The dilemma of donating an organ

As a doctor, I come across the dilemma of those willing to donate their tissue or organ to someone who needs it, almost on a daily basis. As a medical professional who has been practising medicine for nearly four decades, I would like to state that there is no medical dilemma in this issue. It is clear that any willing donation of an organ by a competent adult to someone who is in need of this is acceptable as long as the procedure is medically acceptable and the risk of donation is nil or minimal.

Donation procedures with no risk include blood donation, sperm donation, breast milk donation, and bone marrow donation. Certainly, organ donation such as kidney, liver and pancreas have some risks (kidney donation is the least risky procedure), but these procedures are still medically acceptable.

An interesting debate now going on is surrogacy where in a lady rents her womb to carry someone else’s baby for nine months which involves some risks associated with pregnancy, along with the anaesthetic and surgical risks of a caesarean section which may be needed in some pregnancies.

The real dilemma here is not over medical issues but about donating or renting an organ for non-altruistic reasons or in other words, for commercial reasons. A lot of debates, media space and television time have been devoted into the ethics and moral issues of organ donation and many so called organ donation scams.

Because of this, the Human Organ Transplant Act (HOTA) was promulgated by the Government of India to control organ transplantation procedures. Interestingly, this may be the only procedure in medicine where an approval is needed by concerned authorities before it is performed even when the medical need is obvious.

Interestingly, surrogacy which involves renting one’s womb for nine months and many a time to foreigners for commercial reasons, has not received the same kind of critical review by the press, regulatory authority, ethicists and the general public. It’s only in the recent past that the central government has contemplated banning surrogacy for foreigners and regulate non-altruistic surrogacy.

Even though there is a lot of similarity between commercial organ donation and commercial surrogacy — one is to produce life and the other to gift a life — there has been very little negative publicity in the media and among the general public on surrogacy as compared to organ donation.

Of course, this is all set to change with the new surrogacy bill. The fundamental issues that we as a society need to debate over a medically justified procedure are issues such as who should have the right to decide whether donation should be only on altruistic, moral and ethical grounds, especially when people have donated blood and sperm for commercial reasons.

There is no doubt that we should avoid exploitation and coercion of the weaker sections of the society and follow the law of the land in these issues. We also need to revisit an individual’s right to donate or rent an organ or tissue, whether it is for altruistic or a commercial reason in a medically acceptable procedure, where the risk to the donor is nil or minimal.

There needs to be a healthy debate involving the regulators, media, ethicists, jurists, health care professionals, civic society members and patient representatives before outright condemnation and banning of non-altruistic donation.

(The writer is Chairman, Manipal Hospitals)