The Transplantation of Human Organs Act, 1994, which seeks to provide for the regulation of removal, storage and transplantation of human organs -- live and cadaver -- for therapeutic purposes and prevention of commercial dealings, is not applicable throughout the country. This limitation has a two-fold impact. First, the authorised centres have a mindboggling backlog. Second, it opens the doors for unauthorised centres to undertake transplants, which may not only be health hazardous but also involve commercial transactions.

The Act makes written consent by donors mandatory. ``Written consent is rare in a countrywhere the level of awareness about organ donation is very low,'' said Dr M R Rajasekar, one of the two leading liver transplant experts in the country. Even if the consent is in place, the relatives may not stand by it, rendering it useless.

Many countries have got around this procedural problem by providing for presumed consent, which authorises doctors to remove organs of a brain dead person if he/ she has not prohibited transplant of his/ her organs.

The Act recognises the concept of brain-stem death, but it doesn't have popular acceptance, added Dr A S Soin, the other leading liver transplant expert. ``Brain-stem death, which accounts for 1 per cent of all deaths, is the stage at which all functions of brain-stem have permanently and irreversibly ceased.'' In a brain-stem death, other organs may continue functioning for some time with the help of life-support systems, and can be transplanted within 12-24 hours. It's in contrast to cardio-vascular deaths where heart ceases functioning before thebrain.

Besides, the law is not punitive enough. Unauthorised doctors who undertake removal or transplant of organs are punishable with a a jail term of up to five years and a fine of up to Rs 10,000. Touts are liable to be imprisoned for two to seven years and fine of Rs 10,000-Rs 20,000. The punishments are hardly a deterrent, considering the chances of conviction and the monetary benefits involves.

Added Dr Anupam Sibal, a paediatric hepatologist, ``Apart from the legal lacunae, transplants are hampered by lack of infrastructure. Only five centres in Delhi have been authorised to certify brain death. Most of the hospital don't have trauma centres.''

Even the support systems are missing. Elaborated Raj Takkar of HOPE, a Delhi-based NGO dedicated to donation and transplant of organs, ``There is no specialised counselling available to counsel the relatives of brain dead people, who are too traumatised by the death of their kith and kin to think about another, unrelated life. Even those who would considerdonation fear the perceived mutilation of the deceased and cumbersome paperwork. In fact, counsellors could even motivate people in lawful possession of the brain dead to donate their organs even in the absence of a written consent.''

Suggested Rani Jethmalani, an eminent lawyer, who has had a liver transplant herself, ``A nodal agency needs to be set up which will take care of process from donation to the transplant.'' Obviously, there is not only a need to make the law more comprehensive but also to create amenable conditions for its proper implementation.