Question : "An Opt-Out Organ Donation System Can Address India’s Transplant Shortage But Requires Careful Ethical Consideration." Discuss.

 Question : "An Opt-Out Organ Donation System Can Address India’s Transplant Shortage But Requires Careful Ethical Consideration." Discuss.

(UPSC Mains Answer Framework - GS Paper II: Governance & Ethics)

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Introduction

India faces an acute organ shortage, with an estimated 500,000 people dying annually due to unavailability of organs. The current opt-in system (where donors must actively register) has failed to bridge the gap. While an opt-out system (presumed consent) could boost donations—as seen in Spain (49 donors/million population vs. India's <1)—it raises ethical, legal, and cultural concerns. This discussion evaluates the feasibility of such a system in India.

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Body

1. How Opt-Out Can Address India’s Organ Shortage

Proven Global Success:

• Spain (world leader) and France saw 20-30% increase in donations after adopting opt-out.
• UK reported a 7% rise in consent rates post-2020 opt-out law.

Reduces Family Refusals:

• In India, 50% of potential donations fail due to family objections. Opt-out makes donation the default, reducing last-minute denials.

Economic & Social Benefits:

• Reduces dependency on illegal organ trade (India has 2,000+ black-market kidney transplants annually).
• Aligns with SDG 3 (Health for All) and Article 47 (DPSP) on public health improvement.

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2. Ethical Considerations & Challenges

Autonomy vs. Paternalism:

• Opt-out may violate informed consent (Article 21: Right to Life includes bodily autonomy).
• Example: In Wales (opt-out system), 6% opted out, but many were unaware of the policy.

Cultural & Religious Sensitivities:

• Many communities oppose organ retrieval due to beliefs about bodily integrity after death.
• Case Study: Japan switched to opt-out but still has low donations due to cultural resistance.

Implementation Barriers:

• Lack of Infrastructure: India has <5% of hospitals certified for organ retrieval.
• Awareness Gap: Rural populations may not know how to opt out, leading to exploitation.

Risk of Mistrust:

• China’s organ scandal (forced prisoner donations) shows how lack of transparency harms public trust.

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3. Balancing Ethics & Efficacy: A Hybrid Model for India?

Modified Opt-Out with Safeguards:

• Mandatory Awareness Drives (e.g., SMS alerts, voter ID-linked registries).
• Family Veto Rights (like Spain, where relatives are consulted despite legal presumption).
• Priority for Registered Donors: Israel’s model gives transplant priority to those who actively opt in.

Legal Reforms:

• Amend Transplantation of Human Organs Act (THOA), 1994 to include opt-out with strict oversight.
• Strengthen NOTTO’s capacity to audit donations and prevent fraud.

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Conclusion

An opt-out system could revolutionize India’s organ supply, but its success depends on:

1. Ethical safeguards (autonomy, family consent).
2. Grassroots awareness to prevent exploitation.
3. Infrastructure investment (trained coordinators, certified hospitals).

A phased, hybrid approach—combining opt-out defaults with active public engagement—may be India’s best path forward. As the Spanish model shows, systemic change requires both legal reform and societal trust.

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UPSC Relevance

Previous Year Questions:

• Mains (GS-II): "Examine the ethical issues in organ transplantation in India. Suggest reforms." (2021)
• Essay: "The right to life includes the right to health." (2018)

Key Terms for UPSC:

• THOA Act, NOTTO, Presumed Consent, SDG 3, Article 21 & 47.

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