With rates of private air-carriers that transport cadaver organs for life-saving transplantation procedures continuing to vary, the Directorate of Medical Education and Research (DMER) claims to have made an appeal to state medical education department to push Director General of Civil Aviation (DGCA) to regularise rates of private air-carriers flying inter-city and inter-state for medical purposes. “This issue has been ongoing for sometime now. We requested the medical education department to approach the union aviation ministry to make air-travel affordable for poor patients,” said Dr Pravin Shingare, Director, DMER.
According to Lalit Gupta, joint general manager at DGCA, no such communication has come from any state so far. State medical education secretary Rajagopala Devera said, “If charges are too high, we will see how to bring them down. A reasonable price is necessary for patients. Discussions will start now.”
In a letter to state medical education department, DMER stressed on the need for affordable prices for cadaver organ transplant. Cadaver organ transplant is a procedure to retrieve organ from brain-dead patients to save the life of a chronically ill patient. In 2016, Mumbai saw 58 cadaver donations, and in 2017, 15 donations so far. Doctors claim that if people in Mumbai donate organs following brain stem deaths, dependence on other cities will drastically reduce. “Inter city transport also needs close coordination. If say, a heart is not transported from retrieval site to recipient patient in four hours, it may go waste,” said Dr Anvay Mulay, heart transplant surgeon.
At least three private air carriers— MAB Aviation, United Helicharters and Leo Air Charter Services— have shown interest in flying cadaver organs for transplantation. In December 2016, a heart transport procedure between Nanded and Mumbai was called off after a private carrier demanded Rs 10 lakh to fly a heart to Mumbai’s Fortis Hospital. “A heart’s shelf life is four hours and road transport is not an option,” transplant coordinator for Fortis Hospital said. The cost of heart transplant ranges between Rs 15-20 lakhs and cost of transporting organ varies between Rs 1.5 lakhs to Rs 8 lakhs depending on time of day and flying hours. “If it is a poor recipient, to pay Rs 25-30 lakhs is a difficult prospect,” he added.
For a kidney, the shelf life, the duration for which an organ survives outside body, is 24 hours and for liver, eight hours, which makes road transport viable between nearby cities. Mumbai usually gets donors from Surat, Indore and Pune where cadaver donation awareness is huge. Air charges from Surat range between Rs 3-3.5 lakhs, from Indore Rs 6-7 lakhs and from Pune Rs 3-3.5 lakhs. On April 10, a heart that was air-lifted from Surat to Mumbai cost the patient Rs 3.5 lakhs. Mumbai has two to three private carriers that provide organ transport facility, while Delhi has four. According to Rajesh Sahu, managing director at Aura Aviation, the operational cost is high due to ground charges, handling fee, parking fee at airport, landing charges, salaries of pilot and of supporting staff.
“Calls for organ transport are always urgent and we have to use whatever aircraft is available. Large aircraft can cost more due to increased fuel requirement. Airports also levy penalties if private aircraft are parked beyond 48 hours. Some times we have to fly the carrier from Nagpur or Ahmedabad, where it is parked, to Mumbai for transportation. The cost of flying then increases,” said Sahu. He adds that DGCA needs to allow more carriers to transport organs and make rules flexible. Airports in several cities, like Surat and Nagpur, charge extra for handling carriers that fly at night.
The landing charges for private aircraft are Rs 37000 plus service tax and the penalty beyond 48 hours, 2,000 Rs per hour. “The challenge is availability of carriers at odd hours. Certain locations do not have airports that are equipped for 24×7 transfers,” said Dr S Narayani, Zonal director at Fortis Hospital. The hospital has three heart patients wait-listed for a transplant.
In 2016, DMER held discussions with three airliners to fix prices and lower them to suit patients’ needs. “But they claim they face operational issues. We need DGCA to frame a policy,” he said.