With organ donation picking up but still unable to keep pace with the requirements, a growing number of doctors feel that India should consider adopting the Spanish model of ‘opt-out’ cadaver donation. In Spain, organs of all cadavers are donated by default unless the deceased voluntarily opted out during his/her lifetime.

“The Spanish organ donation model is regarded as the best in the world. After implementing an opt-out system, Spain dramatically emerged as the world leader in organ donations. The system works on presumed consent. The deceased’s consent to organ donation is presumed unless his/her name is on the nation’s refusal registry,” explains Dr Sanjeev Gulati, Head Nephrology and Kidney Transplant at Fortis Hospital, Vasant Kunj, New Delhi.

In India, the organ donation rate is 0.5 per million while Spain has an organ donation rate of over 36 per million Cadaver donations are taken only from brain dead patients with viable organs.

Recently, France also enacted the law of presumed consent. Unless one does not sign the National Rejection Register, their organs will be removed. Immediate family’s consent is immaterial under these laws.

In India, however, dead bodies are property of the family, making application of the ‘opt-out’ model contentious, says Dr Aarti Vij, head of the Organ Retrieval Banking Organisation (ORBO), All India Institute of Medical Sciences (AIIMS), New Delhi.

While the annual requirement for kidney and liver transplants in India is over 3.2 lakh, only 14,000 patients find viable donors for transplant.

“India definitely needs cadaver donations but a lot of things need to be organised for the system to be successful, and at present, we are far from that,” says Dr Sanjay K Agarwal, Professor & Head, Department of Nephrology, AIIMS, New Delhi.

News in numbers

India’s annual requirement for hearts is estimated to be around 50,000 and lungs about 20,00012,000 kidney transplants are carried out annually against an estimated requirement of 2,20,000Only 2,000 liver transplants are performed every year and over 1 lakh die due to end stage liver disease while waiting for a viable organ (Source: Fortis Memorial Research Institute, Gurgaon)