After being bedridden for almost all of last year, 41–year–old Jayashree Mehta finally underwent a successful lung transplant a couple of months ago at Mumbai’s P D Hinduja Hospital. Diagnosed with pulmonary fibrosis eight years go, she had been living on an external oxygen supply for almost two years. The surgery in July marked a milestone event as it was Mumbai’s first ever lung transplant and the sixth in the country, the previous five having been performed at various hospitals in South India since 1999.

It took a wait of six months to find a match for Jayashree. Even when they did get a call about a potential donor, it did not work out. "A week before the actual surgery, we got a call from the hospital saying they had found a match. However, the family of the donor backed out at the last minute," said Parag Mehta, her husband. "Luckily, a week later we got news of another donor and the surgery was performed."

There are thousands in the country who die waiting for a suitable organ to come. The dearth of usable organs, bureaucratic procedures and sheer lack of general awareness mark the organ transplantation scene in the country.

As per data collated from 48 top hospitals in the country by the Indian Society of Organ Transplantation, the total kidney transplants performed between 1971 and 2011 was 20,952 and the total liver transplant surgeries done between 1995 and 2011 was only 329. Experts say there is a need for 1,50,000 kidneys, 2,00,000 livers and 1,50,000 heart cadavers for transplants every year in the country.

In 1994, The Transplantation of Human Organs Act was framed for the regulation of removal, storage and transplantation of human organs for therapeutic purposes and also for the prevention of commercial dealings in organs. The Act, first introduced in Goa, Maharashtra, Himachal Pradesh and the UTs, was later extended to all other states. Amendments were made in 2008 to specifically address concerns about an organ trading racket. While the Act did put in place a mechanism for transplantation, medical consultations continue for further streamlining of its implementation.

"There is ambiguity regarding a brain–dead patient who will eventually be the organ donor. There are two types of transplants that are done. While the liver and kidney can be transplanted from a live donor, the heart can be transplanted only after the person is declared brain–dead. However, hospitals themselves cannot declare a patient brain–dead," said Dr Kishore Adyanthaya, professor & head of the surgery department at Bombay Hospital. As per the Act, a team of four medical authorities needs to declare the patient brain–dead twice in six hours. Procedural rules and bureaucratic interferences also often hinder the harvest process.

"There are certain rules and norms such as paperwork, permissions etc that come into play at the time of transplantation. While these can be the reason for several patients dying waiting for the organs, these rules are crucial to check the illegal organ trade. It is important to strike a balance when it comes to such rules," said Dr Mohammed Rela, who was supervising the treatment of former Maharahstra chief minister Vilasrao Deshmukh at Global Hospitals in Chennai.

Setting an example for the entire country is the Tamil Nadu model for organ transplantation. Since the first lung transplant in the country, performed in Chennai in the late 1990s, Tamil Nadu has seen around 1.3 million cadaveric donations. Support from the Tamil Nadu government and mass awareness has largely contributed to the success of organ transplantation in that state.

"The Tamil Nadu government has helped in pushing the cause of organ donation . There is a transplant coordinator in every hospital," said Dr T Sunder, senior consulting cardio–thoracic surgeon at Apollo Hospital, Chennai. "But most importantly it is public awareness that has helped the most. People are now more willing to come forward to help the cause."

"Awareness among the masses about transplants is high in the south. NGOs and governmental organisations conduct various campaigns and activities that help spread the word," Dr Rela said.

In other states, misconceptions, superstition and sheer lack of awareness prevail even among the "educated" masses. "Relatives fear mutilation of the donor’s body and are not willing to come forward. Awareness levels even among the educated people are low. This is something that must change if we are to save the millions who are dying just waiting for a suitable donor," said Dr Sunil Keswani of the National Institute of Burns, Airoli.