For a cadaveric transplant programme
http://www.hinduonnet.com/fline/fl1425/14250700.htm
ONE of the objectives of the Transplantation of Human Organs Act, 1994 was to clear the decks legally for the development of a cadaver-based organ transplantation programme. Towards this end, the Act recognised and defined, for the first time in India, the concept of "brain-stem death".
Since the Act came into force, however, only about 110 kidney transplants from cadavers have been performed in the country, according to Dr. J.V. Thachil, Chief Urologist at the Apollo Hospitals, Chennai, and Dr. J. Amalorpavanathan, Transplant Coordinator at the Government General Hospital, Chennai. Tamil Nadu is the clear leader in the field, with three leading medical institutions in the State accounting for 79 of these. Apollo Hospitals, Chennai, has done 53 cadaveric renal transplants; the Sri Ramachandra Medical College and Research Institute, Chennai, 14; and the Christian Medical College and Hospital, Vellore, 12. In addition, the Government General Hospital, Chennai, has done 8 cadaveric kidney transplants, and K.G. Hospital, Coimbatore, 2.
Leading nephrologists and urologists argue that the continuing commerce in kidneys acts as a disincentive to investments in cadaver-based programmes by capable medical institutions. There are, however, a few hospitals and organisations that are working with the objective of putting in place an effective cadaveric transplant programme and changing social attitudes towards organ donation.
Apollo Hospitals, Chennai, is way ahead of the rest. It performed the country's first renal transplant from a brain-dead person in October 1995. Since then the hospital has performed 52 more, making its programme the best cadaveric transplant programme in the country.
One lesson to be learnt from the Apollo experience is that a cadaveric transplant programme cannot take off unless the paid-donor programme is stopped and independent investments are made in setting up the infrastructure for a cadaveric programme. "What a hospital needs for a cadaveric transplant is a 24-hour laboratory that can do cross-matching as soon as we harvest a kidney from a cadaver," notes Dr. Thachil. "It must have a physical plan and an infrastructure for transplants; not just doctors, but theatres and nurses in a constant state of preparedness. We have done up to five transplants in a day."
A kidney can be harvested from brain-dead accident victims and also from victims of brain haemorrhage and cardiac arrest. Apollo has up to 35 persons on a waiting list for cadaver-based kidney transplants. Many of these patients, who are on dialysis, return to their cities and workplaces, and come when the hospital finds a kidney to match their specific needs. Apollo has given six kidneys that it harvested from brain-dead persons to other hospitals for transplantation as it could not find a match for persons on its waiting list.
On November 21, Dr. Thachil performed a renal transplant surgery on a 75-year-old patient from South Africa. Two kidneys harvested from a cadaver were transplanted into the recipient using what is called a "piggy-back technique". The patient had been on the waiting list for almost four months. Dr. Thachil says: "This man could easily have bought a kidney, but he chose to wait."
Once a brain-dead person's relatives have agreed to his or her organs being harvested, the transplant team has to move fast as delays affect the success rate; the best results are obtained when the kidney is harvested while the heart is still beating. The hospital bears the expenses of keeping the person on a life-support system; the organ retrieval costs are passed on to the recipient.
Asking for permission to harvest a brain-dead person's organs requires sensitivity to the family's grief. Dr. Thachil says that in 90 per cent of such cases, the relatives have given permission. "We brief the family fully and we tell them that the organ can be taken without any physical disfigurement of the body. Whenever I give a lecture, I tell people: when you die let you soul go to heaven, but leave your organs behind."
A donor card programme, under which a person may give consent for doctors to harvest his or her organs in the event of death, is at work in its initial stages in Chennai, Bangalore and some other cities. Such programmes are popular in other countries. Moreover, in several countries, the Law of Assumed Consent prevails: the state assumes that it has an accident victim's consent to harvest his or her organs in the event of death, unless he or she has left a statement expressly forbidding this (see interview with Dr. Christiaan Barnard, Frontline, November 14).
Dr. Thachil, however, believes that such a law may "backfire" in India. "In India you cannot overlook the family's wishes after a death has occurred. Apollo's experience has shown that you can have a cadaveric programme and can convince persons on a case-by-case basis."
AN organisation whose objective is to change social attitudes to organ donation is the Chennai-based Multiple Organ Harvesting Aid Network (MOHAN). MOHAN was launched in January 1997 by Dr. Sunil Shroff, a transplant surgeon who heads the Department of Urology and Renal Transplantation at the Sri Ramachandra Medical College and Research Institute, Chennai. It has begun a donor card scheme to raise awareness about the need to donate 'solid' organs (kidney, heart, liver, lungs and pancreas). A person who enrols in the scheme signs a card and thus consents to his organs being harvested after his death. MOHAN has distributed 17,000 donor cards so far.
