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ORGAN DONATION : BEYOND PLEDGE
THE PRESENT SCENARIO:
Approx 2,00000 Corneal Donations are needed annually. However only 50000 corneas are donated in India every year. 3 out of 4 people awaiting Corneal Donation remain visually impaired.
Approx 500000 people need an organ transplantation every year. By the end of each year many of them die due to lack of organs available for transplant. There is a gap of more than 75% between the organs available and the organs required.
India’s Organ Donation rate is perhaps one of the Lowest in the World . Not even 1% all those who died in India donated their Organs .
THE PROCESS:
Organ Donation is the entire process of retrieving a human organ from a living or deceased person (Donor), and transplanting it into the recipient. Recipient in all circumstances would be a patient suffering from organ failure and will not survive unless he/she receives an organ replacement.
Deceased organ donors can donate: kidneys (2), liver, lungs (2), heart, pancreas, and intestines. In 2014, hands and faces were added to the organ transplant list. Living organ donors can donate: one kidney, a lung, or a portion of the liver, pancreas, or intestine. Cornea, bones, skin and veins can also be donated.
This is indeed miraculous and this progress of medical science is unparalleled. However, due to the prevalence of myths around the subject , organ donation is not a common practice. Pledging is however just the start of this journey, there is still lot of awareness required on how to actually donate the organs.
The Living Donation Process:
- The medical compatibility of the proposed donor and recipient is determined through medical tests and evaluations.
- After positive ascertainment of the compatibility of donor with the recipient, the transplant is confirmed .
- The living donor’s organs are then retrieved surgically by the doctors on the specified date .The retrieved organs are then stored in a chemical solution briefly until they are transplanted into the recipient.
- The donor will need to remain under medical care for a few days or weeks after organ retrieval until fit to go home.
The Deceased Donation Process:
- A deceased donor is usually someone who has suffered a fatal injury to the head or had a Brain Hemorrhage. He/she is declared brain stem dead by a group of medical experts in a hospital.
- The donor’s family has to give consent
- Suitable recipients are then identified and notified .
- Post retrieval the body of the donor is respectfully handed over to the family.
Law Governing Organ Donation In India:
The legislation called the Transplantation of Human Organs and Tissues Act was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence.
Transplantation of Human Organs & Tissues Act is aimed at regulation of removal, storage and transplantation of human organs for therauptic purposes and for the prevention of commercial dealings in human organs.
Brain Death and Organ Donation:
A brain stem death results from a severe irreversible injury to the brain or hemorrhage which causes all the brain activity to stop completely. This leads to the person not being able to sustain his/her own life. With the help of medical science, the vital organs may be maintained by an artificial support system. The circulation to vital organs is maintained long enough to facilitate organ donation.
What happens once the Brain Stem Death is declared?
In India organ donations require prior consent from the donor’s family. The decision to donate the organs and tissues is in the hands of the next to kin. The family is then made aware of the option of donating organs and is given counseling for the same. The family has the right to refuse such transplant. But counseling if done effectively has on many occasions proved to be very effective in getting them to donate the organs of the loved one who is no longer alive. This process has to be performed in the interval between the diagnosis of brain stem death and cardiac death.
Inspite of the donor having pledged his/her organs, and also having a donor card, the entire process of taking the families consent has to be followed. The above may however facilitate the process of convincing the donor kin.
On consent from the donor kin, the vital organs are removed for transplantation. This process requires coordination between different teams operating almost simultaneously and sometimes may be in different locations. This may require getting surgeons from different specialties together for both donor and recipient surgeries.
In case of Medico-Legal Cases:
In medico legal cases, police NOC is prerequisite to proceed with organ donation. The same must be intimated to the designated forensic expert responsible for conducting the post mortem. The forensic expert can be present during the retrieval of the organs and conduct the post mortem simultaneously or the retrieving doctor may make notes of the retrieved organs which will form part of the post mortem report, and the body is sent to the forensic expert for completion of post mortem formalities.
How long can an organ survive inside and outside the body :
A deceased organ donor is kept on a ventilator after she / he has been declared brain dead. They will have to kept on the ventilator until the necessary approvals are taken and the organs can be retrieved. A brain dead persons organs may stay alive for a period of time that may range from a few days to a few weeks depending on numerous factors. The longer it takes to retrieve the organs, the more deterioration takes place inside the body. Therefore , the entire process of counseling the family, taking permissions etc should be quickly taken care of. Not only this , the retrieved organs cannot be kept without being transplanted for long. In such cases usually the family of the donor does not receive anything , and the recipient is thus not charged for the organs. The recipient will however have to pay for the transplantation to the hospital where they are being operated. Usually after consent for donation , the cost for the donor is borne by the hospital.
