Organ Transplants Continue To Be mired In Controversy
India Today|July 30, 2018

Despite growing awareness and a raft of changing laws, organ transplants remain mired in controversy, the latest being suspicions of favouring rich foreigners

Amarnath K. Menon

The good news first: Organ donation for transplants is surging. In a country famously skittish about gifting organs, there has been a spectacular spike. Total organ donations have gone up from 1,149 in 2014 to 2,870 in 2017. This includes a two-and-a-half times increase in kidney and liver donations, not to mention a whopping 6.5 times rise in heart donations.

Now for the bad news: despite all this, less than one in a million Indians donates an organ. More than three million Indians have died for want of a life-extending transplant since 2005. The wait list is so daunting that just 9,000 out of 200,000 patients needing a kidney get one.

And the ugly controversy: Some 20-25 per cent of heart or lung transplants in Tamil Nadu are performed for foreign recipients/ beneficiaries. The question is: is this happening at the expense of Indian patients?

RAISED EYEBROWS

Come August 13, World Organ Donation Day, and more Indians will pledge their organs to extend or save the lives of others. Yet the demand-supply gap is yawning, drawing unethical commercial intent into a medical procedure that relies on personal generosity and public trust. So what’s going on?

A particular concern is the opaque process in harvesting and transplanting organs. The bias in implementing organ transplant laws has raised suspicions about a lack of transparency. The Transplantation of Human Organs and Tissues Rules clearly give priority to citizens enrolled on the state and national waiting lists rather than foreigners. But it is apparent, from data analysed by social activists in Tamil Nadu, that hospitals and surgeons perhaps make preferential allotment to foreign patients, possibly with overriding commercial factors.

SOURCING AN ORGAN

Gifting and sourcing organs are at the core of this controversy. Despite the growing awareness, live donations alone can never meet the increasing need for organs. Only a kidney or part of the liver can be tapped from a living source. The live donor pool has, with the changes in transplant laws, since 2011, widened the scope of near-relative donors. But it is inadequate. For most transplants, including those of heart, lungs, pancreas and intestines, the dire need is for deceased donors.

It’s a stiffchallenge that’s prompting courts to intervene. On June 28, Justice A. Rajasheker Reddy of the Hyderabad High Court directed the Telangana government to permit P. Ratnakar, a businessman, to receive a kidney being donated ‘out of love and affection’ by his chauffeur K. Raju. The court dismissed the objections of the state transplant authorisation committee and the appellate authority, which observed that “it was difficult to believe there was no financial consideration in the matter and the prospective donor could not explain reasons for his donation”. The court passed the order keeping in view that Ratnakar, who lost one kidney in 2007, undergoes dialysis three times a week to survive with the other damaged kidney.

A SKEWED SYSTEM

The numbers are telling. During 2017, foreigners received 31 heart transplants, 32 lung transplants and 32 heart and lung transplants while Indian recipients were 91, 75 and six in the three categories in Tamil Nadu. What makes it a skewed system is that there were 5,310 Indians and 53 foreigners on the wait list of active patients in June this year. Predictably, it has kicked up an unseemly row about foreign patients bypassing Indians on the waiting list for organs.

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