The SRMC&RI has performed 57 kidney transplants (including 14 cadaveric kidney transplants) since 1995. A team of doctors from the Department of Urology and Renal Transplantation at SRMC&RI conducted a sample survey in Chennai to test social attitudes towards organ donation. The sample was stratified to capture different socio-economic classes and religious groups in Chennai's population. Individual questionnaires were given to 8,000 persons, of whom 5,008 responded. Their responses indicated that awareness about organ transplants was high; more than half the people who responded expressed "some degree of familiarity" with the concept of brain-death. More than 70 per cent were willing to carry a donor card. The most significant finding was that the proportion of people who were willing to donate their eyes was substantially higher than the proportion of people who were willing to donate solid organs after death.
The survey's results point to the significant success of the campaign for eye donations. Such a campaign could serve as an example for a similar effort to raise awareness about the need for donating other organs.
NO cadaveric renal transplant has yet been performed in Karnataka. However, the Foundation for Organ Retrieval and Transplant Education, a non-profit trust founded in September 1996, is helping put in place a programme under which people can signify their willingness to allow doctors to harvest their kidneys, liver, pancreas, heart, heart valves and eyes after their death. The programme was begun by Dr. Philip G. Thomas, a transplant surgeon at St. John's Hospital, Bangalore, and his wife Rebecca Thomas, a trained transplant coordinator who worked at the Centre for Organ Recovery and Education (CORE), Pittsburgh.
FORTE works with the 10 Bangalore hospitals that are authorised by the Karnataka Government to perform cadaveric transplants, and coordinates the donation and transplantation of organs. It has distributed 1,000 donor cards and received consent from 200 persons for the harvest of their organs after death. Nine patients with End-Stage Renal Disease and one heart patient are currently registered with FORTE seeking organ donors.
Multi Organ Transplant
Multi Organ Transplant
Overview
The Multi Organ Transplant is becoming famous day by day. The donation of the organs has made the procedure easier. The common problem of the organ transplantation is rare availability of the donators. The most important part is to make people more aware of the fact that it is like giving a person a new life.
Multi organ transplant involves bone marrow, heart, kidney, kidney-pancreas, liver, and multi-visceral transplantation. All the surgeries are regarded as the complicated surgeries and Apollo plays role of an efficient in performing these vital operations. All the surgeries are done by our experienced expert surgeon who not only help you with the procedure but will take a special care.
Apollo facilities
Apollo has a well-equipped Multi Organ Transplant department. Various surgeries have their respective requirements and characteristics; most importantly each human problem differs from the other so you should consult your surgeon before entering your respective procedure of surgery.
Apollo offers the excellent centre for the surgery and provides its best service, hospitality and expert doctors for the Multi Organ Transplant, creating a pleasing appearance for the person.
Procedures and Prices
Specialities/ Procedures
Price
Duration of Stay
(US $)
(UK £)
Transplant
Kidney Transplant
a) Open (Recipient & Donor)
14500
8400
10 Days
b) Laproscopic (Recipient & Donor)
14500
8400
10 Days
Liver Transplant
To be quoted on case basis
Medical India tourism offers online bookings .To book your medical packages and for more information present your queries in the form below.
Overview
The Multi Organ Transplant is becoming famous day by day. The donation of the organs has made the procedure easier. The common problem of the organ transplantation is rare availability of the donators. The most important part is to make people more aware of the fact that it is like giving a person a new life.
Multi organ transplant involves bone marrow, heart, kidney, kidney-pancreas, liver, and multi-visceral transplantation. All the surgeries are regarded as the complicated surgeries and Apollo plays role of an efficient in performing these vital operations. All the surgeries are done by our experienced expert surgeon who not only help you with the procedure but will take a special care.
Apollo facilities
Apollo has a well-equipped Multi Organ Transplant department. Various surgeries have their respective requirements and characteristics; most importantly each human problem differs from the other so you should consult your surgeon before entering your respective procedure of surgery.
Apollo offers the excellent centre for the surgery and provides its best service, hospitality and expert doctors for the Multi Organ Transplant, creating a pleasing appearance for the person.
Procedures and Prices
Specialities/ Procedures
Price
Duration of Stay
(US $)
(UK £)
Transplant
Kidney Transplant
a) Open (Recipient & Donor)
14500
8400
10 Days
b) Laproscopic (Recipient & Donor)
14500
8400
10 Days
Liver Transplant
To be quoted on case basis
Medical India tourism offers online bookings .To book your medical packages and for more information present your queries in the form below.
Cadaver Organ Donation and Transplantation in India
Dr.Sunil Shroff, Dr.Sumana Sundaram, Dr.Georgi Abraham, Dr.Sounddarajan, Dr.Suresh, Dr.Subba Rao, Dr.Paulose Thomas
Introduction
Patients& Method
Results
Discussion
References
Introduction
Since the passing of the legislation in India, entitled, 'Transplantation of Human Organ (THO) Act' in 1994, it has been possible to undertake multi-organ transplant activity from brain dead donors. The required pre-requisite for success of the cadaver program depend on various factors1-3 and these include:
1. Positive attitude of public towards organ donation
2. Consent by relatives for organ donation in event of brain
death.
3. Successful brain Death identification and certification.
4. Adequate hospital infra-structural and support logistics
5. Successful retrieval and transplantation of organs and
auditing long term graft outcomes.
