Organ donation can save 500,000 lives in India each year. But many Indians are saving them up for their next lives.

Nearly 20% of Indians fear they will be reborn without a donated organ, according to a recent survey by the Mumbai-based Edelweiss Tokio Life Insurance. Another 21% are unsure if that will happen or not.

This, along with other factors like fear of disapproval from family, lack of faith in medical practitioners, and low transparency results in dismal levels of commitment to the cause, according to Edelweiss Tokio, which surveyed 1,565 respondents across 12 cities in the country.

Many respondents said organ harvesting is a scam. There is also mistrust in India’s healthcare system and hospitals’ ability to carry out organ donations efficiently. The country has only 412 hospitals that are equipped to perform organ transplants and retrievals, said the survey.

“The belief that harvesting of the organs would mutilate the body, or that the family would lose all rights to the body of their loved ones perpetuates fear regarding the organ donation process,” said Sumit Rai, managing director and chief executive officer at Edelweiss Tokio Life Insurance.

Individual prejudices, too, hinder organ donation. Many of those surveyed said they would not donate organs to, or receive from, LGBTQ individuals. About 54% of people are in favour of disallowing LGBTQ people from donating organs.

The paradox

It’s no surprise then that India has among the lowest organ donation rates in the world—0.3 per million population, compared with the US’s 26 per million population.

The paradox, though, is that Indians are aware of its importance in saving lives.

To be sure, the number of organ donors in the country increased from 313 in 2013, to 905 in 2017, according to the National Organ and Tissue Transplant Organisation. Yet, it still falls short of making an impact.