How is brain death established?
A series of tests establish and document the absence of brain stem function.
Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined to be brain dead is legally and clinically dead.
The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, are conclusively performed.
In some patients, skull or cervical injuries, cardiovascular instability, or other factors may make it impossible to complete parts of the assessment safely. In such circumstances, a confirmatory test verifying brain death is necessary. These tests may also be used to reassure family members and medical staff.
Any of the suggested tests may produce similar results in patients with catastrophic brain damage who do not fulfill the clinical criteria of brain death. The confirmatory tests shall.
OUR ROLE:
A lot of the above skewed statistics can be made right with very small actions we take. Awareness is already being created at various levels starting from schools, colleges, various organizations and the like for organ pledging for donation. This is a wonderful way of creating more pledges. But have we ever wondered, why more pledges and less actual donations? Why the thinking and doing do not match? Because the one who pledges and the one who donates is not the same person. The donor pledges , but the family donates. The family members of the donor have various reasons for not doing so. Some of them are enlisted below:
- Lack of knowledge of the process
- They have no idea whom to connect to when the time arises
- They have not been counseled for the happening
- The delay in cremation makes things difficult for them
- Overwhelming pain of losing someone close
Thus, pledging only will not help. It only makes the promise. The promise needs to be fulfilled. A thorough counseling of the family members by the donor is absolutely essential. A clear mandate of how the things should be done, whom to contact and in how much time, should be given to the family members. Some gap can be bridged if this is followed. There can be no counselor better than the donor himself for his near and dear ones. This should be done very near to the pledging.
Last but not the least, do make this wish a part of your Will. Live On…even after you are Gone!!
(Compiled from various sources. OrganIndia has been a very inspiring read in this entire endeavour.)
CA Namita Lakhotia
Co Founder
DiLSEWiLL
Wednesday 11 August 2021
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Thursday 20 May 2021
Why Writing a Will for appointing a guardian for your child is very Important- As soon as one becomes a Parent.
As the second wave of COVID-19
continues to wreak havoc across India with more than 400,000 cases being
reported daily in the country, thousands of families have lost their kin to the
deadly virus.
While experts suggest that the
mortality rate in the second wave is similar to last year’s wave, data shared
by the Indian government clearly shows that the ratio of young adults, in the
30 to 40 age group, dying of the disease is higher than the first wave. This
means there are more young children losing their parents and some have been
left totally alone as their entire immediate family has succumbed to the virus.
While most of the
time one parent has succumbed to the virus and other remains hospitalized,
there are also instances where children of single mothers became orphans.
Though these kids may sometimes be taken care of by their relatives or distant
family, there needs to be a behavioral check on the caretakers as the emotional
situation of these children is very sensitive at the moment. The counselling of
such children is very delicate as they are in a very fragile emotional state
and talking to them about these traumatic events resurfaces them.
Lets see a small
instance of what is happening (names changed to secure identity).
In a rural
village in north India, Shanta Devi received a call. It was a young girl
claiming to be a member of a child rights NGO, asking for financial help for a
12-year-old girl who had lost everyone to COVID-19 in Delhi.
Shanta, upon
hearing the story says that she transferred a decent amount of money for the
child. They asked for an online payment and assured that it would be used for
the child’s nutrition.
“After I tried
calling them to know about the condition of the child the next day, I realized
they had blocked my number. That’s when I understood that I have been duped,”
she says while complaining that it was a crisis in the country at this time and
filing a police complaint against these people would hardly bring any results.
Meanwhile, Indian
Government said that no organization or individual is officially
authorized to take custody of children whose guardians have died from the
pandemic unless authorized by the government. They said that they have
established a dedicated child helpline number 1098 for the emergency messages
about children who have lost their families COVID. They said that it was not
legal for someone to transfer custody of an orphan child of anyone else.