This review looks at these aspects in the Indian context and discusses the difficulties encountered in implementing this program over the last 6 years.
Patients & Method
1. After passing of the THO legislation a major survey of the 5008 members of Indian public's attitude towards organ donation was conducted in 1995-96 by the principal author and a brief analysis of this survey's result are presented 4.
2. In one major hospital in Chennai, undertaking cadaver transplants regularly; an audit of 159 'Brain death' patients over the last 5 years was undertaken. This was to look at the number of these patients who actually became organ donors.
3. Data of all the transplants centers in India undertaking cadaver transplants since the passing of the legislation was collated for this study.
4. Infra-structural Support services available at the hospitals undertaking the cadaver program was looked at and a critical analysis was made of the deficiencies.
5. The results of first 100-kidney cadaver transplant from 4 major hospitals in the country were analyzed to look at 1 and 2 year kidney allograft and patient survival.
Results
1. "Public attitude Survey to organ donation": This survey showed 72% of the population were willing to donate eyes and carry a 'Donor Card', however less than 50% were willing to consider solid organ donation. 74% of Hindus, 72% Christians, 58% Muslims were willing to consider organ donation; however the concept of brain death was new to most of the people surveyed 4.
2. Organ donation in Brain death situation: An audit of 159 brain death patients showed that 30 or 19% of the relatives donated of the organs of their loved ones.
3. The Total Cadaver Transplants activities: For various solid organs5 are as follows from Jan 1995 to Jun 2001:
Kidney 379
Heart 34
Liver 12
Pancreas 02
Lungs 01
TOTAL 428
In the last 6 years 35 hospitals in the country from various regions have undertaken cadaver transplants. Chennai has done the maximum number of cadaver transplants in the country (189). Besides Chennai the other cites where the cadaver organ transplantation is taking place include New Delhi (68), Ahmedabad (46), Pune(32), Bangalore (32), Vellore (22), Mumbai (20) and Coimbatore (12).
4. Hospital Infra-structural and Support Logistics: All 35 hospitals were supported by intensivists and adequate Intensive care facilities and fully qualified and trained
medical and para-medical staff to undertake the cadaver transplant program.
However most of them lacked motivated medical or social workers who could be trained to speak to the relatives in brain death situations. There were only 15 transplant co-coordinators of whom very few had any proper or formal training in the field. There were about 12 organizations in the country working to promote and help out with the cause of organ donation however only 3 were actively involved and worked as a central co-coordinating agency for allocation and distribution of organs.
5. Results of the first 100 transplants from 4 major centers: The mean age of the patients was 45 years with a range from 3 years to 72 years. There were 62 males and 38 females transplanted. The one-year allograft and patient survival was 82% and 86% respectively and the 2-year allograft and patient survival was 74% and 80%.
Discussion:
The passing of Transplantation of Human Organ Act heralded a new era in Indian medicine. This legislation was written on similar likes as the UK Transplant Act. The essence of this legislation was threefold:
1. To accept brain death as also a definition of death.
2. To stop commercial dealing in organs
3. To define the first relative (father, mother, brother, sister, son, daughter and wife) who could donate organs without permission from the government. In event of the donor not being a first relative an approval had to be obtained by a government appointed authorization committee in each state of the country.
When the THO act was passed there were very few evangelist and many more detractors of this legislation. The evangelist in the country felt it would stop commercial dealing in organs, open up multi-organ transplant activity and increase the number of transplants in India. The detractors felt that this legislation was unlikely to succeed in the Indian context in view of the religious and cultural diversity, poor socio-economic background and lack of infra structural support available for implementing the cadaver transplant program.
The public attitude survey indicated a positive attitude of the people towards eye donation. After this survey a simple protocol was devised (Ramachandra required request protocol when asking for organ from relatives). It was suggested that' Eyes' should be requested for first and only if the relatives were willing other organs requested. This it was felt was less likely to upset the relatives in a brain death situation, and would also give the hospital staff asking for organs an idea about the family's attitude towards the sensitive issue like organ donation in the difficult brain death situation4. The Eye donation activists of the country are already lobbying for a "required request law" in event of a death in a hospital. This is likely to be soon passed by the parliament and be enacted as a law. This same law can be extended for solid organs in a brain death situation. If this is done it can give the required boost to the program and make it obligatory for the hospitals staff to ask for organs.
A major center (Sri Ramachandra Research Medical College And Research Center) undertaking cadaver transplants in the last 6 years has had a brain death conversion rate of 19% (30/159). In this institution the ICU staff have been sensitized to the issue of brain death and organ donation. The number of fatal road traffic accidents every year in India is constantly rising and averages at about 8,500 per year. At any given time there are 8 to 10 brain dead patients in different ICU's in any major city of the country. There is hence potentially a huge pool of brain death donors available in India6.
Most of the hospitals undertaking cadaver transplants are either private or trust
hospitals and there are very few government hospitals undertaking this program.
