The Act recognises only two categories of live donors: near relatives and those who donate “by reason of affection or attachment towards the recipient or for any other such special reason”. Even for these categories, the approval for the donation has to come from an Authorisation Committee established under the Act. The “affection and attachment” part is the grey area and hence has seen no convictions so far.

The Act’s other purpose, of encouraging cadaver donation has not taken off at all — there have been only 500-odd such donations in the country. When a patient is brain dead, relatives have to be convinced to let the organ be harvested, doctors have to be in a state of readiness and the match has to take place in hours, the kidney transplanted in 48 hours.

There are glaring lacunae in both attitude and infrastructure. “It is because the programme is individual-based and not government-based,” said Jauhari calling for an “Indian solution.”

There are some international examples that are often referred to as models. Spain has one of the most efficient organ-transplant programmes. It allows “presumed consent” as each person is given a health card that will ensure that organs are harvested in case of brain death. It is not done only if relatives register their objections. Spanish hospitals have highly skilled and organized organ coordinators who counsel patients’ families, Result: 85% of families agree to such donations.

In India, in the absence of a government campaign, fighting the mindset of families is the biggest hurdle. “I try and talk to 10 families a month but have only managed six to seven cadaver transplants in 10 years,” admits S C Sharma, consultant with Gangaram Hospital.

... contd.