Living donor transplants thrive as Kerala turns its face away from deceased donor organ donations

The Hindu

14-06-2025

Patients with end-stage organ damage and who are on the transplant waiting list in Kerala are being left to their fate as the rate of deceased donor organ donation continues to plummet on the one side while unrelated live donations seem to be thriving on the other.
While the poor die, unable to secure viable organs, those with the means get access to organs (kidney and liver) relatively easily.
In the last five years, the number of unrelated organ transplants has been growing disproportionately in some organ transplant centres in the State and neither the State government nor the Kerala State Organ and Tissue Transplant Organisation (K-SOTTO) seems to have any idea how to arrest this trend.
It is a strange situation wherein the State has no evidence of forced organ donations or human trafficking with an eye on organ donations. The unrelated organ donations that are thriving in Kerala are not happening undercover. All unrelated organ donations happening in private hospitals in the State are subject to stringent laws and procedural norms. They are all tagged as 'altruistic' because open advertisements seeking organs are banned by the State.
It is possible that not all of these live donations are truly 'altruistic' and that there are middlemen and agents involved who take the lead in bringing together donor and recipient.
'People are desperate to secure organs to save the lives of their loved ones. Do we crack the whip and stop all unrelated transplants and let all these people die? This is the backlash of laying to rest a robust deceased organ donation programme that the State had initiated,' says Noble Gracious, the Executive Director of K-SOTTO
Senior doctors point out that even those cases of 'altruistic' donations that may be denied by the district authorisation committees on suspicion that money might be exchanging hands are all being cleared by courts. Courts take the stand that 'unnecessary suspicions' should not stand in the way of someone's chance at life, they say.
Apathy towards deceased donation
Health officials maintain that it is not the public's reluctance towards organ donation, rather, it is the apathy of government doctors towards initiating brain death certification processes and other related procedures that is preventing a revival of Mrithasanjeevani, the government-run deceased donor organ donation programme.
'Mrithasanjeevani never fully recovered from the trust deficit it hit, thanks to the unnecessary litigations raised against the brain death certification process and movies like Joseph, which suggested that an organ racket was behind all deceased donations. Even the executive order issued by the State, de-linking brain death certification from organ donation and making brain death certification a standard procedure in all ICUs did not help because doctors were too fed up and wary of being dragged into litigation. We are now trying to persuade our doctors to be more proactive about deceased donation because people are dying every day just waiting for organs,' Dr. Gracious says.
In fact, even doctors and hospitals now seem to encourage families to go for live organ donors rather than wait endlessly for an organ to come through via Mrithasanjeevani. Of all the organ donations that had taken place in the State in the last five years, less than 10% constituted deceased donor organ donations.
From an average of about 900-1,200 unrelated transplants that used to happen every year in Kerala, the numbers have been climbing steadily. This is also because unlike earlier, more people are opting to go for an organ transplant rather than drag the treatment. It is also much easier now to raise money for a transplant through crowdfunding.
'Deceased donations can take off only if we resolve all systemic issues and take government doctors into confidence. There are infrastructure, logistics, human resource issues in government hospitals and Medical Colleges which make deceased donation a cumbersome activity. The government has to stand solidly behind the doctors and help smoothen out the issues they face so that deceased donations can take off again,' a senior nephrologist at one of the government medical colleges says.