Out
of 27 states in India four states are still to enact the 'Transplant legislation' and accept brain death concepts. Hence to make the cadaver program a success a re-think of how to implement this program is necessary. One of the major hurdles seems to be the unrelated transplant activity that continues unabated. Kidney scandals still continue to haunt the country every so often. The unrelated activity is due to loop holes in the present THO Act as under the Sub Clause (3), Clause 9 of Chapter II it states: "If any donor authorizes the removal of any of his human organs before his death under sub-section (1) of section 3 for transplantation into the body of such recipient, not being a near relative as is specified by the donor, by reason of affection or attachment towards the recipient or for any other special reasons, such human organ shall not be removed and transplanted without the prior approval of the Authorization Committee". It is not necessarily difficult to find an unrelated donor who suddenly develops an "affection or attachment" for the recipient provided he or she is properly rewarded. Most of the unrelated transplants are a result of the patients and clinicians using this section of the law to obtain permission from the Government to do live unrelated transplants. This aspect of the law has either to be scrapped or tightened so that only genuine cases are helped, otherwise unrelated activity will continue with the permission of government's authorization committee.
Up to 1997 only four hospitals in the country were undertaking cadaver transplants. However, now more and more hospitals encouraged by the success of others are now indulging themselves in this program. On an average over 55 cadaver transplants are being undertaken in India every year. This is unlikely to meet the present demand for organs. It is estimated that every year there are 3500 kidney transplants are being undertaken.
As the cadaver program is still in infancy stage the early results of kidney cadaver transplants are acceptable. Two hospitals (All India Me Institutes of Medical Science, Delhi and Madras Medical Mission, Chennai) are undertaking heart transplants. Only one hospital, Indraprastha Apollo Hospital Delhi is undertaking liver transplants regularly.Over the last 2 years local state based networks are being established by a few non- governmental and non-profit motivated organizations in the country. Among these the Initiative for Organ sharing group started by MOHAN (Multi Organ Harvesting Aid Network) Foundation in Tamil Nadu has shared 68 organs in the last 2 years between five hospitals. This is a encouraging start to the program. The foundation is also hoping to affiliate with other similar organization in other regions such as FORTE (Foundation for Organ Transplantation and Education) at Bangalore & ZTCC (Zonal Transplant Co-coordinating Committee) at Mumbai that have also similarly shared organs between different hospitals.
There is potentially a huge pool of brain-death patients in the country who could not only meet the local demands of organs but may be able to meet the needs of some of the neighboring countries which sometimes looks towards India for their healthcare needs. Despite the many problem in implementation of this program in India a start has been made and the first hurdle has been crossed. Education of public on concepts of brain death and having more trained transplant coordinators, allocation of resources from government and private agencies for the program and having a state based network with a central network office would help to give this program the required boost in the country.
REFERENCES
1. Evans RW, Manninen DL: Transplant Proc 20: 781, 1988
2. Feest TG, Reid HN, Collins CH, et al: Lancet, 335:1133, 1990
3. Wakeford RE, Stepney R: British Journal of Surgery,
76:435, 1989
4. Shroff S, The Antiseptic, 94:73-74, 1997
5. Cadaver Transplant Activity - All India Figures - 1999 to
June 2001 Indian Transplant Newsletter 3:9, 4,2001
6. INOS and the essence of organ sharing- Editorial, Indian
Transplant Newsletter, 3-10, 2001
Institutions:
Sri Ramachandra Medical College & Research Institute, Chennai
Apollo Hospital, Chennai,
Christian Medical College, Vellore,
Sundaram Medical Foundation, Chennai
MOHAN (Multi Organ Harvesting Aid Network) Foundation, Chennai
http://www.medindia.net/articles/article5.asp
Introduction
Patients& Method
Results
Discussion
References
Introduction
Since the passing of the legislation in India, entitled, 'Transplantation of Human Organ (THO) Act' in 1994, it has been possible to undertake multi-organ transplant activity from brain dead donors. The required pre-requisite for success of the cadaver program depend on various factors1-3 and these include:
1. Positive attitude of public towards organ donation
2. Consent by relatives for organ donation in event of brain
death.
3. Successful brain Death identification and certification.
4. Adequate hospital infra-structural and support logistics
5. Successful retrieval and transplantation of organs and
auditing long term graft outcomes.
This review looks at these aspects in the Indian context and discusses the difficulties encountered in implementing this program over the last 6 years.
Patients & Method
1. After passing of the THO legislation a major survey of the 5008 members of Indian public's attitude towards organ donation was conducted in 1995-96 by the principal author and a brief analysis of this survey's result are presented 4.
2. In one major hospital in Chennai, undertaking cadaver transplants regularly; an audit of 159 'Brain death' patients over the last 5 years was undertaken. This was to look at the number of these patients who actually became organ donors.
3. Data of all the transplants centers in India undertaking cadaver transplants since the passing of the legislation was collated for this study.
4. Infra-structural Support services available at the hospitals undertaking the cadaver program was looked at and a critical analysis was made of the deficiencies.
5. The results of first 100-kidney cadaver transplant from 4 major hospitals in the country were analyzed to look at 1 and 2 year kidney allograft and patient survival.
