When Dr Gabriel M Danovitch, medical director of a kidney transplant programme in America, addressed  the annual conference of the Indian Society for Organ Transplantation  in Bangalore recently, it was an eye opener for both doctors and laymen to learn about the multilayered problems surrounding one of the most complicated and risky surgeries ever — the transferring of a living organ from one person to another. Besides, there are several social, moral and ethical issues involved here.

According to Danovitch, "successful organ transplantation requires a sophisticated medical infrastructure and cannot flourish in a medical vacuum."

Again, he feels that commercialisation of kidney transplantation might seem like a tempting solution to the organ shortage. But, when the motivation is money rather than altruism, and the donors are poor and vulnerable, he asks: "How could we be sure that paid donors are not being manipulated or even blackmailed?"

Paid donation also implies "tourism" to countries where kidney vending is openly or tacitly permitted and the outcome for the donors is of little concern. "Is this not a form of slavery?" he asks.

Excerpts from an interview:

Is living organ transplantation as safe as cadaveric transplants?

Living kidney transplantation is a safe procedure, but even in the most experienced hands, it is never risk-free. Safe donation, both for the donor and the recipient, requires honesty and openness about the potential donor's health, high-risk activities, and family history.

How about liver transplants?

Liver transplant from a living donor is extremely dangerous for the donor unless performed by a highly trained expert. Of course, partial liver transplants are done and are found useful in children.  

What are the safety measures to be taken before the operation?

Donor's past and future health should be assured.  Kidney transplants are 90 per cent successful in the US.

Is organ transplantation an elitist medical activity?

Not at all if the country has correct health policies for the poor who can also benefit by it.

Should this procedure be used only for saving lives?

It can also be used to prolong life when its worth prolonging. Not suitable for the very old or for those suffering from other life threatening diseases.

Is it ethical to remove  organs from brain dead persons?  

A person can be kept alive by machines. It is for doctors to decide who is medically dead or alive.  

Are not poor people exploited in vended donations?

That will continue as long as governments are indifferent to the needs of the poor. Iran, for example, has solved this problem by legalising the sale of organs. No middleman needed either.

Which organs can be transplanted successfully?

Liver, heart, lungs from cadavers. Kidneys from living donors. But, I repeat. OT can be successful only in countries where thoughtful investment is made on universal healthcare systems.

As a visiting physician, do you have a message?

Yes. Improve the living conditions and health of the community first by proper planning, investing and implementing health care programmes. The world community is watching. You are the focus of the world now with your economic progress and nuclear strength. But, when people have to sell their vital organs to feed their families — the rest becomes meaningless.