Organ donations: India
This is a collection of articles archived for the excellence of their content.
The legal position
Minors can donate organ/ tissue in rare situations: HC
NEW DELHI: A minor can donate an organ or tissue in a rare situation unless there is a risk to her life in the procedure, Delhi high court has said.
Justice Sanjeev Sachdeva on Wednesday set up an expert medical board to assess any risk to the life of a girl, who wishes to donate part of her liver to her ailing father, if she undergoes the procedure. The court noted that “there is no complete prohibition in a minor donating an organ or tissue prior to attaining majority. Donation is permissible but in exceptional circumstances and in accordance with the rules.” The observations came after it was informed that a committee set up by Delhi government had refused permission to the girl to donate her liver merely on the ground that she is a minor.
“There is no medical opinion in the present case to suggest that there is a potential risk to the petitioner. The minor is aged over 17 years and 10 months. ...The decision of the committee of rejecting the representation of the petitioner solely on the ground that the petitioner is a minor is not sustainable,” Justice Sachdeva, who heard the matter via video-conferencing, noted.
The girl wants to donate part of her liver to her father as he is suffering from a severe case of liver cirrhosis and urgently requires a transplant to survive.
The court directed the hospital, where the father is admitted, to set up the panel to examine if there is any potential risk to the girl’s life. It said the panel’s decision will be communicated to the government which shall “forthwith” take a decision on the girl’s representation for approval to donate part of her liver to her father, and listed the matter for hearing on April 3.
In her plea through her mother, the girl informed the court that she will turn 18 in last week of May, but her father needs urgent organ transplant.
2013-17, an increase
Over 2.5 Lakh Die In The Country Due To Organ Failure Annually While Cadaver Donations Are Marginal In Comparison. Some States Are Yet To Make A Debut
Of the 85,000 liver failure patients who join the country's waitlist annually , less than 3% get an organ. Also, of the two lakh fresh annual registrations for kidneys, 8,000 manage a transplant. Thousands waiting for heart or lungs face bigger odds as barely 1% get an organ before time runs out.
Despite cadaveric organ donations witnessing a near fourfold increase in the last five years, the demand-supply disparity in the country remains grave.Over 2.5 lakh deaths in India are attributed to organ failure annually , while cadaver donations are still very few in comparison.India's organ donation rate in 2016 stood at an abysmal 0.8 persons per million population compared to Spain's 36 per million, Croatia's 32 per million or US's 26 per million.
Experts say the gap exists because only ten states and two UTs have an active donation and transplant programme.States such as UP , Chhattisgarh, Himachal Pradesh, Goa and the North-East are yet to make a debut. Stakeholders blame lack of awareness, infra and political will as well as myths and misconceptions for the sluggish pace of cadaver donation.
“Even after decades, the programme is a non-starter because of systemic complexities.The problem lies within hospitals and is not so much about people's acceptance any more. Police formalities remain difficult and time-consuming, discouraging people from donating,“ says Dr Sunil Shroff of Chennaibased Mohan Foundation. “There have been cases where people have approached us wanting to donate organs but either the hospital or the city lacked the infrastructure to retrieve organs,“ he says, underlining how in a country with an acute shortage, organs get wasted.
Tamil Nadu, Maharashtra, Kerala, Karnataka, Telengana and Gujarat currently lead the way . Delhi and Chandigarh too managed 30 donations in 2016.
Dr Vimal Bhandari, director of the National Organ and Tissue Transplant Organisation, says the government is aware of the crisis. “We have signed an MoU with Spain which has the world's highest donation rate. About 100 countries are learning their model. Their experts will train five of our regional coordination centres,“ he says, adding that Spain took 30 years to build its programme.Unlike Spain, where majority of brain deaths occur due to haemorrhage, in India, road accidents are the main killer.
India's infrastructure too is growing. The national network facilitated 136 instances of organ sharing between cities and states. “Last year, we even saved the lives of two foreigners who underwent heart transplants here,“ Dr Bhandari says.
Tamil Nadu runs India's most successful programme by taking a slew of decisions to ease donations about a decade back; families donating organs don't have to move for NOCs or post-mortems. Also, the state offers free kidney , liver and heart transplants in government hospitals like developed nations.
Maharashtra, that crossed 100 cadaver donations last year despite one of Mumbai 's top hospitals being involved in a kid ney racket, has carried out 1,064 transplants in the last five years. Pune has suddenly emerged as a high-donation centre, surpassing Mumbai. “Till April 2017, 69 donations took place in Maharashtra,“ said Dr Gauri Rathod, Maharashtra's nodal officer for organ donation.
Hyderabad and other dis tricts of Telangana have crossed over 1,000 organ donations since 2013. From less than 1 per million population, the donation rate has now reached 4.4.From just 41 being recorded in 2013 to 106 organ donations in 2016. In 2017, over 80 organ dona tions have already been reported. “But there is an urgent need for education among doctors. In many cases, doctors are uncomfortable in declaring brain death. This is true of government hospitals,“ says Dr G Swarnalatha, in-charge Jeevandan.
Karnataka, too, is charting its own success story with donations taking a leap from 18 in 2013 to 70 in 2016. Dr Kishore Phadke, convener at Jeevasarthakathe--the state organ transplant authority--attributes this to linked Aadhaar cards with pledging organs. “ Anyone who enrols for Aadhaar will be directed to the website of Jeevasarthakathe where they can pledge organs,“ he says.
However, many states face unique problems. Consider Kerala which has recorded only 11 donations after 73 in 2016. “ A doctor filed a PIL in the high court alleging hospitals are falsely declaring brain deaths to procure organs. It led to negative propaganda in the social media.Even government authorities didn't stand by the transplant doctors,“ says Dr Jose Chacko Periappuram of Lisie Hospital in Kochi. Kerala, however, has to its credit some of the unique organ transplants that include larynx, pancreas, small intestine and hand transplants.