Results
1. "Public attitude Survey to organ donation": This survey showed 72% of the population were willing to donate eyes and carry a 'Donor Card', however less than 50% were willing to consider solid organ donation. 74% of Hindus, 72% Christians, 58% Muslims were willing to consider organ donation; however the concept of brain death was new to most of the people surveyed 4.
2. Organ donation in Brain death situation: An audit of 159 brain death patients showed that 30 or 19% of the relatives donated of the organs of their loved ones.
3. The Total Cadaver Transplants activities: For various solid organs5 are as follows from Jan 1995 to Jun 2001:
Kidney 379
Heart 34
Liver 12
Pancreas 02
Lungs 01
TOTAL 428
In the last 6 years 35 hospitals in the country from various regions have undertaken cadaver transplants. Chennai has done the maximum number of cadaver transplants in the country (189). Besides Chennai the other cites where the cadaver organ transplantation is taking place include New Delhi (68), Ahmedabad (46), Pune(32), Bangalore (32), Vellore (22), Mumbai (20) and Coimbatore (12).
4. Hospital Infra-structural and Support Logistics: All 35 hospitals were supported by intensivists and adequate Intensive care facilities and fully qualified and trained
medical and para-medical staff to undertake the cadaver transplant program.
However most of them lacked motivated medical or social workers who could be trained to speak to the relatives in brain death situations. There were only 15 transplant co-coordinators of whom very few had any proper or formal training in the field. There were about 12 organizations in the country working to promote and help out with the cause of organ donation however only 3 were actively involved and worked as a central co-coordinating agency for allocation and distribution of organs.
5. Results of the first 100 transplants from 4 major centers: The mean age of the patients was 45 years with a range from 3 years to 72 years. There were 62 males and 38 females transplanted. The one-year allograft and patient survival was 82% and 86% respectively and the 2-year allograft and patient survival was 74% and 80%.
Discussion:
The passing of Transplantation of Human Organ Act heralded a new era in Indian medicine. This legislation was written on similar likes as the UK Transplant Act. The essence of this legislation was threefold:
1. To accept brain death as also a definition of death.
2. To stop commercial dealing in organs
3. To define the first relative (father, mother, brother, sister, son, daughter and wife) who could donate organs without permission from the government. In event of the donor not being a first relative an approval had to be obtained by a government appointed authorization committee in each state of the country.
When the THO act was passed there were very few evangelist and many more detractors of this legislation. The evangelist in the country felt it would stop commercial dealing in organs, open up multi-organ transplant activity and increase the number of transplants in India. The detractors felt that this legislation was unlikely to succeed in the Indian context in view of the religious and cultural diversity, poor socio-economic background and lack of infra structural support available for implementing the cadaver transplant program.
The public attitude survey indicated a positive attitude of the people towards eye donation. After this survey a simple protocol was devised (Ramachandra required request protocol when asking for organ from relatives). It was suggested that' Eyes' should be requested for first and only if the relatives were willing other organs requested. This it was felt was less likely to upset the relatives in a brain death situation, and would also give the hospital staff asking for organs an idea about the family's attitude towards the sensitive issue like organ donation in the difficult brain death situation4. The Eye donation activists of the country are already lobbying for a "required request law" in event of a death in a hospital. This is likely to be soon passed by the parliament and be enacted as a law. This same law can be extended for solid organs in a brain death situation. If this is done it can give the required boost to the program and make it obligatory for the hospitals staff to ask for organs.
A major center (Sri Ramachandra Research Medical College And Research Center) undertaking cadaver transplants in the last 6 years has had a brain death conversion rate of 19% (30/159). In this institution the ICU staff have been sensitized to the issue of brain death and organ donation. The number of fatal road traffic accidents every year in India is constantly rising and averages at about 8,500 per year. At any given time there are 8 to 10 brain dead patients in different ICU's in any major city of the country. There is hence potentially a huge pool of brain death donors available in India6.
Most of the hospitals undertaking cadaver transplants are either private or trust
hospitals and there are very few government hospitals undertaking this program.
Out
of 27 states in India four states are still to enact the 'Transplant legislation' and accept brain death concepts. Hence to make the cadaver program a success a re-think of how to implement this program is necessary. One of the major hurdles seems to be the unrelated transplant activity that continues unabated. Kidney scandals still continue to haunt the country every so often. The unrelated activity is due to loop holes in the present THO Act as under the Sub Clause (3), Clause 9 of Chapter II it states: "If any donor authorizes the removal of any of his human organs before his death under sub-section (1) of section 3 for transplantation into the body of such recipient, not being a near relative as is specified by the donor, by reason of affection or attachment towards the recipient or for any other special reasons, such human organ shall not be removed and transplanted without the prior approval of the Authorization Committee". It is not necessarily difficult to find an unrelated donor who suddenly develops an "affection or attachment" for the recipient provided he or she is properly rewarded. Most of the unrelated transplants are a result of the patients and clinicians using this section of the law to obtain permission from the Government to do live unrelated transplants. This aspect of the law has either to be scrapped or tightened so that only genuine cases are helped, otherwise unrelated activity will continue with the permission of government's authorization committee.
