Organ Donation and Transplantation

NOTTO: National Organ and Tissue Transplant Organization

1. Transplantation of Human Organs Act, 1994 was established in 1994. 25 years over. NOTTO was established under the Transplantation of Human Organs (Amendment) Act, 2011.
2. NOTTO is a national level organization set up under the Ministry of Health and Family Welfare.
3. It has 2 divisions:
   1. National Human Organ and Tissue Removal and Storage Network: for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
   2. National Biomaterial Centre (National Tissue Bank): to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in availability of various tissues.
4. Transplantation
   1. India’s 1st voluntary liver transplant registry initiated by Liver Transplantation Society of India aims to collate national data of procedures and their outcomes.
   2. India has around 2000 liver transplants a year which is highest in the World yet no India specific data. Hence Doctor takes help from US and UK registries. The move will address this.
5. In NOTTO, only close relatives & blood relation are in a condition to donate organ otherwise NOTTO registration is mandatory wherein according to the queue and availability, people get organs (tissues, lungs, kidney, heart).

National Organ Transplant Programme (NOTP)

• Under the National Organ Transplant Programme (NOTP) a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organisation (NOTTO), New Delhi.
• Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio- material centre.
• As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organisation (ROTTO), Chennai, Tamil Nadu.
• Funds have also been released to the States of Bihar and Maharashtra for establishment of Bio-material Centre under NOTP.
• The Government of India is implementing National Organ Transplant Programme (NOTP) to promote organ donation and transplantation across all States/Union Territories (UTs)including Karnataka.
• The provisions under the programme include:
  1. Setting up of State Organ and Tissue Transplant Organisations (SOTTOs) in each State/UT.
  2. Setting up of National/ Regional/State Bio-material centres.
  3. Financial support for establishing new Organ Transplant/retrieval facilities and strengthening of existing Organ Transplant/retrieval facilities.
  4. Training to transplant experts including surgeons, physicians, transplant coordinators, etc.
  5. Financial support for hiring of Transplant Coordinators to medical colleges and trauma centres.
  6. Post-transplant immune-suppressant drugs to Below Poverty Line (BPL) patients.
• Under this programme, an apex level National Organ and Tissue Transplant Organisation (NOTTO) at New Delhi and Five Regional Organ and Tissue Transplant Organizations (ROTTOs) and fourteen SOTTOs have been established so far.
• Further, Regional Bio-material centre has been established at ROTTO, Tamil Nadu and funds have been released to the State of Bihar and Maharashtra for purpose.
• The ‘National Organ and Tissue Transplant Organisation (NOTTO)’, ‘Regional Organ and Tissue Transplant Organizations (ROTTOs)’ and ‘State Organ and Tissue Transplant Organizations (SOTTOs)’ disseminate relevant information about organ donation in the public.
• A website www.notto.gov.in and a 24x7 call centre with a toll free helpline number (1800114770) have been made operational.
• A number of activities, for generating awareness are carried out from time to time. These include seminars, workshops, debates, sports events, walkathons, participation in marathons, nukkadnatak, celebration of Indian Organ Donation Day, etc.
• Social media is also being deployed to create awareness about organ donation among the citizens.

Issues

• Organ trade is going on in Karnataka, AP, Kerala & TN because of lifestyle changes and IT life; High purchasing Power; Migratory workers with low money and Kidnapped people.
• But there is a steep drop in Kerala donors due to a perceived scandal that Private hospitals are declaring persons brain dead when they are not really so, to harvest organs and profit from them.
• There is a trust gap between patients and doctors.
• The reality is that majority of accident victims who become donors are Lower middle class and below. While only a few can afford transplant surgery and costly lifetime medication thereafter.
• Public hospitals should not be involved because the public spend on healthcare remains abysmal 1.2% of GDP - less than a third of what even some developing countries spend. Hence it should be spent on areas where greatest number of people will be benefited. As a Thailand study suggests that Money spent on Dialysis can save 300 times more healthy life years if spent on TB control. Hence money that is spent on organ failure prevention will save more lives than if spent on organ transplant.

Conclusion:

• Making online organ distribution norms and full details on every organ Donation will help build public confidence in the system.
• India is in top 10% of unequal countries in the World and in top 10% of high proportion population spending > 1/10th of their income on health.
• Indian Organ Donation Day = Nov 30. Objective is promoting organ Donation & transplantation so that people suffering from organ failure (kidneys & liver) can get organs from those brain-dead (road accidents etc).