For instance, a 16-year-old girl in
Lucknow’s Alambagh lost her parents, younger brother and grandmother in 10 days
between April 22 and May 2 to the pandemic, while her elder brother was yet to
recover from Covid infection. The girl was left abandoned after the tragedy and
was later shifted to her relative’s place. In another case, three infants were
found in the past one week after being abandoned by two families in Hardoi and
Barabanki. The two infants in Hardoi were handed over to Child Line.
Social media posts appealing for adoption
of kids allegedly orphaned during the Covid-19 pandemic may be a trick played
out by child trafficking gangs that generally get activated during such
calamities, warned UP police officials and child rights activists. The
authorities have not only launched a probe into such posts but also begun
gathering data on children actually orphaned by the pandemic.
Several children in
the State lost parents to the pandemic, and their relatives, who might not be
fully aware of the adoption process, are falling prey to some messages
circulating on the social media. "The persons who are sharing these
messages may be doing it with good intentions, but child traffickers can easily
take advantage of this situation. The kids might get sold for adoption,
begging, child labour, flesh trade or even organ transplant. Enough awareness
is lacking in the society on the legal system with regard to adoption,"
says Andrew.
A senior child
psychologist and behavioral consultant based in India, says that in today’s
situation it has become all too common that children are confronted with the
death of their parents. She adds that parentally bereft children in the
pandemic may face unique challenges and the social isolation, institutional
strain, and economic struggles caused by the pandemic might make them feel
aloof and unsupported.
In nuclear families where children are not
very close to other family members. The situation is completely unprecedented.
It is very difficult to describe what the child will be going through.
Teenagers will be in denial and grief. They behave abnormally and go numb. If
the child has also tested positive, even relatives wouldn’t come closer.
Suddenly the child will feel he or she is alone in this world and may slip into
anxiety and depression. Immediate moral and psychological help with regular
long time follow up is very necessary for such children.
It’s been over 30
years since the Juvenile Justice Act was formulated and this constitutes the
children adoption process. Yet, the authorities have failed to educate citizens
about this Act or the 1098 childline, which works along with government
agencies like Social Defense, Child Welfare Committee, Social Welfare, and
Juvenile Justice Board, among many others. The adoptions are regulated through
the Central Adoption Research Agency (CARA).
All said, by now, we as parents should gather
our thoughts about the following:
1.
As soon as we
become parents, we are responsible for the following:
·
Healthy
upbringing of children
·
Financial support
and security to them
·
Looking after
their Emotional well being
·
Healthy and
timely advisory
2.
In case of loss
of one parent , the other parent is the natural legal guardian
3.
In case of loss
of both the parents, there can be two possible situations:
a)
The parents DID
NOT have a WILL and had not appointed a legal guardian. The following may be
the possibilities:
Ø Either the paternal or maternal grandparents may agree to look
after the child/children
Ø In the above case it should be noted that sometimes financial or
physical problems may be there
Ø The uncles and aunts in such homes may not approve of the kids
staying with them
Ø Other relatives, friends etc may not be willing to take the
responsibility
Ø They may want to give the child for adoption in an informal way
Ø This is sometimes risky as mentioned in the article above
Ø Legal adoptions may take time and is a lengthy procedure
Ø Adoptions are monitored by the Central Adoption
Research Agency (CARA)
Ø These incidents certainly take a toll on the
mental wellness of the child
b)
The parents DID
HAVE a WILL and HAD appointed a legal guardian. The following are the turn of
events:
Ø The parents will think of all aspects before appointing a Guardian
for their child.
Ø Sometimes, the parents might thing that a trust formation would be
a better option along with appointing of the legal guardian.
Ø The legal guardian, trustees are also well aware of their roles
and responsibilities.
Ø The mental condition of the child is not further put to test with
every passing day and event.
From the above, I hope as parents you will be
able to comprehend, decide and take action. In this pandemic we read a lot of
news of orphaned kids but would never think this could be a reality in any of
our lives. PAUSE, THINK, TAKE ACTION.
Our team at DiL SE Will is
striving hard to bring awareness about the importance of making Will in India.
We are way in making all possible effort to make the task of Will creation easy
and a hands on job. Make it your priority, your “to do” for 2021.
It is no more a luxury. It is a necessity.
Disclaimer-
This blog is informative in nature and created for pro bono purpose , it is not
a legal advice.
Visit us at https://www.dilsewill.com/
to make your will online or offline.
Connect to us at 9830648068 / 8017053224 for assistance.
Mail us your queries at info@dilsewill.com.
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