Up to 1997 only four hospitals in the country were undertaking cadaver transplants. However, now more and more hospitals encouraged by the success of others are now indulging themselves in this program. On an average over 55 cadaver transplants are being undertaken in India every year. This is unlikely to meet the present demand for organs. It is estimated that every year there are 3500 kidney transplants are being undertaken.
As the cadaver program is still in infancy stage the early results of kidney cadaver transplants are acceptable. Two hospitals (All India Me Institutes of Medical Science, Delhi and Madras Medical Mission, Chennai) are undertaking heart transplants. Only one hospital, Indraprastha Apollo Hospital Delhi is undertaking liver transplants regularly.Over the last 2 years local state based networks are being established by a few non- governmental and non-profit motivated organizations in the country. Among these the Initiative for Organ sharing group started by MOHAN (Multi Organ Harvesting Aid Network) Foundation in Tamil Nadu has shared 68 organs in the last 2 years between five hospitals. This is a encouraging start to the program. The foundation is also hoping to affiliate with other similar organization in other regions such as FORTE (Foundation for Organ Transplantation and Education) at Bangalore & ZTCC (Zonal Transplant Co-coordinating Committee) at Mumbai that have also similarly shared organs between different hospitals.
There is potentially a huge pool of brain-death patients in the country who could not only meet the local demands of organs but may be able to meet the needs of some of the neighboring countries which sometimes looks towards India for their healthcare needs. Despite the many problem in implementation of this program in India a start has been made and the first hurdle has been crossed. Education of public on concepts of brain death and having more trained transplant coordinators, allocation of resources from government and private agencies for the program and having a state based network with a central network office would help to give this program the required boost in the country.
REFERENCES
1. Evans RW, Manninen DL: Transplant Proc 20: 781, 1988
2. Feest TG, Reid HN, Collins CH, et al: Lancet, 335:1133, 1990
3. Wakeford RE, Stepney R: British Journal of Surgery,
76:435, 1989
4. Shroff S, The Antiseptic, 94:73-74, 1997
5. Cadaver Transplant Activity - All India Figures - 1999 to
June 2001 Indian Transplant Newsletter 3:9, 4,2001
6. INOS and the essence of organ sharing- Editorial, Indian
Transplant Newsletter, 3-10, 2001
Institutions:
Sri Ramachandra Medical College & Research Institute, Chennai
Apollo Hospital, Chennai,
Christian Medical College, Vellore,
Sundaram Medical Foundation, Chennai
MOHAN (Multi Organ Harvesting Aid Network) Foundation, Chennai
http://www.medindia.net/articles/article5.asp
Dialysis & Kidney Transplant in India
Common diseases like diabetes, hypertension and chronic glomerulo-nephritis can lead to permanent loss of renal functions - with dialysis and renal transplantation being the frequent outcome. The emergence of new therapeutic interventions has created opportunities in India to manage the progression of renal diseases. ISO certified major hospitals in India like Manipal Hospital and Sir Ganga Ram Hospital have departments of Nephrology and Organ Transplant equipped with the latest computerized dialysis machines, reverse osmosis water plant to provide pure and trace element-free water supply, as well as state-of-the-art facilities in the operating rooms and Transplant Intensive Care Units.
For those who need renal replacement therapy, services like Hemodialysis, Chronic Ambulatory Peritoneal Dialysis (CAPD) and Transplantation are also available. In addition to the basic hemodialysis facilities, the patients' requirements for other modalities of treatment such as Continuous Arterio-Venous Haemofilteration (CAVH), Continuous Veno-Venous Haemofilteration (CVVH), Continuous Cycler-Assisted Peritioneal Dialysis (CCPD) are also available. Patients can also avail of the bicarbonate dialysis facility at Manipal Hospital, Bangalore. Round the clock service is available at these hospitals for the critically ill patients in the intensive care units who may need fluid, electrolyte management and renal supportive therapy. The cost of getting a dialysis is around US$ 50 to US$ 75 per dialysis whereas the same costs about $ 300 in the U.S.A. Similarly a kidney transplant package in India is available for around US$ 7500 which is comparatively much cheaper than what it would cost abroad.
Diabetes
Diabetes Mellitus is a condition characterized by raised or increased fasting blood sugar (>126 mg/dl) and / or >200 mg/dl two hours after a meal / any random value. You may or may not have classical symptoms. It may be detected during routine medical check-up.
Diabetes in children
Childhood Diabetes Mellitus is traditionally called Type1 Diabetes or Juvenile Diabetes where pancreas fails to produce the key enzyme Insulin, as a result the child becomes dependent on Insulin for whole of his/her life. We all know the incidence of Diabetes is increasing very rapidly all over the world but fortunately we do not have much cases of type 1 Diabetes in our country as opposed to the west.
Manipal Hospital (Bangalore), Indraprastha Apollo Hospital (New Delhi) has the largest renal transplant program in the country, having successfully performed both living related and cadaveric transplants. a host of urological and nephrological problems find a cure through the availability of medical expertise.
