Bring back the cadaver
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"I understand it is not easy for the living to donate a kidney; but then why is the government not encouraging transplants from cadavers,' asks esrd patient Nozeer H Canteenwala. This aspect of the problem has been obscured in the media spotlight over illegal organ trade. Most doctors believe that cadaver organ transplants hold the key to change.
"When the organ trade act came into effect in 1994, the focus was on banning trade in human organs and setting up of a system for cadaver donations. After the Amit Kumar expose, the media has been concentrating on illegal organ trade. But what about a control mechanism?' asks Rana of the Indian Society of Nephrologists.
"Cadaver organ does not require a special infrastructure. But rather than encouraging such transplants, the government is promoting transplants from live donors,' Trivedi of ztcc rues.She carried out Maharashtra's first successful cadaver kidney transplant on March 27, 1997. She has conducted 36 such transplants since. But there aren't many like her in the country.
A bad contrast
Rashmi Jadhav, a government employee in Mumbai, is a living testament to the advantages of cadaver transplants. She got a new lease of life after a kidney donation from a brain dead person in 2004. "We do not have the words to thank the parents of our beneficiary,' says Jadhav, a resident of a slum-settlement in Mumbai.
Developed countries have a lot more people like Jadhav. For cadaver donations provide a large majority of the organs required for transplant. "For example, 95 per cent of kidneys used for transplant in Spain come from cadavers,' says Katti. In the uk, one in seven organ transplants is from non-beating heart donors, individuals whose deaths result from heart and respiratory failure. In India, contrastingly, most cadaver transplants are from brain dead people. Organ retrievals are very difficult when deaths happen outside a hospital, medics say.
There are many who believe retrieval from the brain dead would go a long way in dealing with the organ shortage problem. "Every year, about 4,000 people end up brain dead in the country. That means 8,000 potential kidneys and corneas and 4,000 heart, lungs, pancreas and livers that can be used for transplants,' says Suniel Shroff, managing trustee of the Mohan Foundation, a Chennai-based charitable organization that promotes transplants from cadavers.
Many doctors are pinning hopes on dghs' National Organ Transplant Programme. It is slated to be in operation in the next three to four months. dghs sources say the programme will emphasize cadaver donations, and make live donations simpler. "We have proposed that the donor be given medical insurance for three years and the first premium be paid by the organ recipient,' says Jauhari one of the programme's architects.
Other doctors say that a cadaver donation programme must have the provision for a national network that allows hospitals to exchange organs so that they can be used for the best matched recipient. Creating such a registry is not much of a problem, says Sanjay Agarwal, senior consultant at the nephrology department of the All India Institute of Medical Sciences. The institute has an organ retrieval system which does precisely that. But then it is not a national network.
Many doctors are, however, sceptical of registries. For one, doctors cannot legally remove organs without the family's consent. "Anyhow, a very small percentage of people who register as donors will die a brain death,' says Sumana Sundaram, project coordinator at the Mohan Foundation. "The challenge is in getting brain dead road accident victims to the hospital quickly," she says.
Draft in limbo
Katti says India needs a national organ retrieval programme to boost cadaver transplant; it should require the setting up of retrieval centres across the country. Suggestions such as Katti's were considered by a committee set up by the Union Ministry of Health and Family Welfare (mohfw) in 2004. Its mandate was to review the organ transplant act. The committee recommended that:
- it be incumbent on hospital staff to request families of brain dead people for organ donations;
- increase in icu facilities in hospitals to keep the brain dead; and
- organ retrievals from non-beating heart donors.
A draft amendment to the organ transplant act put up on the mohfw's website does not give much space to these recommendations. Is the ministry dragging its feet? No, assures an official at the ministry. "A cadaver donation programme is in the making and it will take another month or so," he says.
Trivedi remains optimistic. "If we promote a cadaver transplant programme sincerely, 75 per cent of the organ demand can be met. Only after this option is exhausted should we consider live donor transplants," she says.
With contributions from Vibha Varshney, Sumana Narayanan and Ravleen Kaur