3. Current scenario: trends

2. Allograft: Transplant of an organ between two genetically non identical individuals, it is called allograft. Due to the genetic difference, the donor's organ will be treated as foreign

3. Isograft: Transplant of organ/tissue from a donor to genetically identical recipient is called

4. Xenograft: Transplantation of organ/tissues forms one species to another species. For

5. Split transplant: An organ like liver retrieved from the deceased donor can be divided

6. Domino transplant: When the lungs are to be transplanted, surgically it is easier to replace them along with the heart. If the recipient's original heart is healthy, it can be transplanted

7. ABO incompatible transplantation: The immune system of young children aged below 12 months might have developed fully. They can receive organs from incompatible

1. Live donors: A living person, mentally and physically healthy can donate one of a paired organ, part of an organ or a tissue. The organs donated are kidneys, part of live, one of the lung, part of small intestine, skin, bone marrow, one of the testis and one of the ovaries.

2. Unrelated donors: For altruistic reasons, a person can donate one of his organs to an unrelated donor. According to TOHO act, the unrelated donor should be known to the recipient and have some obligation to him. It has to be established that there is no monetary transaction between them. But in many other countries, even a stranger can

3. Deceased donors: Organs are harvested from brain dead person whose respiration and circulation are maintained artificially. Brain dead has to be certified by a team of doctors

4. Paired exchange: When a living donor is not compatible with the related recipient, but may be compatible for another recipient. That second recipient related donor is compatible to the first recipient, then permission can be granted for transplantation. The surgery for all four donors and recipient are conducted simultaneously and anonymity is kept until after

5. Spousal donation: A spouse can donate an organ to the partner. It has to be recorded that

donate one of his organs to a needy person on altruistic grounds.

nominated by Government I every organ retrieval centers.

isograft. There will not be any immune response hence no transplant rejection.

by the recipient and will try to destroy it. This is called s rejection.

example, the heart valve of pig is transplanted successfully to human.

between two recipients, usually an adult and a child.

20 Organ Donation and Transplantation - Current Status and Future Challenges

into another recipient in the need of one.

Live donor can either be related or unrelated.

donors.

Types of donors

the transplant.

the couple is legally married.

Despite advances in medicine and technology, and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen. Each year, the number of people in the waiting list is increasing in both donor and transplant. The donation statistics according to OPTN Annual report shows that in 2016, total of 41,335 organs were donated. It can be either deceased or living and four out of five donations came from deceased donors and four out of ten from living donors. According to the report by OTPN 2018, 115,033 people need life-saving organ transplant, of those 74,926 people are the active waiting list candidates.

The real reason behind a living person's interest in donating one's organ is important to determine but it is often difficult. Now days, money has become the motivation for donation. The relationships also have played a great role in increasing donation rates. The shortage of available organs can be reduced if; people choose to donate their organs after they die. If more people did that the issue regarding organ shortage can be minimized.

The trend is expected to accelerate each year. Many organ procurement and the Joint Commission on Accreditation of Healthcare Organizations actively participate to increase the donation rates. The organizations take various to steps against traditional social taboos.

The approach, known as "donation after cardiac death" (DCD), usually involves patients who have suffered brain damage, such as from a car accident or a stroke. After family members have made the difficult decision to discontinue a ventilator or other life-sustaining treatment, organ-bank representatives talk to them about donation. Sometimes, the donor is suffering from an incurable disease also end up with the decision of organ donation.

According to U.S Department of Health and Human Services, more than 1,23,000 men, women and children currently needed life-saving organ transplants every 10 minutes and another name is added to the national organ transplant waiting list. In 2014, more than 8500 deceased donors made possible approximately 24,000 organ transplants. In addition, there were nearly 6000 transplants from living donors. In India, nationally with a population of 1.2 billion people, the statistics stands 0.08 persons as organ donor populations. Mrithasanjeevani, Kerala network of organ sharing which began in 2012, also states that the need for organ transplantation is high as the patients in waiting list is increasing day by day who requires organ transplantation.

