There has been a terrible car crash. A young woman in her twenties is critically injured, and you - her mother/father/sister/brothergrandparent - are her next of kin. At hospital, the attending doctor regretfully confirms that her brain has stopped functioning and that she cannot be saved. As you struggle to hang on to disbelief that this can have happened, grief eventually begins to set in, pushing hope back down.
Apologetically, the doctor informs you that the young woman had signed onto the Indian Transplant Registry. In the event of a road accident claiming her life, she wanted her organs donated so that others may live. As gently as possible, the doctor states that her recorded are wishes are not quite enough for them to begin harvesting her organs. As her next of kin, they also require your approval.
A form on a clipboard is explained to you, and a pen offered if you are ready to sign.
What do you do?
It must be an impossibly devastating position to be in, even without that piece of paper at the end, but it’s one that more and more people in India are facing every year. There is no positive spin to be put on the ever-increasing numbers of road deaths in India (136834 in 2011, Tamil Nadu the leading state), as with needless destruction of life in any other form. However, it is surely a positive thing that more Indians are choosing to be organ donors if they reach an unfortunate and untimely end.
Judging by recent reports of organ donation in The Hindu recently, the phenomenon does indeed seem to be gaining acceptance. Interestingly, the reports are at pains to point out the altruism of both the victim and his or her family:
“M. Sharanya had a positive outlook towards organ donation. She believed organs should be donated so that the beneficiaries could have a fresh lease of life. And when she died in a road accident on Saturday, her parents overcame their shock and made sure that their daughter’s wish was fulfilled.” -'Budding engineer’s organs harvested to fulfil her wish’, The Hindu, July 9 2012
“Mr. Remin's colleagues lauded his wife and kin for acting fast on their decision to donate his organs. They recalled that the teacher was the first to sign up for organ donation when an awareness camp was held in the school.” -'Organs of brain-dead teacher harvested for donation’, The Hindu, May 13 2012
“Death of their only son Jayasuresh (27) came as a shock to Stella and Arulnathan, agricultural labourer couple of Nayudumangalam village near here. But, they tried to overcome their grief by consoling themselves that their son was able to save many lives even after death, thanks to organ donation.” -'Organs of brain-dead taxi driver harvested’, The Hindu, June 24 2012
As endearingly earnest (and editorialised) as these reports are, the word ‘harvested’ jars. It first brings to mind a farmer detachedly reaping a crop from a field -- and in this human context, a Hannibal Lecter figure removing pieces of a person’s body against their will. This has at times been a lot closer to the truth. Before 1995, Indians were able to sell their organs in an open market until the Government decided to put a stop to it; the practice, fraught with subterfuge, reportedly continued off the legal grid. Then there was the sinister 'Amit Kumar', who removed organs from unwilling donors for several years, and other unscrupulous physicians like him.
The issue of forced black market organ donation in India then briefly gained some worldwide notice when it was featured in the film ‘Slumdog Millionaire’, which showed children being taken into orphanage care for the express purpose of harvesting their eyes for resale. It would be foolish to presume that such evil practices had been stamped out altogether, but those reports in The Hindu suggest that the Indian attitude towards organ donation may be changing.
Even more encouraging is the fact that it is becoming much easier to become a registered organ donor in case of accidental death. In the past, registrations had to be mailed to Delhi and a donor card awaited; this sounds simple on paper, but anyone familiar with Indian bureaucracy will know of several links in this chain which could break for any reason, sometimes at a bureaucrat’s behest. Now, online registration can be done through official websites such as Indian Society of Organ Transplantation (all of India) and Deceased Organ Retrieval Sharing Organization (Delhi), as well as the unofficial The Internet People. It has never been so easy for an Indian, having decided they want to donate their organs, to take official action toward that end.
However, there is nothing anyone can do about getting their next of kin to sign that hospital form. That responsibility falls completely to the person or people being asked. For the question to arise as a crushing sucker punch in a hospital room, after the body blow of learning that a loved one is braindead, is too much for many to bear. They would have to be forgiven for lashing out, cursing the medical professional concerned, and indeed refusing to sign the form.
In that case, a person wishing to register for organ donation has two important responsibilities. The first is to register, which is relatively easy. The second is to have a conversation about it with one’s next of kin, which is difficult even in the most loving and accepting families. The thing to remember is that no matter how difficult that conversation might be, it could never be as shocking as leaving it up to the next of kin after you’ve gone. Both responsibilities of the decision must be taken, hand-in-hand. Ideally, the conversation would come first.
One hopes that M. Sharanya, Mr. Remin and Jayasuresh did indeed have this conversation with their families, and that the earnestness of The Hindu’s reporting is reflective of their next of kin’s belief that they did the right thing. One also hopes that in having the insight to see their bodies as the sum of very distinct parts, which have ongoing value even after death, people who sign up to the register in future also have the inner strength to discuss it with those close to them.