Donor nation

Organ transplant is an area fraught with individual prejudice and institutional inefficiency in India. So much so that even when the Transplantation of Human Organs Act (THOA) came into force in 1995,it proved ineffective either in coming down on the booming black market or in streamlining the process. As the ministry of health has noted,while about 1.5 lakh people are diagnosed with renal failure every year,their only hope often being a successful kidney transplant,the number of transplants has fallen: from an already meagre 3,600 in 2002 to just over 2,000 in 2004. In a move to redress this crisis in healthcare,the cabinet has finally cleared the amendments to THOA,where both the scope and definition of transplant have been widened and penalties and punishment made more stringent.

In a belated but welcome step to address the scarcity of organs for transplant,the bill proposes not only the creation of a registry of those who have undergone transplant but also an ambitious nationwide network that would incorporate transplant centres,retrieval centres and patients awaiting transplant. Much depends on the governments commitment to follow through with these proposals and on making it a viable,accessible database that could make life easier for patients waiting for transplants of lungs,hearts,livers,pancreata and corneas. It also,as expected,allows for the transplant of tissues and widens the ambit of near relation from whom one can receive organs for transplant without having to go through an authorisation committee to grandparents and grandchildren.

A small step that could be a gamechanger is the creation of the post of transplant coordinator. In this,the Centre has followed the successful experiment in Tamil Nadu where trained transplant coordinators counsel the relatives of a person who is brain dead,convince them of the need to gift organs

and take them gently through the process. A country that often baulks at the very suggestion of cadaver donation needs a hand-holder like that. It is a long way yet to the goal of presumed consent,but the bill recognises the need,first,to create awareness,one family at a time.