4.1. Pre-donation challenges

religious obligation or self- identity.

4.1.4. Family attitudes toward donation

4.1.2. Donor's decision-making

4.1.3. Support

Most donors are likely to be motivated by multiple factors. These factors include intrinsic factors (e.g., desires to relieve the suffering of another or to act in according to the religious convictions) and extrinsic factors (e.g., the social pressures or perceived norms) that may operate simultaneously. The particular combination of motivational forces will also differ

Organ Donation and Transplantation: "Life after Death" http://dx.doi.org/10.5772/intechopen.76962 23

Among living related donors, it has long been assumed that family members or emotional partners are motivated primarily for saving the lives of their loved ones. Such motives are indeed the most commonly expressed feelings, as noted in a variety of studies over the past 30 years. Among nondirected living donors (individuals donating to unrelated patients whom the donors did not select)(NDLDs), it was identified as the altruistic/humanitarian motives, along with beliefs that the donor's self-worth would be improved, and feelings of moral and

The motivation for the organ donation is purely on the donor's decision of organ donation and it may be influenced by many factors including the relationship to the recipients. Decisionmaking swiftness may indicate the type of decision being made. There appear to be two decision-making approaches that include the moral decision making and the rational decision making. "Moral decision-making" involves awareness that one's actions can affect another; ascription of responsibility to oneself; acceptance of the social/moral norm governing the behavior; and taking action consistent with that norm. Because moral decision-making does not involve the costs and benefits of a given behavior but, instead, is based on perceived norms governing that behavior, it is likely to lead to non- deliberative, instantaneous decisions. In contrast, "rational" decision-making includes various steps that focus on gathering relevant information, evaluating alternatives, selecting an alternative, and implementing the decision.

It includes mainly the assessment of the donor's available physical, financial and emotional support. It is necessary to identify whether the donor have someone to provide care in the recovery period, have sufficient financial support and so on. This important to avoid distress if the donor develops any complications. Finally, does the donor have the support of significant others for being a donor, or is he or she choosing to donate over the objections of persons who

Spouse and family attitudes about donation should also be explored. Collateral interviews with significant others is necessary, especially those who will be providing tangible support to the donor during the recovery period, should be conducted whenever possible. Conflicts

have a legitimate interest in the outcome of an autonomous decision.

depending on whether and how the donor is related to the recipient.

4.1.1. Donor's motives

The need for organ has gone up substantially all over the world. India also suffers from acute organ shortage with little to no solution for this issue. It is estimated that every year 1.5 lakh people suffer from renal failure out of which only 3000 people get donors. Similarly, every year around 2 lakh people die of liver failure or cancer and rarely get any help in the form of organ donors. It is the same for heart patients, for every 50,000 heart attack patients there are only 15 hearts available for transplant. Therefore, there is an urgent need for widespread campaigns to spread awareness about organ donation in India and to bridge the gap between supply and demand. The numbers that are mentioned here are estimates and real numbers could be far more than this, it is scary because this means very few people get relief and get a second chance in life.

The main reasons for organ shortage in India are mainly ignorance and lack of knowledge. People are not well informed enough about the benefits of organ donation. Today social media and so many other forums can promote the positives of organ donation and how it will save so many lives if more people register themselves for organ donation. The reason for organ shortage is myth and superstition. Many people do not want to donate their organs even after death because of so many myths and superstition they are instilled with. People with existing medical condition or old people, who wish to donate, do not donate thinking they are not fit or eligible. Almost everyone can donate some part or the other unless you have any extreme medical condition.

The need for organ donation is necessary because out of the 1.5 lakh people who need kidney in India only 3000 people receive them, only 1 out of 30 people receive kidney and 90% of people in the waiting list die without getting any donor. Around 70% liver transplants are dependent on a live donor but 30% dependent on cadaver (corpse) donations. Hence, there is an urgent need to increase the organ donation rates and give a person a second chance in their life.
