‘Progress in cadaver transplantation has been tardy’

Member, MCFOT and former head of nephrology at KEM Hospital Dr Vidya Acharya in conversation with Rita Dutta about various facets of Human Organ Transplantation Act (HOTA), problems of implementing it and suggestions to improve it

Can you brief us about the history of organ transplantation?

In India, the concept of organ transplant has been in existence from ancient times- the oldest example is Lord Ganesh - an example of xeno-transplantation. First ever human organ transplant in India was conducted in 1966 at the KEM Hospital, Mumbai. The first two were from cadaveric donors. The third transplant was at BHU in Varanasi in 1967. The first successful live related donor transplant was done at CMC, Vellore in 1971. Thereafter the transplants, live related, were started in KEM Hospital Mumbai and PGI, Chandigarh and AIIMS, New Delhi.

There was constant attempts in Maharashtra to enact legislation for organ transplant and thus Maharashtra Kidney Transplant Act was passed in 1984 to curb commerce in organs, which was rearing its head.

Unfortunately, the law missed to define “brain stem death” by oversight. Hence a Public Interest Litigation (PIL) forced the govt to form an organ transplant committee and the law was completely overhauled. By then, the Govt of India requested that the revised version of the law be handed over to them, so that they can pass HOTA Act.

After several delays, HOTA was ultimately passed in July, 1994. This was essentially directed to stop trafficking in human organs and to enable cadaver organ transplant programme to be initiated.

In India, which states are faring better in organ tranplantation? Do we have a good organ sharing programme between various states?

Maharashtra, Gujarat, Tamilnadu, Karnataka, Andhra Pradesh, Punjab, Uttar Pradesh are doing better in organ transplantation. A systematic approach to organ sharing exists in Maharashtra and Tamil Nadu.

Organ traffiking in connivance with doctors has given severe blow to organ transplantation programme. What are your suggestions to curb such malpractise?

The HOTA provisions must be strictly implemented. The authorisation committee and appropriate authorities must forward their recommendation for penal action against individuals and institutions to the police authorities. Police personnel and judiciary need to be educated about provisions of HOTA.

How successful is HOTA Act in curbing malpractices in organ donation?

Not so far, because of lack of proper implementation.

Why is cadaveric organ donation not picking up despite efforts by healthcare experts?

Main impediments for unavailability of cadaver donor in our country include professional and public ignorance, non-availability of adequate ICU beds, non-availability of equipment and trained personnel for use and maintenance of such equipment, poor communication and transport facilities, inadequate data receiving and sharing system and ego; my ego; super ego syndrome in the medical profession.

What are your suggestions to give a boost to the programme?

It is important to have certification of brain stem death, maintenance of registry of recipient waiting for transplantation, liability for punishment for removal of organs without authority and well-organised system to enable sharing and transport of organs.

It is also vital to identify potential organ donor. Inspite of 10 years following the enactment of law, progress in cadaver transplantation has been tardy with just over 700 transplantations done over the last 10 years.

We need to impart education to medical professionals about various aspects of the provisions of the law and the fact that “brain stem death” is a recognised form of death besides cardiac death. We need to recognise a cadre of medico social workers or others who are specially trained for transplant co-ordination, and make them prominent members of cadaver transplant organisation. This will break the “Ego; my ego, super ego syndrome” in the medical fraternity.

Lastly, education and co-ordination between police personnel, hospital administration, ambulance services so that trauma victims are quickly transported from the site of accident to the hospital for quick and efficient treatment.

Of late, many NGOs related to organ donation have mushroomed. What role can an NGO play in this?

NGOs can play a vital role in public education and bring about awareness. However, only recognised NGOs in each state should be allowed to do that after being approved by each State Government. NGOs should be governed by rules of ZTCC as done in Maharashtra. They should co-ordinate with other states through govt-to-govt sanctions only and a central agency like Organ Retrieval Banking Organisation (ORBO) should regulate them.