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IMA Required Request in Every Death: “Puchjna mat bhulo”

IMA Required Request in Every Death: “Puchjna mat bhulo”

Dr K K Aggarwal
National President Elect IMA

All IMA members should, in case of routine death, request the near relations for corneal donation and in situations with brain stem death for eye and other organs donations. Ima campaign is “Puchna mat bhulo”.

As per Transplantation of Human Organs and Tissues Rules, 2014 any Registered Medical Practitioner of a hospital having ICU facility, in a situation of brain stem death, in consultation with transplant coordinator (if available) will have to ascertain from the next of kin or the legal heir of the body whether the dead person, while he was alive, had authorised for donation of his or her organs either by filling form 5 or in driving license.  If yes, then the RMD is duty bound to request the next of the kin or the legal heir to submit the aforesaid authorisation and sign the declaration/authorisation.

As per Transplantation of Human Organs and Tissues Rules, 2014 any registered medical practitioner of the hospital having ICU facility, in consultation with transplant coordinator, if available, SHALL ascertain, after certification of brain stem death of the person in ICU from his or her adult near relative or, if near relative is not available, then, any other person related by blood or marriage, and in case of unclaimed body, from the person in lawful possession of the body the following

(a) whether the person had, in the presence of two or more witnesses (at least one of who is a near relative of such person), unequivocally authorised before his or her death as specified in Form 7 or in documents like driving license, etc. wherein the provision for donation may be incorporated after notification of these rules, the removal of his or her organ(s) or tissue(s) including eye, after his or her death, for therapeutic purposes and there is no reason to believe that the person had subsequently revoked the aforesaid authorisation; 

(b) where the said authorisation was not made by the person to donate his or her organ(s) or tissue(s) after his or her death, then the registered medical practitioner in consultation with the transplant coordinator, if available, SHALL  make the near relative or person in lawful possession of the body, aware of the option to authorise or decline the donation of such human organs or tissues or both (which can be used for therapeutic purposes) including eye or cornea of the deceased person and a declaration or authorisation to this effect shall be ascertained from the near relative or person in lawful possession of the body as per Form 8 to record the status of consent, and in case of an unclaimed body, authorisation shall be made in Form 9 by the authorised official as per sub-section (1) of section 5 of the Act; 

(c) after the near relative or person in lawful possession of the body authorises removal and gives consent for donation of human organ(s) or tissue(s) of the deceased person, the registered medical practitioner through the transplant coordinator shall inform the authorised registered Human Organ Retrieval Centre through authorised coordinating organisation by available documentable mode of communication, for removal, storage or transportation of organ(s) or tissue(s).

"Mandatory" or required request for donation of the organs of patients dying in hospitals is likely to increase the rate of organ harvest and will alleviate the critical shortage of transplantable organs.

“Required request” or “required referral” is defined as that it shall be illegal, irresponsible and immoral to disconnect a ventilator from an individual who is declared dead following brain stem testing without first making proper enquiry as to the possibility of that individual's tissues and organs being used for the purposes of transplantation.

Required request as on date is only for brain dead patients. IMA feels in every death situation the RMP should explore about corneal donation. India needs 2 lakh donor eyes per year to take care of corneal blinds. One is able to collect only 25,000 donor eyes per year.

If request is made for eye donation at the time of death and even if 1% people of total deaths donate eyes one will be able to cover the shortage. For every 1000 population 7.89 persons die every year. 

There are currently an estimated 15 million blind people in India. 6.8 million of these suffer from corneal blindness with vision less than 6/60 in at least one eye, and of these, about 1 million have bilateral corneal blindness. If the present trend continues, it is expected that the number of corneally blind individuals in India will increase to 8.4 million in 2010 and 10.6 million by 2020.

Of these at least 3 million can be benefited by corneal transplantation. Thus, to effectively meet the ever growing demand, we need around 150,000 to 200,000 corneal transplants to be performed every year.

International scenario

1. Opt In: UK, Germany, Italy, Canada, Australia, and New Zealand have ‘opting-in’ systems. This means that the person in lawful possession of the body may authorize the removal of organs and tissues. 

2.  Opt out: Austria, Belgium, and Singapore, have ‘opt-out’ or ‘presumed consent’ systems that assume individuals have granted permission for their organs to be donated, unless they specify otherwise, in advance of their death. 

3. ‘Required request’ or routine enquiry of the next-of-kin of a potential donor, forms part of state law in the US