Karnataka flexes its social welfare arm

But alas! they could not find a healthy cadaver liver or part of the liver of a living donor. The lone cadaver liver that came their way, of a police officer left brain dead after an accident, was unworthy of use - the deceased was HIV-infected.

The hapless parents of the dying girl could neither advertise in the media for donors as the law prohibited it. Organ donations have to be routed through a government-appointed coordination committee or authorised NGOs, to prevent illegal, commercial trade in organs.

Contrast this tragic incident with the shocking kidney scam of the mid-’90s when some private hospitals in Bangalore were charged with running the 'great kidney bazaar' where kidneys could be bought, sold and transplanted just like clothing or shoes in a free trade zone. While no law existed then, against commercial trade in human organs, medical and other regulatory bodies did not take any action even in obvious cases of malpractise. The scam taint stuck to Karnataka's medical fraternity for ten years on and doctors as a whole were treated as suspicious and dishonest.

Cut to the present. Both the above scenarios are fast lapsing into history. A strict law, streamlined apparatus to check malpractise, slowly but steadily growing people's support to cadaver organs donation and increased awareness among the poor and gullible about the exploitation and health risks inherent to organ trade have rendered organ sale unprofitable.

Yet, no law can eradicate nepotism. Doctors do come under pressure to perform out of turn transplants. Should a critically ill and old patient, whose chances of benefiting from the transplant are poor, get an organ ahead of a healthier, younger patient simply because of his seniority on the waiting list? Doctors may have to take a call in such cases. However, overall transparency has clearly improved with elaborate regulatory mechanisms in place for permitting hospitals seeking to perform organ transplants, overseeing their efficient functioning, authorising related, unrelated (by the living) as well as cadaver donations.

The Karnataka Government has added more teeth to the Central Act by framing stringent rules that scrutinise even closely related donors. But the process of authorisation has been fasttracked by expanding and reconstituting the committee under the chairmanship of a senior urologist, Dr G K Venkatesh, who is also director of the government-run Institute of Nephro-Urology in the Victoria Hospital campus. The new institute takes pride in having performed its first cadaver kidney transplant in April this year, the recipient being 43-year-old hotel worker Mohammed Ayaz of Tumkur. What’s more, the operation costing Rs 1 lakh and more expensive post-operative care to prevent organ rejection have been completely free under the Chief Minister’s Kidney Suraksha Yojana. The lone cadaver transplant and related publicity has given a giant thrust to transplantation with nearly 500 fresh registrations with the zonal coordination committee for cadaver kidney and liver from patients with end-stage organ disease. Notes Dr Venkatesh: “Unpublished statistics put the number of brain deaths at 20,000 a year. This translates to 40,000 kidneys waiting to be harvested along with other organs. Even if half the number of organs are saved, there will be no need to take organs from living donors.”

Heart tissue-valve bank
Another government hospital, Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore is all set to open a heart tissue-valve bank in December, which will help preserve up to three months cadaver heart tissue and valves for use in heart patients. “Instead of artificial valves which are expensive and need to be supported with blood thinners to prevent clotting, cadaver tissue-valves are better, especially for children for whom the artificial valves are too big,” said Dr C N Manjunath, medical director of the hospital. The institute implants 750 valves a year. By January, the hospital plans to launch into heart transplants as well, though it is still not very popular as post-operative care has to be rigorous, Dr Manjunath added.

With the private sector hospitals too contributing to the transplantation programme in a big way, Dr Ajit Huilgol of Columbia Asia hospital said, of the six cadaver kidney transplants done in 2010, three cadaver organs were from his hospital.

While Chennai and Ahmedabad lead in cadaver transplants, in the rest of the country it was in a “cadaveric state” because doctors need to be educated about brain death, he said. Besides, cadaver transplants were 15-20 per cent less effective than organs coming from living related/unrelated donors. Some cadaver transplants fail as malignancies like cancer may go undetected unlike major diseases such as HIV, Hepatitis, TB and heart/lung disease.

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