A family friend recently described his wait for a kidney as being on death row, interspersed with spells of utter desolation. Today, he thanks God and his doctors for this second chance, and hopes that he can bounce back to his former life, so that he can care for his father, without whose kidney he would not be alive today. He shudders at the long wait and even more at the evaluation that the hospital authorities put him and his father through.
The sad fact is that while organ transplants offer a lifeline for the living dead, the demand-supply gap has spawned an organ trade industry. The Human Organ Transplantation Act, 1994 was amended in 2011 and states like Tamil Nadu have further fine-tuned the Act to make it more difficult for unethical conduct, but unfortunately the lawbreakers outnumber the lawmakers.
And when the lawmakers do act, it’s a hasty reaction. For instance, it took the death of a former Chief Minister of Maharashtra for the state to finally do something about its dismal record of organ donation. Stung by the fact that Vilasrao Deshmukh had to be rushed to Chennai for his transplants, and the fact that crucial time was lost during the wait in Mumbai, the Maharashtra State Government passed four resolutions on the Human Organ Transplantation Act, 1994 in a single day.
The first resolution mandates a Brain Stem Death Committee to confirm if a patient is brain dead and, if so, to inform the Zonal Transplantation Coordination Committee. A second resolution deals with the composition of the Brain Stem Death Committee while a third allows non-transplant hospitals with an ICU and an operation theatre to remove organs after a patient is certified as brain dead. The fourth resolution makes it mandatory for hospitals registered under this Act to maintain records of transplant surgeries, the counselling department and the transplant coordinator in order to ensure that there is transparency in the system.
The intentions are fine, but as always, the devil is in the details. Practical considerations like maintaining and transporting of harvested organs from non-transplant hospitals to organ transplant centres still need to be worked out. Also, as the state government is contemplating converting and upgrading its district and civil hospitals to retrieval centres, do these hospitals have the facilities and trained personnel to maintain brain-dead patients until their organs can be harvested?
On the ethical side, how will the state government ensure that there is equitable distribution of the harvested organs between rich patients and their poorer counterparts? There have been many reports of a nexus between non-transplant hospitals and private hospitals, where the former would tip off the later whenever they received a certified brain-dead patient so that the latter could arrange transplants for its rich patients. Poor patients who cannot afford kick backs to the hospitals and doctors would remain far down the waiting list.
But while hospital managements wait for governments to decide on the exact mechanisms and insert safeguards, they can still play a positive role by counselling patients and their relatives on the act of organ donation. Bollywood siren Priyanka Chopra recently pledged to donate all her organs after seeing the work done by the University Of Rochester Medical Centre, where her father was being treated for his liver illness. We need many more such champions of this cause before organ donation becomes more acceptable.
Viveka Roychowdhury
Editor
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