Some of Nephrology & Urology related treatments professionally done in India at Manipal Hospital (Bangalore) as well as Indraprastha Apollo Hospital (New Delhi) are;
++ renal transplantation
++ dialysis
++ graft survival
++ transplant surgeries
++ pediatric kidney transplant
++ pediatric kidney transplantation
++ cadaveric donation
and simultaneous pancreas-kidney transplantation to name a few.
Current legal Status of Kidney Transplant in India is as follows;
"As per the rules of our country, only a relative who is compatible can donate a kidney to the patient. Among the relatives, there is a category called the near relatives which is parents, siblings, children and spouse. People in this category can donate the kidney if they are medically compatible without the permission of the Government. Any other relative not belonging to this category in addition to being medically suitable, the permission from the Respective Government needs to be taken
Please note: We can send you the relevant documents that are needed for near related and non near related transplants upon request.
For those who need renal replacement therapy, services like Hemodialysis, Chronic Ambulatory Peritoneal Dialysis (CAPD) and Transplantation are also available. In addition to the basic hemodialysis facilities, the patients' requirements for other modalities of treatment such as Continuous Arterio-Venous Haemofilteration (CAVH), Continuous Veno-Venous Haemofilteration (CVVH), Continuous Cycler-Assisted Peritioneal Dialysis (CCPD) are also available. Patients can also avail of the bicarbonate dialysis facility at Manipal Hospital, Bangalore. Round the clock service is available at these hospitals for the critically ill patients in the intensive care units who may need fluid, electrolyte management and renal supportive therapy. The cost of getting a dialysis is around US$ 50 to US$ 75 per dialysis whereas the same costs about $ 300 in the U.S.A. Similarly a kidney transplant package in India is available for around US$ 7500 which is comparatively much cheaper than what it would cost abroad.
Diabetes
Diabetes Mellitus is a condition characterized by raised or increased fasting blood sugar (>126 mg/dl) and / or >200 mg/dl two hours after a meal / any random value. You may or may not have classical symptoms. It may be detected during routine medical check-up.
Diabetes in children
Childhood Diabetes Mellitus is traditionally called Type1 Diabetes or Juvenile Diabetes where pancreas fails to produce the key enzyme Insulin, as a result the child becomes dependent on Insulin for whole of his/her life. We all know the incidence of Diabetes is increasing very rapidly all over the world but fortunately we do not have much cases of type 1 Diabetes in our country as opposed to the west.
Manipal Hospital (Bangalore), Indraprastha Apollo Hospital (New Delhi) has the largest renal transplant program in the country, having successfully performed both living related and cadaveric transplants. a host of urological and nephrological problems find a cure through the availability of medical expertise.
Some of Nephrology & Urology related treatments professionally done in India at Manipal Hospital (Bangalore) as well as Indraprastha Apollo Hospital (New Delhi) are;
++ renal transplantation
++ dialysis
++ graft survival
++ transplant surgeries
++ pediatric kidney transplant
++ pediatric kidney transplantation
++ cadaveric donation
and simultaneous pancreas-kidney transplantation to name a few.
Current legal Status of Kidney Transplant in India is as follows;
"As per the rules of our country, only a relative who is compatible can donate a kidney to the patient. Among the relatives, there is a category called the near relatives which is parents, siblings, children and spouse. People in this category can donate the kidney if they are medically compatible without the permission of the Government. Any other relative not belonging to this category in addition to being medically suitable, the permission from the Respective Government needs to be taken
Please note: We can send you the relevant documents that are needed for near related and non near related transplants upon request.
TRANSPLANT RACKET A KIDNEY FOR A LIVING
TRANSPLANT RACKET
A KIDNEY FOR A LIVING
http://www.tehelka.com/story_main27.asp?filename=Ne030307A_kidney.asp
Hospitals, brokers and doctors in Tamil Nadu cash in on the desperation of the poor who sell their kidneysPC Vinoj Kumar
Chennai
The desperately poor in Tamil Nadu, many of them victims of the December 2004 tsunami, are being lured into selling their kidneys. Chennai has emerged as the kidney transplant capital of India though the racket is also flourishing in other cities in the state. Brokers or middlemen, who work in collusion with government and private hospitals, usually never pay the promised amount to the mostly illiterate donors. What is worse, doctors and brokers often remove a ‘donor’s’ kidney without his or her consent.
When 28-year-old Suresh Raju of Namakkal approached a friend for a Rs 50,000-loan, he was advised to donate a few bottles of blood for the money. He agreed and went to a hospital in Coimbatore with his friend, where he was administered sedatives. When he woke up he realised that one of his kidneys had been removed. According to sources in the police, as many as 500 people in Kumarapalayam and Pallipalayam areas of Namakkal district have sold their kidneys in the last few years. The poor sell their kidneys for as little as
Rs 30,000
while the recipients pay around
Rs 5 lakh
to the hospital
Chennai has become the kidney transplant capital of the Subcontinent. Those familiar with the kidney trade in the city say that it is easy to get a kidney if one is willing to spend a few lakh rupees. All one needs to do is to get admitted in one of the government registered hospitals that perform kidney transplants — there are 62 in the state — and rent a house near the hospital. Brokers take care of the rest.
