The death of a teenager who consumed rat poison after being repeatedly sodomized shook Mumbai last week. The boy fought liver failure in a public hospital as his parents and doctors desperately prayed for an organ. But no matching donor could be found for a liver transplant and the 13-year-old succumbed 13 days later.Of the 85,000 liver failure patients who join the country's wait list annually, less than 3% get an organ. Also, of the two lakh fresh annual registrations for kidneys, 8,000 manage a transplant. Thousands waiting for heart or lungs face bigger odds as barely 1% get an organ before time runs out.Despite cadaveric organ donations witnessing a near fourfold increase in the last five years, the demand-supply disparity in the country remains grave.Over 2.5 lakh deaths in India are attributed to organ failure annually, while cadaver donations are still very few in comparison. India's organ donation rate in 2016 stood at an abysmal 0.8 persons per million population compared to Spain's 36 per million, Croatia's 32 per million or US's 26 per million.Experts say the gap exists because only ten states and two UTs have an active donation and transplant programme.States such as UP , Chhattisgarh, Himachal Pradesh, Goa and the North-East are yet to make a debut. Stakeholders blame lack of awareness, infra and political will as well as myths and misconceptions for the sluggish pace of cadaver donation." Even after decades, the programme is a non-starter because of systemic complexities.The problem lies within hospitals and is not so much about people's acceptance any more. Police formalities remain difficult and time-consuming, discouraging people from donating," says Dr Sunil Shroff of Chennaibased Mohan Foundation. " There have been cases where people have approached us wanting to donate organs but either the hospital or the city lacked the infrastructure to retrieve organs," he says, underlining how in a country with an acute shortage, organs get wasted.Tamil Nadu, Maharashtra, Kerala, Karnataka, Telengana and Gujarat currently lead the way. Delhi and Chandigarh too managed 30 donations in 2016.Dr Vimal Bhandari, director of the National Organ and Tissue Transplant Organisation, says the government is aware of the crisis. "We have signed an MoU with Spain which has the world's highest donation rate. About 100 countries are learning their model. Their experts will train five of our regional coordination centres," he says, adding that Spain took 30 years to build its programme.Unlike Spain, where majority of brain deaths occur due to haemorrhage, in India, road accidents are the main killer.India's infrastructure too is growing. The national network facilitated 136 instances of organ sharing between cities and e states. "Last year, we even saved the lives of two foreigners who underwent heart transplants here," Dr Bhandari says.e Tamil Nadu runs India's g most successful programme by e taking a slew of decisions to ea se donations about a decade , back; families donating organs a don't have to move for NOCs or post-mortems. Also, the state offers free kidney , liver and heart transplants in government hospitals like developed nations.Maharashtra, that crossed 100 cadaver donations last year despite one of Mumbai 's top hospitals being involved in a kid ney racket, has carried out 1,064 transplants in the last five years. Pune has suddenly emerged as a high-donation centre, surpassing Mumbai. "Till April 2017, 69 donations took place in Maharashtra," said Dr Gauri Rathod, Maharashtra's nodal officer for organ donation.Hyderabad and other districts of Telangana have crossed over 1,000 organ donations since 2013. From less than 1 per million population, the donation rate has now reached 4.4.From just 41 being recorded in 2013 to 106 organ donations in 2016. In 2017, over 80 organ donations have already been reported. "But there is an urgent need for education among doctors. In many cases, doctors are uncomfortable in declaring brain death. This is true of government hospitals," says Dr G Swarnalatha, in-charge Jeevandan.Karnataka, too, is charting its own success story with donations taking a leap from 18 in 2013 to 70 in 2016. Dr Kishore Phadke, convener at Jeevasarthakathe--the state organ transplant authority--attributes this to linked Aadhaar cards with pledging organs. “ Anyone who enrols for Aadhaar will be directed to the website of Jeevasarthakathe where they can pledge organs,“ he says.However, many states face unique problems. Consider Kerala which has recorded only 11 donations after 73 in 2016. "A doctor filed a PIL in the high court alleging hospitals are falsely declaring brain deaths to procure organs. It led to negative propaganda in the social media.Even government authorities didn't stand by the transplant doctors," says Dr Jose Chacko Periappuram of Lisie Hospital in Kochi. Kerala, however, has to its credit some of the unique organ transplants that include larynx, pancreas, small intestine and hand transplants.Eastern India is the worst, with most states not having conducted cadaver donations at all.Only seven cadaver donations, including five in 2016, took place in West Bengal since 2012. According to Aditi Kishore Sarkar, state's nodal officer for cadaver donation, "The drive to popularize organ donation through donor card distribution has failed.In 2017, there has not been a single cadaver organ transplant so far." The state plans to introduce new laws to improve brain death screening.Even states like Karnataka show a unhealthy skew . As Dr H Sudarshan Ballal, senior nephrologist and chairman at Manipal Hospitals, Bengaluru, says, "Of more than 300 transplants conducted by private hospitals, only 20% are cadaver organ transplants.'' He says India needs more retrieval centres. “India's largest centre of neuroscience, NIMHANS, is still not recognized as a retrieval centre."