Deceased organ donation rate in India is just 0.58 per million population compared to more than 30 donors per million in some western countries.

Thousands of people are dying every year owing to the non-availability of organs. The sector is regulated by Transplantation of Human Organs and Tissues Act, 1994. This is the government data that highlights the poor state of affairs:

Organ/Tissue	Required No. of Organs	Available No. of Organs
Kidney	200000	8000
Liver	50000	1500
Heart	30000	200
Cornea	100000	25000

According to a recent report of the Eye Bank Association of India, an NGO, the count of collected corneas decreased to 102 in 2014-15 from 192 in 2013-14. And, it's not just cornea transplants. Here is a list of the reasons as to why the number of organ donations in India is so poor on the whole.

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Poor facilities

Infrastructure is crucial. Dr Venkatesh Reddy, an orthopedic surgeon in Bangalore who runs a private hospital says that many of the small hospitals in the city lack facilities for organ donation and storage. “The situation is grim in the government hospitals which cater to a majority of the population,” said a Chief Medical Officer with the government of Karnataka. Besides improving facilities, government doctors needs to be trained to spread awareness on organ donation.

Organs are usually not stored, and they must be transplanted as soon as possible post retrieval. However, cornea, skin, and bones may be stored for a longer time and require a banking facility. The central government has only now set up a National Biomaterial Centre (Tissue Bank) and five State Level Biomaterial Centres (Tissue Banks) in the country. Also, three government medical colleges in Guwahati, Silchar, and Dibrugarh, and two private hospitals in Assam have eye banks but the state still lags behind in eye donations like many others.

The shortage

Priyanka Shylendra, CEO of Bangalore-based NGO Gift Your Organ Foundation, points out the magnitude of this problem. She says,

About 2.2 lakh people need kidney transplants every year but only about 750 get one through a deceased organ donor. About 80,000 are awaiting a liver transplant, 50,000 are awaiting a heart transplant, and about a lakh are looking for corneal transplants.

Road accidents alone leave about 93,000 people in India braindead every year. However, less than a thousand of them are registered as organ donors. It is critically important to create awareness and infrastructure to promote organ donations.

Explaining the need for awareness, transplant coordinator at Bangalore's St John's Medical College and Hospital, Dr Roopa Hiremath, says many people don't understand what "braindead" means. She says often the kin of the deceased think the hospital is trying to take the organs even though the person is still alive. Highlighting the importance of registering as an organ donor, she says is an uphill task and a race against time to harvest organs after a person's death.

Medical colleges need bodies for students to study human anatomy. Practicing on cadavers is a crucial part of medical education, but medical colleges in the country perennially face a shortage of cadavers. So, encouraging people to pledge their bodies is of great significance for educational reasons too.

Bangalore has seen a spurt in the cases of organ donation last year after a young man's body was cut into halves in a road accident. In his dying moments, he told the ambulance driver he wanted his organs to be donated. His last wish was fulfilled but it was the compassion he displayed in excruciating pain that moved and inspired many to emulate him. Proponents of organ donation firmly believe that media focus on the issue will immensely help the cause.

The society’s sentiments

"I have been insulted, threatened, kicked out from the house of the bereaved family; it gets very humiliating," says Pawan Keswani, as he describes how tough it has been to convince people to donate the organs of their deceased kin. Based in Durg, in the neglected state of Chhattisgarh, he has been working tirelessly to promote organ donation since 2008. The task has been anything but easy.

Keswani, who edits a Hindi magazine, claims he is behind 561 people pledging their bodies for donation. Just one meeting with him, and his enthusiasm to promote organ donation is catching. Yet, the stiff resistance he faces when he approaches a bereaving family with the idea of donating the body of a loved one often dampens his spirit. People are offended that somebody, no less than an acquaintance, is suggesting that they donate a close relative's body, to be cut up and the organs given away.

Superstitions and misconceptions are the biggest roadblocks. Blind faith that one will be born blind in the next birth if the eyes are pried out and donated is hard to fight. So, is the conviction that you'll be reborn crippled if your organs are cut up and donated.

These beliefs are what stand in the way when Keswani tries to convince people to change their minds. He says the mythological Indian text, Garuda Purana, has been (mis)interpreted in a way that such fallacies have gained currency. In a country that considers its mythology sacrosanct, persuading people to act in its defiance is uphill.

That explains why he is proud that he could convince even an undertaker to pledge his body. "This man burns the dead for a living. He's a firm believer in the importance of last rites for the soul's ascension. Yet, I could convince him to pledge his own body," says Keswani, adding that the wife of the staunch Hindu also pledged her body along with him, seeing reason in his argument that giving life to somebody after death cannot be against any religion.

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On a positive note

Last year Keswani made headlines when he got 32 members of a family in Chhattisgarh to pledge their bodies to donation. The family patriarch from Balod, who works as an energy auditor with the National Mission on Climate Change, read in the press about Keswani's work and invited him to a family function. There, he indicated that he would like to pledge his body. This got his family talking. After four hours of counselling by Keswani, 31 other members of the family followed suit. Put together, organs from their bodies can provide a new lease of life to 216 people.

Gift of vision in Assam

Motivated individuals are leading such drives across the country. Realizing that her eyes can help others to see after her death encouraged Guwahati-based school teacher Beauty Talukdar to pledge her eyes and body four years ago. The belief in Hindu society that after death our bodies must be burnt by our sons has no practical meaning. I read in newspapers that medical colleges need bodies for research and our eyes can be transplanted on another person, helping him or her to see this world again. That is when I asked my husband and when he had no objections, I pledged my body, says Talukdar, a 49-year-old mother of two.

Her husband, Hariprasad Talukdar, who did not object to her decision, has not emulated her. Maybe he does not want to, or he may do so after a time, says Beauty. Like Beauty's husband there are hundreds of others in Assam who remain undecided. And there is a reason for that.

"A few years ago, the family of a person of Palashbari in Kamrup district donated his body after his death. The news spread, and other villagers stepped out to oppose it. They labelled the family anti-social. Among Hindus, it is a belief that the son of a deceased person must light the funeral pyre of his parents. If there is no body to cremate it's a great sin... This belief makes many people reluctant to donate bodies," says Dinesh Goswami, a Jorhat-based (upper Assam town) scientist who has not only pledged his body for donation but is also associated with the campaign to promote cadaver donation in Assam.

"Many believe that if one donates his/her eyes, they are born blind in their next life. Such superstitions have stopped many from donating their eyes," he says. Both he and his wife pledged their eyes and bodies for donation in 2006. Goswami is also associated with Assam Science Society, an organization that is conducting awareness camps against superstitions in the state.

Hemant Gairola is a freelance writer and reporter, and a member of 101Reporters.com, a pan-India network of grassroots reporters.