current Transplant of Human Organ Act envisages that every hospital doing transplant activity, whether retrieval or organ transplantation must have a transplant coordinator in the hospital before the center is registered for transplantation under the act. Transplant coordinator is a pivot of the organ donation and transplantation.
19. Does government of India financially support organ transplant?
Yes, government of India has started National Organ and Transplant Program (NOTP), under which patients below poverty line are supported cost of transplant as well as cost of immunosuppression after transplant for one year. Other than this, renal transplant in all public hospitals is subsidized as per government of India policy.
20. Can I donate an organ while I am still alive?
Yes, living donor organ and tissue transplant is a process in which person during his/her life can donation an organ or tissue to another person, who needs it. But, obviously, this is NOT possible for all the organ or tissue. Only few organs can be donated during life. The most common organ donated by a living person is a kidney as a healthy person can lead a completely normal life with only one functioning kidney. Kidneys transplanted from living donors have a better chance of long term survival than those transplanted from people who have died. Nearly 90% of all kidney transplants currently in India are from living donor. In addition to kidney, part of a liver can be transplanted and it may also be possible to donate a segment of a lung and, in a very small number of cases, part of the small bowel. For all forms of living donor transplants the risk to the donor must be considered very carefully. Before a living donor transplant can go ahead there are strict regulations to meet and a thorough process of assessment and discussion.
21. Is there age limit for living donor?
Yes, there is some age-limit for living organ donation. Living donation should be done by a major, means person should be above 18 year of age. Please see information in general transplantation set of questions also
22. Can people other than relation also donate organs?
In relation to kidney, THOA accept grandparents, parents, sibling, children, grand children and spouse as legally related donor The THO Act 2011 (Amended), allow two other kinds of living kidney donation – paired and altruistic donation. Donors are mostly a close relative but may also be individuals who are not related but have an established emotional relationship with the recipient such as a close friend. Sometimes a donor and a recipient may be incompatible with each other because of blood group or tissue-type and in this case it may be possible for them to be paired with another donor and recipient in the same situation so that each recipient will benefit from a transplant that they would otherwise not have had (paired donation). Where more than two pairs are involved in the swap it is called “pooled” donation. Donors may also offer to give a kidney to someone who is on the waiting list for a transplant but whom they have never met (non-directed altruistic donation). However, all such other than near related donor and patients need to be assessed by a committee called authorization committee, before such transplant can be done.
23. What all organs living donor can donate?
As mentioned above, following organs during life can be donated for organ transplant:
  • One kidney
  • Part of the liver
  • Part of pancreas
  • Uncommonly part of lung and intestine
24. What is risk to living donor?
Broadly speaking, there is no major risk to donor if he/she has been properly evaluated before donation takes place. There are some risks to living donor. Firstly, living donor is subjected to certain investigations where there is minor risk to some investigations like angiography etc. Secondly, for donation, person is subjected to a major surgery and howsoever is small, but there is minimal inherent risk of complication in any major surgery. Finally, there is very mild risk of because of donation of the specific organ. Like in case of kidney donation, person has some risk of development of mild high blood pressure and some loss of protein in urine after many years of donation. However, these minor problems are unlikely to affect the life of person. Thus one should be reasonably confident that organ donation does not affect the life of the person who donates, for most of the time.
25. What is paired donation?
Sometimes in the family, there is potential related donor who is otherwise willing but due to blood group matching criteria or due to some other medical reasons is not fit to donate organ to that particular recipient in family. Further, in another family similar situation exists. However, in these two families, donor of one family may become medically fit for recipient of other family and vice versa. These two families then make a pair and make organ transplant possible for these two recipients of different families. This is called ‘paired donation’ transplantation. This is also called ‘swap transplant’. Swap transplant is legally permitted in THOA (Amended) act 2011.
26. Will I become medically unfit after organ donation?
NO. It is basic principle of living donation program that person remains absolutely healthy after donation for rest of his/her life after donation. Thus, donor is not medically unfit for any purpose. However, in certain situation, organ donor is treated differently. Like in armed forces, an organ donor is not taken as normal and donor promotion etc. are an issue.
