In Spain, when an organ donor’s body is taken for funeral, a team from the hospital’s transplant department attends the ceremony as a mark of respect. Taking a leaf out of this, the committee set up to frame India’s National Organ Transplant Programme has suggested that every donor be given a state funeral and a government functionary, preferably an MLA, be present at his/her funeral.The final goal: to de-stigmatize donations, to encourage more and more people to donate and to break the shady, backroom surgeries that have now come to mark the transplant trade in the country as illustrated in the Gurgaon racket.Clearly, the committee, set up by the Delhi High Court in 2004 to review the 1994 Transplantation of Human Organs Act and chaired by the Secretary, Ministry of Health, has its task cut out.For, as reported in The Indian Express yesterday, the biggest reason for the illegal organ trade is the chasm between demand and supply — while 1.5 lakh patients need kidney transplants each year, only 3,500 get it. The donor is mostly a blood relative as the cadaver programme that would allow retrieving organs from a brain-dead donor has just not taken off. That’s the starting point for the committee. To encourage cadaver organ donation via a long list of to-dos that range from respecting the donor to coordinating massive government support to set up both infrastructure and capacity. Fortunately, there are examples to emulate. In fact, officials from the Ministry of Health and Family Welfare have toured several countries to study their best practices. And it’s the Spanish model that offers the most valuable lessons. “The entire system in Spain is geared towards organ donation in the event of brain death,” says S C Sharma, a noted transplant surgeon with Gangaram hospital. Sharma did his post-graduation from Barcelona in organ transplantation, procurement and management. He came back to India and tried implementing the same programme. He admits he failed even in a hospital that has a transplant department. And therein lies the key. Over the last five years, Sharma says, he has counselled 10 patient families each month — that works out to about 600 families — but has only been able to do six cadaver transplants. This when the first cadaver kidney transplant took place in KEM Hospital in Mumbai in 1967. And since then, only 400-odd such transplants have been done nationwide, a pointer to the long road ahead. There’s reason for hope, though. The first hurdle in cadaver transplant has been passed — the recognition of brain death in the 1994 Act. Most registered centres have a panel of usually four doctors who conduct a standardized battery of tests to determine whether a person is “brain dead”. This certification was expected to kick off a spate of organ transplants but that hasn’t happened. This has prompted experts to look at other features in the Spanish model that show the way:• A parallel authority, Spain’s Organizacion Nacional de Trasplantes (ONT), takes charge of donations. Under this, the responsibility for handling the donation process is on specially trained individuals called “donation teams.” They identify potential donors, handle evaluation and management of the donor, ensure the family understands that death has occurred and makes the request for organ donation. • A central registry of waiting recipients with priorities, down to states and districts. Once a potential donor is found, the entire mechanism is set into motion. The first priority is given to a patient in the same hospital with matching blood group. Priority is also given to younger people and heart patients. No political or extraneous interference is allowed.• There are standardized protocols for handling road accident victims who are brain dead. Advanced ambulances keep the body on life support, pumping the heart to keep other organs flushed until the patient reaches the ICU, keeping in mind that each victim is a potential donor who can save several lives. • Transplant coordinators constantly counsel families and maintain contact with them throughout. In India, while the patient may be declared “brain dead,” as per the new law, such systems are not in place. Families, traumatised by death, do not understand the importance of the programme. They also have reasons to: One, religious faith, according to which a body has to be cremated “in full.” Two, the stigma attached to organ transplant is so deep that relatives are scared of being accused of selling organs. Third, most associate organ removal with “disfigurement” of the body. These concerns need to be sensitively handled, experts agree. “For, there is no other way out but to give impetus to the cadaver programme,” says Harsha Jauhari, transplant surgeon with Gangaram hospital and a force behind the national programme that is in the final stages of being drafted.Dialysis is not an option: It costs Rs 10,000 per month for an average span of five years. If all 1.5 lakh renal failure patients were to get this done, the costs would be staggering.“Given these prohibitive costs, live as well as cadaveric transplant is the only way out,” Jauhari says. Hence the proposal includes providing incentives to the living family members like insurance, concessions at hospitals and even an honour. “The political will seems to be very much in place. The plan is to expand the number of exclusive donor centers at 350 nursing homes and ICUs with transplant coordinators, dialysis facility at every district and state-of-the-art ambulances.(Tomorrow: why a scheme in Chennai has some answers)
