'India Had Come To Be Known As The International Kidney Bazaar'

EHM News Bureau

The availability of quality indigenous grafts has expanded the scope of reconstructive surgeries. It is now possible to apply safe, reliable and cost-effective grafts enabling patients of all economic strata to gain from these services with concurrent hospital and medical cost benefits, stated Dr K A Dinshaw, Patron, Asia Pacific Association of Surgical Tissue Banks (APASTB) 2006 and Director, Tata Memorial Hospital. She was speaking at the 11th international conference of APASTB with the theme 'Issues on Tissues' which was held in Mumbai recently.

Rudi von Versen, MD, DMSc from Germany spoke about challenges at present and in future in tissue banking. He said that despite a clear progress there are different levels of technology, quality standards and regulatory systems world over in tissue banking. This concerns the establishment of tissue banks in the Asian and Latin American regions, and despite considerable efforts and some international support, problems are beginning to emerge in Central Europe and North America too. The hospital tissue banks and hospital bone banks, which continue to exist in many industralised countries, are to be assigned to sort out this problem.

"In spite of some problems, we are seeing very rapid development, which bears to some degree the character of pharmaceutical enterprises, namely the industrialisation of tissue banking. This increasingly raises the demand for generally valid standards and internationally accepted ethical regulations. These demands led the Governments to take steps for assuring a drastic improvement in the compatibility and efficacy of new products and processes," stated Versen. D Michael Strong, Chief Operating Officer, Puget Sound Blood Center, Northwest Tissue Center, USA, gave a brief overview of the changing paradigm in tissue distribution in the US. He said that a great deal of change has occurred in tissue banking during the last several years in the US. In a recent survey by the American Association of Tissue Banks (AATB), the number of tissue donors recovered in the year 2000 was 18,021, which increased to over 23,295 in 2003. This increase in collections and distribution has been largely fuelled by the increased involvement of for-profit organisations and partnerships between non-profit tissue banks and non-profit device manufacturers. Dr Ratnadeep Patil, PCAD (USA), Diplomat (ICOI), Associate Fellow (AAID), while speaking on sinus lift and augmentation in maxillary arch rehabilitation, gave an insight into the varied aspects of sinus lift procedures. "Dentures, which are often used to treat edentulous patients, may not completely restore function because of poor fit related to jaw atrophy and pneumatisation of the maxillary sinus. Dental implants can be an alternate solution to improve function and appearance almost completely, provided there is adequate bone dimensions," explained Dr Patil. To increase the amount of bone in the maxilla, the sinus life procedure, or subantral augmentation, has been developed. This procedure involves placing bone-graft material in the maxillary sinus to increase the height and width of the alveolus, he said.

Dr Vatsala Trivedi, General Secretary, Zonal Transplant Co-ordination Centre (ZTCC), Maharashtra, and Honorary Consultant of Urologly and Transplant at Sir H N Hospital, Nanavati Hospital and Dr LH Hiranandani Hospital, Mumba, spoke about the medico legal issues in organ and tissue transplant. "In India, by the last decade of the last century, living kidney transplantation programme had created a sensation due to social exploitation, and to some extent 'criminalisation' also. India had come to be known as the international kidney bazaar,” stated Dr Trivedi. According to her, the anxiety of law makers is clearly seen in the drafting of TOHA 1994 (Transplantation Of Human Organs Act 1994). This has prevented any law or Act from being totally comprehensive, which could be one of the reasons for failure of implementation of this act for the last 12 years. The entire focus of the law has been on kidney and other solid organs (liver, lung, heart) but the issues concerning tissue donation are totally ignored in the law. She acknowledged the need of having a national body with representatives from medical and legal community, NGO's committed to the cause and visionaries, so that comprehensive broad based amendments can be brought in, which will boost the cadaver transplant programme in the country.