27. Can a donor live normally on one kidney?
Yes. As explained before also, a person remains healthy for rest of life after donating one kidney. Uncommonly, some kidney donor may develop very mild high blood pressure or some degree of urine protein loss, after many years of donation. However, these minor side effects usually do not affect survival and quality of life of kidney donor.
28. What is brain stem death?
Brain death or also called Brain Stem Death (BSD) is a clinical situation, which once diagnosed will unambiguously concludes that the person in question is not going to survive and unlikely to recover to life. Enough observation period is given before this diagnosis is made. There is every justification of defining BSD to avoid wasting limited resources to be used for a person not likely to survive (whether organ donation materializes or not). A determination of brain stem death is made with accepted medical standards. The parameter emphasized the 3 clinical findings necessary to confirm irreversible cessation of all functions of the entire brain, including the brain stem: coma (loss of consciousness) with a known cause, absence of brain stem reflexes, and apnea (absence of self spontaneous breathing). BSD is accepted under the Transplant Human Organ Act since 1994.
29. What all organ and tissue a cadaver donor can donate?
If different organs and tissues are in medically fit conditions, following organs and tissues can be donated:
  • Two kidneys
  • Liver
  • Pancreas
  • Heart
  • Two lungs
  • Intestine
  • Two corneas
  • Bones
  • Tendons
  • Cartilage
  • Heart valves
  • Ear drum
  • Skin
  • Vessels
30. Does organ/tissue removal disfigure the body?
NO. Organs and tissue are always removed with the greatest of care and respect for the person. This takes place in an operating theatre under all sterile conditions by specialist doctors, like any surgery being done in a otherwise living person. Afterwards the surgical incision is carefully closed and covered by a dressing in the normal way. Tissues are also removed in an operating theatre, mortuary or funeral home. Specialist healthcare professionals who always ensure that the donor is treated with the utmost respect and dignity carry out the operation. Body is never disfigured by organ donation.
31. Who is a suitable cadaver donor?
Suitability of a cadaver donor depends upon many factors but the most important factor depends upon the organ to be donated. For different organs, criteria of suitability are different.
32. Who will receive my organs?
Many things need to be taken into consideration before deciding who will get the organ and tissue. Blood group matching, transplant antigen matching, age, waiting period in the wait list, etc. There is a state, regional and national computerized list of patients waiting for an organ transplant. The computer will identify the best-matched patient for an organ or the transplant unit to which the organ is then offered. Normally, priority is given to patients who most urgently need a transplant. NOTTO and its state units work round the clock, every day of the year and cover the whole of the country. Tissue is very occasionally matched, eg. for size and tissue type, but otherwise is freely available to any patient in need of a transplant.
33. Can I/my family choose who gets my organs?
NO. Organs and tissue cannot be accepted unless they are freely donated. Potential donor or his/her family members cannot decide who gets the organ and tissue. Donor and family can only decide which organs and tissue they want to donate.
34. How the organs distributed/allocated?
As described above, distribution and allocation of organs is done on strictly medical ground so as to expect the best outcome of the transplanted organ and tissues.
35. Can I donate an organ while I am still alive?
NO. In organ donation program, confidentiality is always maintained, except in the case of living donors who usually already know each. If the family wishes they would be given some brief details such as the age and sex of the person or persons who have donated the organs. It is almost impossible to provide details of donor information to recipient families for most of the tissue transplant. Those involved may want to exchange anonymous letters of thanks or good wishes through the transplant co-ordinators and in some instances donor families and recipients have arranged to meet.
36. What if I had pledged to donate an organ but my family refuses?
In most situations, families agree for donation if they knew their loved one’s wish. If the family, or those closest to the person who has died, object to the donation when the person who has died has given their explicit permission, either by telling relatives, close friends or clinical staff, or by carrying a donor card or registering their wishes on the NOTTO website, healthcare professionals will discuss the matter sensitively with them. They will be encouraged to accept the dead person’s wishes. However, if families still object, then donation process will not go further and donation will not materialize.
