From ICU to new life: Tracing the journey of a donated organ in India

From confirming brain death to racing against the clock, here's how India's doctors, labs, and Notto work together to deliver a donated organ and save lives

In the dimly lit corridors of a Delhi hospital, a cooler packed with ice leaves the ICU under heavy escort. Inside is a human heart, still warm, still beating in spirit, and on its way to a patient hundreds of kilometres away. Traffic lights will turn green just for this journey, pilots will ready an aircraft at short notice, and surgeons will stand scrubbed and waiting.

 

But how does such a mission even begin? And who makes sure this gift of life reaches the right person in time? On World Organ Donation Day, let’s trace the journey of a donated organ.

 

 

How is a potential organ donor identified?

It usually begins in the Intensive Care Unit of a hospital. According to Dr Ahmed Kamaal, senior consultant, Renal Transplant, Amrita Hospital, Faridabad, the potential donor is often someone with a severe, irreversible brain injury, after a road accident, brain haemorrhage, or prolonged lack of oxygen.

 

“The key is that the brain has stopped functioning completely and permanently, even though the heart is still beating with the help of a ventilator,” explained Dr Kamaal.

 

Before the donation process starts, doctors follow India’s Transplantation of Human Organs and Tissues Act (THOTA) to declare brain death. A team of doctors also checks that the organs are healthy, don’t have any major infections, and there is no cancer that could spread to a recipient.

 

What tests confirm brain death?

In India, the process follows Notto (National Organ and Tissue Transplant Organisation) protocols.

 

“A board of four senior doctors, none from the transplant team, carries out the tests,” said Dr Kamaal. They check brainstem reflexes such as pupil reaction to light and gag reflex, and perform an apnea test to see if the patient can breathe without the ventilator.

 

“These checks are repeated after six hours to be absolutely sure,” he said. In rare cases, when clinical tests are not possible, scans like a brain blood flow study may be used.  Also read: Brain death explained: The hardest 'yes' and a window for organ donation

 

How is the donor’s family approached?

“This is one of the most sensitive conversations in medicine,” said Dr Kamaal. The family is spoken to in a private space, with clear explanations of what brain death means, that it is legally and medically the same as death.

Families are also reassured that organ donation is considered only after all life-saving measures have been tried and failed. “People often ask, ‘Will treatment stop early because of donation?’ The answer is no, never,” he emphasised.

   

Who decides where the organ goes?

Here’s where Notto steps in. Once the donor is confirmed, details are fed into its central system. Matching is based on medical urgency, blood group, waiting time, and organ size.

 

“Notto also coordinates the organ’s transport across cities and states, ensuring transparency and no bias in allocation,” said Dr Kamaal.

   

Beyond blood type: Matching size, structure, and safety

Size compatibility is crucial, especially for the heart, lungs, and liver. Doctors also ensure there are no transmissible infections and that the organ’s structure, like liver blood vessels, is suitable for transplantation. Special immune tests help predict whether the recipient’s body might reject the organ.

 

How fast must an organ reach the recipient?

Time is everything.

 

• Heart: 4–6 hours
• Lungs: 6–8 hours
• Liver: 8–12 hours
• Kidneys: up to 24–36 hours

 

“Every minute matters,” said Dr Kamaal. “Transport, surgery prep, lab tests, it’s all a race against the clock.”

   

How is the organ preserved in transit?

After retrieval surgery, the organ is flushed with a cold preservation solution, placed in sterile containers with ice packs, and kept in temperature-controlled conditions until it reaches the operating room.

 

How is the recipient prepared?

“As soon as we get the call, the recipient is brought in immediately,” Dr Kamaal explained. They undergo final compatibility checks, scans, and pre-surgery prep so the transplant can begin as soon as the organ arrives.

 

What compatibility tests are done?

Three checks happen quickly, often within hours:

 

• HLA typing (tissue match) to see if their immune systems are compatible.
• Crossmatch test (to prevent immune rejection) to make sure the recipient’s blood won’t react badly to the donor’s.
• Infection screening for HIV, Hepatitis B, Hepatitis C, and other viruses.

 

“We often run them together to save time, and double-check before proceeding,” said Dr Kamaal.

 

Doctors then review the donor’s medical history, run imaging scans like CT or MRI, and sometimes take a tissue sample. If anything suspicious is found, the organ is not used.

   

How are samples handled during transport?

Samples are kept cold, sealed in tamper-proof bags, labelled with unique codes, and tracked at every step, ensuring nothing is lost or mixed up.

 

How do hospitals, labs, and Notto coordinate so fast?

Dr Kamaal explained they stay connected via secure digital systems. In urgent cases, labs directly call the surgical team with results so the operation can start immediately.

   

World Organ Donation Day

Observed every year on August 13, World Organ Donation Day shines a light on the extraordinary gift of life that donation offers and urges people to take the pledge to become donors.

The 2025 theme, ‘Answering the Call’, underscores the important role that healthcare professionals play in the donation ecosystem, and calls on them to deepen their commitment and teamwork to save more lives.

Across the globe, health ministries, NGOs, and organisations such as the World Health Organization use the day to dispel myths, break taboos, and normalise conversations around brain death and organ donation.   

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This report is for informational purposes only and is not a substitute for professional medical advice.