It’s a body that needs work

Hurdles galore in organ transplant. Doctors say about 20 years to clear the state backlog,give or take

Written by MAYURA JANWALKAR | Mumbai | Published: July 3, 2013 12:32:38 am



With nearly 2,000 patients on the waiting list,doctors estimate it will take about 20 years to clear the organ transplant backlog in the state.

In the 15 years since 1997,the zonal transplant coordination centre has recorded only 306 kidney transplants,63 liver transplants and two lung transplants from deceased donors.

There are many hurdles in the way of families seeking expeditious transplants. Unavailability of matching donors is not the only one. Red tape,proving love and affection when the donor and the recipient are not related,lack of awareness about cadaver donation and paucity of funds are the other major obstacles.

On June 21,Bombay High Court asked state government to provide authorisation committees set up under Transplantation of Human Organs Act 1994 the necessary infrastructure and staff,so that sanctions to organ transplants do not take more than a month.

“A cadaver transplant taking four-five years is not rare,” said Shrirang Bichu,leading nephrologist from Bombay Hospital. He said there were multiple reasons for delay.

“A donor from another state needs to furnish a no-objection certificate (NOC). Time taken for this varies. Uttar Pradesh and Bihar take a long time to grant NOCs,” Bichu said.

In January 2012,however,Bombay HC ruled that no state committee authorisation would be required when the donor and recipient are close relatives. It allowed a 33-year-old tribal woman from Chhattisgarh to donate a kidney to her 27-year-old brother in Maharashtra.

When blood groups differ,the needy have to look beyond family. Sub-section 3 of section 9 of Transplantation of Human Organs Act 1994 allows a person,not a close relative of the recipient,to donate organs “by reason of affection or attachment or any other special reasons”.

In Kuldeep Singh versus state of Tamil Nadu,Supreme Court (SC) ruled in 2005 that the state authorisation committee would be in a better position to assess intent and ensure organ transplants are not carried out for commercial reasons.

However,“love and affection” as stated in the statute is for the donor and the recipient to prove.

“Whether there exists any affection or attachment or special reason is within the special knowledge of the applicants (donor and recipient),and a heavy burden lies on them to establish it,” SC said.

“There can be no way of defining love and affection,” said lawyer Uday Warunjikar,who had moved court on behalf of four patients of renal failure awaiting donors for more than six months. “The onus is on the parties to show there is love and affection between them.”

Bichu said when patients do not find donors or transplants are awaiting approval, they have no choice but to continue dialysis.

“Dailysis costs between Rs 25,000 and Rs 30,000 a month. How many in this country can afford that?

“Some patients can afford dialysis but by the time their case is cleared for transplant,they run out of funds. In other cases,prolonged dialysis may cause side-effects; some patients may develop heart diseases and may not be physically fit when transplant is cleared.”

Sion Hospital dean Avinash Supe stressed the need to create greater awareness regarding cadaver donation. “We are doing a lot in Maharashtra to create awareness but we can certainly do more.

“The Tamil Nadu government has made it compulsory for hospitals to declare brain dead patients,” he said.

Supe said hospitals counsel families of brain dead patients but sometimes do not get consent for organ donation.

There is another factor that hampers cadaver donations,he said. “Nobody wants to talk about maintaining brain dead patients. The state may not always be able to bear the expense.”

The need for liver transplants is growing but there is a shortage of donors. At least 15 liver transplants are carried out in Mumbai every year.

“In our liver OPD,around 170 people come for treatment every Monday,10-15 per cent require transplants,” Supe said.

A liver transplant in a public hospital costs Rs 8-10 lakh while in a private hospital it may cost Rs 15-20 lakh.

“Many people fail to find donors and die,” said Supe.

Bichu,who participated in the first five-way domino kidney swap of the country carried out simultaneously in three Mumbai hospitals on June 25,said the apex swap transplant registry,an agency that uses a computer software to facilitate swap,charges only Rs 250 for registration.

“If this becomes more popular,people need not wait for months to find a donor.”

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