The National Organ and Tissue Transplant Organisation (NOTTO) has called for suspension of all cadaver transplants in the wake of the coronavirus crisis.
The NOTTO, the apex organisation for all activities of coordination and networking for procurement and distribution of organs and tissues, has also said that no transplant should be undertaken without a “rigorous epidemiological survey among potential donors and their families”.
In a guidance document, NOTTO, which also functions as a registry of Organs and Tissues Donation and Transplantation in the country, has stated, “Individuals who have been exposed to a confirmed or suspected COVID-19 patient within the last 14 days, who have returned from nations with more than 10 infected patients and those whose cause of death was unexplained respiratory failure should not be accepted as deceased donors. PCR of airways specimens of donors with suspicion of COVID-19 should be undertaken. The deceased donor programme may be temporarily suspended…”
At about 0.34 per million deaths, the cadaver donation rate in India is extremely low. This means that in a year just about 1,000 transplants take place in the country of all organs taken from brain dead persons. However, transplant surgeons say that with living donors staying away because of coronavirus, for many patients cadaver donation is their only hope until things return to normal.
Dr Vasanthi Ramesh, who heads NOTTO, said the guidance was issued based on the experience of many other countries. “However you have to understand that this is not a 100-per cent ban,” Dr Ramesh said. “In emergencies, if a patient needs it to survive, committees in NOTTO will take a call on whether to allow it. Even earlier, the committee decided for urgent cases—now all cadaver cases will go there.”
Transplant surgeons, however, are not happy.
Dr Subhash Gupta, chairman, Max Centre for Liver and Billiary Sciences, said, “Deceased donor transplant should continue, obviously after proper testing. Many people have expressed a desire to donate. Why should we disrespect their last wishes when there are many patients who are waiting for organs?”
One surgeon, speaking on the condition of anonymity, asked who gave the advice for this proposal. “In the US, Spain, Italy – (which are) some of the countries worst hit (by the virus) – transplants are continuing. Are they implying doctors here do not know how to differentiate between a COVID patient and a non-COVID patient? This is a disservice to both patients and doctors.”
Dr Sanjay Nagral, transplant surgeon at Jaslok Hospital, said, “This idea of screening the family sounds a bit over the top because it is very difficult to convince families for cadaver donation. They are grieving and you ask for screening…as it is live donors will get increasingly scarce until the COVID crisis blows over. We should decide who organs go to by how sick the patient is. Internationally, something called the MELD score is used.”