37. Can organ be removed after death at home?
Practically no. Only some of the tissues like cornea & skin can be removed at home after the death. Otherwise, most of the organ and tissues require sterile operation theater environment for removal of organs and tissues.
38. How long the organs can be stored before transplantation?
Different organs can be stored for different period of time before transplantation as mentioned below:
  • Heart 4-6 Hours
  • Lungs 4-8 Hours
  • Intestine 6-10 Hours
  • Liver 12-15 Hours
  • Pancreas 12-24 Hours
  • Kidneys 24-48 Hours
39. If I carry a donor card, will my organ be taken out without my family being asked?
NO. Even though if you carry a donor card, your immediate family members and close relatives will be asked for donation of organs and tissues. Their consent is must before donation can be carried out. After death, your immediate family members are in charge of your body and their consent is must for organ and tissue donation.
40. If family refuse cadaver organ donation, will my treatment be affected?
NO. Even though your family refuses for organ donation, your treatment will be carried out as per your need. Organ donation process is never linked with your own treatment. These two are separate issues.A completely different team of donation would be called in. Also, doctors involved in transplant operation are never involved for asking donation process from the family of potential donor.
41. If I pledge the organ donation, will my treatment be affected at the time of need?
NO. Whether you have pledged or not, your treatment is never affected. Process of donation is only started once potential donor own treatment is not able to save him and patient is brain dead.
42. Is there any charge to my family for organ/tissue donation?
NO. There is no additional charge to family of potential organ donor. Potential donor needs to be medically maintained in ICU till the time of donation. From the time family agree to donate organs and tissue, all charges are borne by the treating hospital and donor family is not charged any further.
43. At the time of death, will my family be asked to donate my organs and/or tissues?
Yes. This is mandatory as per the Transplant of Human Organ Act of India. It is possible that the potential donor may have pledged for organ donation before his/her death, even then at the time of death, immediate family member are asked for consent to donate organ of potential donor. If they refuse, then organ donation will not take place.
44. Does organ/tissue removal affect cremation/burial arrangements?
To some degree yes, but it is minor effect. Once family of potential donor agree for organ donation, the process of donation does take some time from the time of consent till organ retrieval actually take place. However, whole team of organ donation process is very sensitive to this issue and do the things as fast as possible so that there is no undue delay in the cremation or burial. The Transplant Coordinator and other hospital authorities help in the process of cremation.
45. Can my organs be given to a foreigner also?
Unlikely. As per the THOA, organ and tissue will first be allocated to patient of same city, then in same state, then in between different state. It is only when there is no patient in the country, who is fit to get organs that the organ may be given to a foreigner patient. For all practical purposes, this situation will never arise in view of large number of patients requiring organ transplant in our own country.
46. Is there difference in organ between heart beating donor or donor after cardiac death?
Yes. Heart beating donor means that organs are retrieved when heart is still beating. It is possible that heart is beating with help of machines and drugs but it is beating. Beating heart keeps blood supply to organs intact and there is no damaging affect of low blood supply to organs. In case of donation after cardiac death, heart has stopped and blood supply to organs is stopped. Because of that, there is some damage to organs. Because of these issues, donation after cardiac death has to be done immediately as without blood supply, after some time, the organs will not be viable for use.
47. How waiting list of patients requiring transplant is prepared?
Patients requiring cadaver organs are put in a waiting list, as the number requiring organs are more as compared to numbers being done. There are two types of waiting list; one is urgent waiting list and other is regular waiting list. Urgent listing of patients for cadaver organ transplant is primarily based on medical criteria, means patient need organ on urgent basis otherwise he/she may not survive. Regular waiting list is also based on medical criteria and these criteria are different for different organs. Like for kidney transplant, other than blood group, main criteria is time since patient is on regular dialysis. Similarly, for other organs, criteria are different.
