Cadaver donation: ensure dignity, smooth process

Human cadavers are essential to teach anatomy as well as for research purposes. Yet, such donations are extremely rare. Hence, scarcity of bodies for medical education and research is felt all over the world.

The situation is the same in India, too. Also, in India, as of 2017, there are approximately 12 million people suffering from corneal blindness, a majority of them children and young adults. Yet, what happens when one really does decide to voluntarily donate corneas after death and pledges the whole body for donation?

Mr V had pledged his body to a government hospital for “cadaver donation”. No NGO was involved. The deceased had also indicated a wish to donate his cornea. We may note that the Organ Donation Act allows the donation of corneas after death, even without a pledge. The public hospital had printed several landline numbers on the cadaver pledge card. But when Mr V died, however, none of these numbers were reachable. Finally, the relatives took his body to the mortuary themselves. But the staff at the mortuary were inefficient and allowed six hours to elapse, after which donated corneas become useless.

What played out next at the mortuary was a study in the gap between the organ donation law and its implementation. The senior staff of the mortuary said that a ‘mere death certificate’ was not enough to accept the cadaver donation. A ‘cause of death’ certificate on a Form 4, signed by the ‘family doctor’ was required. Also, this form being unavailable at the hospital, was to be printed by Mr V’s relatives at any internet centre. This caused a delay of four hours.

What transpired then was even more bizarre. The body was left to sweat for 40 minutes in the ambulance while being transferred to the medical college attached to the hospital which was five minutes away, since the path was blocked by a cement truck. Finally, the body was “accepted” as a cadaver donation, a full 20 hours after death. For a donor such as this, and his relatives, was it too much to expect a modicum of dignity and respect in death?

However, one must resist the temptation to merely indulge in a blame game. Rather, the focus must relentlessly be on ensuring that the laws and provisions are implemented seamlessly, with stringent guidelines. Surely, there may be other cadaver-donation experiences that were not as harrowing as the one narrated above. For example, cadaver donations committed to private medical colleges are handled far more efficiently as a norm. But then, why should the process of implementation be different whether it’s a public or a private hospital in the first place?

There is clearly a lack of coordination, effective implementation guidelines and awareness within the medical fraternity itself about how a donation should be processed. It is important to study the laws for cadaver donation and organ donation in India and study the implementation or the lack of it.

Lack of stringent guidelines

Body donation in India is governed by the Anatomy Act, 1949, and the Amending Act 15 of 1999, which addressed the provisions to enable a person to express in writing an intention for cadaver donation on his/her death. Since health is a state subject in India, Karnataka, like other states, has its own Karnataka Anatomy Act Amendment 1957 to address cadaver donations.

Additionally, for the purpose of organ donation, the Transplantation of Human Organs Act, 1994 (THOA), is now adopted by all states, except Andhra and J&K, which have their own laws. However, it is noted that the entire THOA Act, as well as the Karnataka Anatomy Act, is oriented towards prevention of malpractice. There is a lack of stringent guidelines about how hospitals or medical entities must function with respect to such a donation.

As per clause 4(iii) of the Anatomy Act of Karnataka, “The body or any part of the body of any deceased person shall not be removed unless a certificate stating in what manner such person came by his death shall, previously to the removal of the body, has been signed by the registered medical practitioner who attended such person during the illness whereof he died or, if no such practitioner attended such person during such illness, then by a registered medical practitioner who shall be called in after the death of such person.”

In the case narrated above, the process of obtaining the “cause of death” certificate by only the “family doctor” caused a delay of four hours. On closely examining the above-said case, it is evident that there must be stringent guidelines and a defined implementation process enshrined in the guidelines, where the responsibility is pinned onto specific roles or agency, to ensure an efficient process. More so, since time is of the absolute essence here.

It is imperative that there is coordination between private hospitals, public hospitals, mortuaries, doctors, medical fraternity as well as NGOs involved. Most important is that the donor and family must be made fully aware of the exact requirements so as to ensure a smooth process in the event of death. Else, the laws will remain mere lip service to the cause of cadaver donation and organ donation. The public must be encouraged to come forward to donate and it must be seen that the act of donation is respected by the government. This can only happen if the process is implemented smoothly and with dignity.

The implementation of both acts must be reviewed and defined in detail and linkages between all stakeholders must be strengthened. All hospitals, both public and private, must be given clear guidelines about the process of implementation of cadaver or organ donation. Such donations must be treated with respect and care so as to ensure a trouble-free and stress-free process for the relatives of the deceased. Else, the cause of cadaver and organ donation will lose ground, to the detriment of science and research.

(The writer is a Research Fellow at the Institute For Social And Economic Change, Bengaluru)