Eastern India is the worst, with most states not having conducted cadaver donations at all.Only seven cadaver donations, including five in 2016, took place in West Bengal since 2012. According to Aditi Kishore Sarkar, state's nodal officer for cadaver donation, “The drive to popularize organ donation through donor card distribution has failed.In 2017, there has not been a single cadaver organ transplant so far. The state plans to introduce new laws to improve brain death screening.
Even states like Karnataka show a unhealthy skew . As Dr H Sudarshan Ballal, senior nephrologist and chairman at Manipal Hospitals, Bengaluru, says, “Of more than 300 transplants conducted by private hospitals, only 20% are cadaver organ transplants. He says India needs more retrieval centres. “India's largest centre of neuroscience, NIMHANS, is still not recognized as a retrieval centre.“
Illegal organ donations
2008:Ayurvedic Dr Amit Kumar
The Times of India, Jun 04 2016
Rajshekhar Jha The kidney racket busted by Delhi Police recalls the unearthing of a similar racket in 2008. The earlier gang was headed by an ayurvedic practitioner, Dr Amit Kumar, and involved the transplants of a staggering 600 kidneys across the country.
The regulatory framework under which Kumar was found guilty and sentenced to seven years' of rigorous imprisonment and fined Rs 60 lakh by a CBI court in 2013 now appears to have so many lacunae as to allow another racket of similar magnitude. The latest case only highlights the need for a fresh evaluation of the norms to curb illegal organ donation. For over a decade, Kumar and his associates in the Rs 100crore business dodged the police with ease, with bribes being their main weapon. Even minutes before his arrest from a wildlife resort close to the India-Nepal border in 2008, Kumar had made an abortive bid to bribe a Nepalese cop. Arrested four times including by Delhi Police, Kumar had become the most wanted man for offences of this sort Jaipur, Guntur, Hyderabad and Mumbai.
While Kumar claimed to be a saviour of those battling kidney disease, including foreigners and NRIs from Greece, Canada, Saudi Arabia, UAE and the US, the so-called donors narrated a tale of being picked up by the doctor's henchmen and being confined to a secret location guarded by gun-toting men. The gang had a car converted into a mini lab where the victims were first brought and their blood samples matched with the clients' before any negotiations on money began.
Kumar used to insert advertisements in international medical journals offering overseas clients a full medical tou rism package that included return airfares, airport transfers, accommodation and cost of surgery . Like in the current case, the members aiding and abetting Kumar stayed in hotels and an upscale guesthouse in DLF-I in Gurgaon to impress wealthy clients.
The 2008 scam was exposed when a deal fell through and the potential donor, a UP labourer, filed a complaint of harassment against Dr Upendra, an aide of Kumar. This time it was a quarrel between a husbandwife duo that alerted the police.
While Delhi Police has been able to unearth a few cases till now, sources said this was only the tip of the iceberg. Once the mastermind and the big fish are in the net, bigger revelations are likely to follow.
2015: shortage of donors
See graphic, 'Number of donors found in transplants, organ-wise, 2015'
2016-17: increase from 9,000 to 15 lakh
Statistics show Spain records 36 donors for every million population, but India has less than one organ donor for every million citizens. Doctors and experts, however, believe India’s youth can help change this abysmal organ donation rate.
The reason for their optimism is the increased awareness about organ donation among the young. Unlike ageing India that still looks at organ donation with suspicion, the youth seem to have adopted it. A recently published study that looked at the attitudes towards organ donation of final-year students of medical, dental, engineering, and arts and science students in Chennai and Thiruvallur found an overwhelming 94% of those interviewed knew about organ donation. Only 31 out of the 486 students hadn’t heard about it.
The study published in the Indian Journal of Transplantation said that 54% of the interviewed students were aware about the “organ transplantation act”. Indeed, when TOI spoke to youngsters across the country, their empathy for the cause was apparent. Eighteen-year-old Siddharth R Chaube from Somaiya College, Vidyavihar in Mumbai, believes organ donation is a “divine concept” as it forges a lasting bond between two, often unrelated, people. “Science has remarkably progressed over the last couple of years, but it still hasn’t found a way to create new organs out of scratch. This is where organ donation steps in,” said Chaube.
Social media marketing executive Kruthika Ravindran (23) signed a pledge to donate her organs after attending a seminar last year. “People do not know what organ donation is. Hence, we need to make people aware of the what, where, when, why and how,” Ravindran said, adding that educating people is the only way ahead.
Freelance photographer Nihar Salvekar (23) wants schools to start talking about organ donation. “The youth would then be able to understand it and decide accordingly,” he said. Signing donor cards, too, would fasten the organ donation process in case of untimely death.
In fact, National Organ and Tissue Transplant Organisation (NOTTO) director Dr Vimal Bhandari advocates pledging as the instrument of change. Pledging doesn’t have a legal standing, it is one of the most effective tools to spread awareness of cadaver donation in a country where people know little about the concept.
“In merely two years, the number of Indians who have pledged organs has jumped from 9,000 to 15 lakh today,’’ said Dr Bhandari. Out of the lakhs, over 70,000 of the pledges have come from the young jawans serving the Border Security Force and other police forces.
Dr Bhandari said a lot of these pledges have come from medical and other educational institutions that NOTTO approached with its network of 60 NGOs. “If we want to witness a big shift, we have to start talking about organ donation early in schools and colleges,” he said.
He added that if young leaders speak of organ donation, it will find an appeal among the youth. “Pledging not just makes one aware, but also provides a window for individuals to discuss it with loved ones,” he said.