48. How can I know that I am fit to be listed for transplant?
Every patient who has developed end stage organ failure may not be fit for organ transplant. Basic principle is that patient must have developed end organ failure and patient should be fit for that organ transplant. Your treating doctor will decide whether you are fit for transplant and other issues before listing in the wait list in the computerized system. Once you are listed, you will also know that you are in waiting list of organ transplant.
49. Is there any age limit for transplant listing?
Broadly speaking yes. As mentioned above, patient should be fit for transplant and age is one of the criteria for assessing fitness of patient for transplant. Thus, age automatically becomes a criterion for listing also.
50. Why waiting list is so long?
Waiting list is long because there is disparity between demand and supply. There are more number of patients requiring different organs as compared to number of organs available for transplantation. Thus, everyone has to wait for some time before he/she gets transplant. That is why there should be awareness for organ donations. Once more persons will agree to donate organs, this waiting list will go on decreasing.
51. Why some have to wait longer than others for cadaver organs?
Fitness for transplant or fitness to get transplant depends on medical criteria and that is often the reasons for different waiting period for different persons. Say some blood groups are common and donors for that blood group are more frequently found as compared to other blood group. Patients with these blood groups will have to wait for shorter period of time. Likewise some patients may have difficult tissue matching and may have to wait longer as compared to others. Different waiting period is mostly because of medical reasons specific to that patient.
52. Can I be listed in more than one hospital?
NO, one cannot be listed in two hospitals simultaneously. One can change the hospital but has to remain listed only in one hospital. This is as per THOA and rules.
53. How long it will take to get a cadaver organ?
Nobody can exactly tell how long one will take to get an organ that he is requiring. This depends on his/her medical situation as explained earlier and how frequently organs are becoming available in a city or state. NOTTO and its centers can approximately tell the waiting period before one get an organ depending on their past experience but it will be only an approximate guess.
54. Can I choose a transplant center?
Yes, patient can choose a transplant center and also can change later on depending on his/her wish. As a right, he is free to do this. However, he/she should not depend on two centers simultaneously.
55. Do I have option other than organ transplant?
This answer can be given by your treating doctor depending on your medical condition and degree of damage of your organ. Like for example in a case of kidney failure, dialysis is an alternative treatment and for kidney failure patient transplant is usually not an emergency as patient can be maintained on dialysis. Also, for a heart failure patient, some patients can be maintained on artificial cardiac assist devices also. Further, for a mild to moderate organ failure, most of the patients can be maintained on medical therapy and transplant is only required in a case of permanent complete damage of the organ.
56. Is the cost of transplant different in living and cadaver transplant?
Broadly speaking cost of these two transplants are not much different. However, as cadaver transplant in a case of kidney is not matching much with patients, so little stronger medicines are used and that may have some additional cost. However, this situation may not be different in case of other organ transplants.
57. Can I know my number in waiting list?
Yes, you can know your waiting list number as this is quiet transparent system but that will not help you significantly as getting an organ depend on many other factors other than just waiting list number.
58. Do I need to be ready for call all the times?
Yes. However, if you are much below in wait list, you may be relax but it may be better to be mentally ready and have some funds for an urgent organ transplant. Cadaver transplant is mostly comes on urgent basis and you have to decide on an urgency basis. Often it comes at odd time also. That is why it is better that your investigations for fitness for cadaver transplant are complete all the time so that whenever you get a call, you can get the organ. Getting a cadaver organ is a gift and one should not miss it.
59. If I get a call for transplant, will I definitely get the organ?
NO. Getting a call for possible cadaver transplant does not mean that you will definitely get it. The transplant team will see you for your immediate fitness for transplant. There is possibility that your tests done just before possible transplant may not be normal to make you fit for transplant. Further, usually more than one patients are called for possible transplant and it may be chance that someone else may be more fit than you for that particular organ donor.
60. How I should decide which hospital to choose for my transplant?
This is not easy question to answer as different patients take different criteria to decide hospital for their own treatment, which also include organ transplant. Reputation of the hospital and hospital doctors, closeness with patient home, cost of treatment, results of transplants of that hospital are some of the criteria which different persons take into consideration for choosing a hospital for treatment. Ultimately it is your wish.

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