Why Organ Donation Still Struggles in India?

• From the mythical act of selflessness to the ultimate aid of giving life through organ donation, donating has always had a strong cultural foundation in India! Although this culture has been the building block, India is experiencing an alarming deficit in the number of organ donations. The country records just 0.7 donations per million people, a stark contrast to 40�50 per million in nations like Spain and the USA.
  
  The causes are complicated and include a lack of public awareness, family reluctance, religious misunderstandings, and even a lack of knowledge among medical personnel. At the center of this challenge lies one crucial process that can make all the difference�Brainstem Death Certification (BDC) ().
  
  

  Understanding Brain Death Certification

  Brainstem Death Certification is the medical and legal process of confirming that a person�s brain has irreversibly stopped functioning, even if machines keep the heart beating. This confirmation is vital before organs can be ethically retrieved for transplantation.
  
  However, many doctors in India are either unfamiliar with the precise BDC procedure or apply it inconsistently. Without a clear understanding and uniform practice, potential donors are often missed, and with them, the chance to save multiple lives!
  
  Most of the respondents were neurosurgeons (64%), mainly men (82%), between the ages of 30 and 40 (35%), and the majority worked in teaching hospitals (75%).
  
  

  Where Knowledge Falls Short?

  The absence of formal training was one of the most notable results of the survey. Fewer than half (41.8%) of physicians indicated that they had learnt about brain death certification during medical school, and only 10% regularly train their residents in it. Most hospitals do not have a fixed BDC curriculum, i.e., their learning occurs on the job, at best.
  
  This loophole generates reluctance and a lack of uniformity among physicians, particularly among young residents who might not know the precise criteria or routines. Lack of confidence and clarity slows down the process of organ donation and, at times, can even make it fatal!
  
  

  Why Donations Are Refused

  Families are not always ready, even when doctors are ready. The survey showed that the greatest barriers to organ donation were a lack of public awareness and family refusal. About 62% of respondents said that family resistance was a key factor contributing to the inability to carry through with a donation, and 50% felt that religious or cultural attitudes contributed to the indecisiveness. There are a lot of families who are just ignorant that brain death implies that the individual is dead medically and legally, although he/she might be kept alive with the help of machines.
  
  On the system aspect, 43% of the physicians identified the lack of transplant facilities in hospitals, and the rest attributed it to a lack of confidence in clinicians to pronounce brain death. These issues together paint a picture of a system that�s compassionate but not yet coordinated.
  
  

  Inconsistencies in Practice

  The survey had revealed a patchwork of practices in hospitals. Although 83% of physicians reported that they wait before they can prove brain death, almost half about 48% claimed that they do not screen for drugs or toxins, which can resemble symptoms of brain death.
  
  Misunderstanding still surrounds patient temperature in testing. As many as 40% of those surveyed mistakenly thought that a fever invalidates a brain death test. In the meantime, only 18% regularly follow up with confirmatory tests like CT angiograms to verify their diagnosis, although such tests may help eliminate suspicion and litigation.
  
  Even documentation varies � 31% said their hospitals lack a checklist for confirming brainstem reflexes, an essential part of the process. Some states, like Kerala, have already improved transparency by video-recording brain death tests, a model that could be adopted nationwide.
  
  

  Restoring Faith Through Training, Trust, and Transparency

  To improve organ donation rates, India needs a multi-pronged approach that addresses both medical and social dimensions.
  
  First, structured training on BDC should be made mandatory in medical education and reinforced through workshops for practicing clinicians. A consistent national curriculum will ensure that every doctor speaks the same �language� of brain death.
  
  Second, public awareness must be amplified through culturally sensitive campaigns involving religious leaders, media, and community health workers. When families understand that organ donation gives life, consent rates rise.
  
  Lastly, standardized national protocols � including checklists, video documentation, and the presence of trained transplant coordinators�can strengthen public trust and make the process transparent and legally secure.
  
  

  From Loss Comes Life

  �These gaps in training and practice directly impact organ donation and transplantation outcomes in India,� said Dr Deepak Gupta, the lead author, who is a professor at AIIMS, Delhi. He further added. �Bridging these disparities through structured training programs, regular continuing medical education, and nationwide standardised protocols is crucial. Improving physician knowledge will help foster public trust, ensure ethical practice, and ultimately save more lives through timely organ transplantation.�
  
  The authors of this article represent leading medical institutions in India. Commenting on the findings, Dr Sunil Shroff, Trustee of MOHAN Foundation, said ():
  
  " We have been aware of this challenge ever since the Transplantation of Human Organs Act was passed in 1995. However, until now, there was no scientific evidence to support what we observed in practice. This publication provides that much-needed proof and should serve as a wake-up call for policymakers to implement uniform training on this critical subject.�
  
  Every organ donor can save up to eight lives, and that possibility begins with a single act � recognizing brain death with certainty and compassion.
  
  India�s challenge isn�t a lack of goodwill; it�s a lack of awareness, training, and uniformity. By bridging these gaps, we can ensure that no potential donor goes unnoticed and no life is lost waiting for an organ.
  
  �To give an organ is to give life � and to certify brain death with care is to make that gift possible.� References:

  1. Disparities in Brain Death Certification Knowledge among Indian Physicians Involved in Organ Donation - (https:journals.lww.com/neur/fulltext/2025/09000/disparities_in_brain_death_certification_knowledge.7.aspx)
  2. A Trusted Organ Donation NGO in India | MOHAN Foundation - (https:www.mohanfoundation.org/)

  
  
  Source-Eurekalert