Ethics, communication and palliative care

Organ donation: the request conversation

Reviewed Nov 2026·2 references
New· views rounded down, updated weekly

Identifying potential donors, the mandated request in India, decoupling the request from news of death, and working with transplant coordinators.

Definition
The THOA amendment (2011) and Rules 2014 require hospitals to ask relatives of a potential brain-stem-dead donor about organ donation and to inform the transplant coordinator. Brain-stem death certification is covered in the raised-icp-neurotrauma-brain-death module.

At the bedside

  1. 1

    Identify early

    Severe brain injury with GCS 3 and absent brainstem reflexes, or planned withdrawal - notify the transplant coordinator (NOTTO/ROTTO/SOTTO network) early.

  2. 2

    Decouple

    Explain death (brain-stem death) first; allow the family to understand it; make the donation request in a separate conversation.

  3. 3

    Who asks

    A trained requester, ideally with the transplant coordinator, in a private setting.

  4. 4

    Content

    Donation is an option and a gift; it is voluntary; no payment; funeral and body appearance not affected; religious views respected.

  5. 5

    Consent and documentation

    Written consent from the person lawfully in possession of the body on the prescribed form; medico-legal cases need police/forensic clearance.

  6. 6

    Donor management

    Continue organ-supportive care (MAP, fluids, temperature, endocrine) after consent - see raised-icp module.

Red flag · call your senior now
Raising donation before the family has understood that the patient has died (or will die) - risks distrust and refusal.
Pitfall
Not informing the coordinator because 'the family will refuse' - the law requires the request.
Pearl
Families who decline should still receive full support - the request is an offer, not an obligation.

References

  1. 1

    Ministry of Health and Family Welfare, Government of India. Transplantation of Human Organs and Tissues Act 1994 (amended 2011) and Transplantation of Human Organs and Tissues Rules, 2014. NOTTO.

  2. 2

    Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017;45:103-28.

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