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India donates over 80,000 corneas a year yet has one of the world’s lowest cadaver donation rates—revealing a system where the burden of consent falls on families at their most vulnerable moment

Like he did as John McClane in his ‘Die Hard’ outings, Bruce Willis is hanging in offscreen too. Just that the loud explosions, shattered glass and rattling gunfire have now given way to failing speech, fractured personality and fraying judgement. And unlike McClane, he won’t be walking out of the rubble. The 71-year-old actor has been undone by frontotemporal dementia and all his aching family can do is wait to bid their final goodbyes, a wait harder than the parting itself. They have decided to donate Willis’ brain to science, hoping that in death, he might bring some light to those staring at the same dark road.

A searing call like this, made by the family on behalf of someone who no longer has a voice, is as much an act of compassion as a legal labyrinth. That’s also where an uneasy tension overshadows organ donation in India: to whom does the body of the deceased belong—the individual or the family?

Consent conundrum

In India, where a new name joins the transplant waiting list every ten minutes, at least 15 people die daily waiting for an organ and the cadaver organ donation rate languishes below one per million population, the odds couldn’t be starker. On top of that, under the Transplantation of Human Organs and Tissues Act (THOTA), 1994, and its 2011 amendment, it is the grieving family that is required to decide, within a narrow window after bereavement, whether their loved one’s organs may be donated, even if the deceased carried a donor card or had registered as a donor.