No wonder then that patients from north India, and from neighbouring countries like Sri Lanka and Nepal, are heading to Chennai for a kidney transplant. According to the sources in the Tamil Nadu health department, at least 50 foreign nationals have undergone kidney transplants at hospitals in Chennai and Madurai in the last couple of years. “Some hospitals offer a total kidney (transplant) package, which includes a donor kidney, for Rs 5 lakh,” a health department source who wishes to remain anonymous, told Tehelka.
Suresh Raju went to a hospital in Coimbatore to donate blood. He was sedated and his kidney removed
The kidney trade has been flourishing in Tamil Nadu despite the Transplantation of Human Organs Act (THOA) 1994, which regulates the “removal, storage and transplantation of human organs.” The full magnitude of the racket came to light only after some tsunami-affected women in north Chennai confessed at a public hearing in January that their poverty had forced them to sell their kidneys.
On January 19, 34-year-old Mallika from Tondiarpet in north Chennai lodged a complaint with the police against a broker who she said had refused to pay her the promised Rs 1.5 lakh for her kidney. She said she had been paid only Rs 30,000.
Venkatalakshmi from Namakkal district also lodged a complaint with the police saying that she was raped in Coimbatore in November 2006 by two kidney brokers and a prospective donor. She had accompanied them to pose as the wife of the donor before the members of the authorisation committee (AC), the authority which grants approval for organ transplants. She said that one of the accused recorded visuals of the rape and unsuccessfully tried to blackmail her into accompanying them again for a similar job.
In a quick survey conducted in the fishing hamlets of north Chennai with the help of a social service organisation, Karunalaya, Tehelka identified 29 people — 26 men and 3 women — who had sold their kidneys.
‘I was assured the family would look after me for the rest of my life. It was a big lie,’ says 29-year-old Bhuvaneshwari
In addition to large sums of money, brokers also dole out false promises like life-long care for the donor. Twenty-nine-year old Bhuvaneshwari of Thideer Nagar sold her kidney for Rs 45,000 in 2003. “I believed the broker who assured me that the family would look after me for the rest of my life. But it was a big lie,” she laments.
K. Murugan, who lives in voc Nagar, sold his kidney in 2005 for Rs 45,000.
His broker took him to a hospital in Tirunelveli for the operation. “The recipient’s son told me to contact him in case I need any help. He gave me his address but it was false,” says Murugan.
S. Kumar, a resident of mth Road, was immediately able to recall the names of 10 residents of a nearby slum who had fallen prey to the racket. At Bharathi Nagar in Villivakkam, almost every home has one donor. “There are about 10 brokers in our area. Most of them are hiding in the wake of the media outcry over the kidney sales,” said K. Viji, a resident.
Many were forced to sell their kidney so that they could repay their debts. N. Paul Sundar Singh, director, Karunalaya, points out that the poor in north Chennai usually borrow from moneylenders at an exorbitant rate of interest. Like many others, Devi, 35, from Kasimedu, sold her kidney over her husband’s protests to save their family from the debt trap. She was taken to a hospital in Anna Nagar, where she says she met an employee who finalised the deal. “I don’t know whether he was a doctor or an agent. But he used to come to the hospital everyday in the afternoons,” she says.
A study conducted by the Centre for Sustainable Development, iit, Chennai, on the kidney trade in Tamil Nadu, refers to “contact persons” in hospitals who “may also help potential recipients in locating potential donors.” The study, conducted by Vangal R. Muraleedharan and S. Ram Prasad notes: “Most of these middlemen literally live in the premises of those hospitals which encourage the kidney business.”
The crime branch of the Tamil Nadu police (CB-CID) arrested three brokers on January 23 on the basis of Mallika’s complaint. In most cases, the kidneys have come from “unrelated” donors. According to official sources, Devaki, Kaliappa, and Apollo hospitals in Chennai; Madurai Meenakshi Mission and the Apollo hospital in Madurai; and the Kovai Medical Centre in Coimbatore have performed the most transplants in recent years.
Sources in the CB-CID said they are not empowered to conduct full-fledged investigations into the racket. The Authorisation Committee and the Appropriate Authority (AA) are the two main bodies supposed to oversee the implementation of THOA in each state. The most abused part of the THOA is Section 9 (3), which permits donation of human organs to an unrelated recipient for “reason of affection or attachment towards the recipient.” Most women kidney sellers said they were coached by brokers to tell the committee that they had been working as housemaids for the recipient for several years. Says 44-year-old E. Thamilselvi of Thideer Nagar, who posed before the AC as Kanniammal, a recipient’s neighbour. “It was my broker’s idea. We produced Kanniammal’s ration card as residential proof.”
A health department official pleaded helplessness in checking the racket. “It is not possible for the ac to verify the addresses provided by the donors and the recipients since the verification is time consuming. Moreover, it is a matter of life and death for patients,” he said.
Surprisingly, aa has not taken action against a single hospital or doctor so far despite the powers bestowed on it by THOA. Director of rural and medical services, Bava Fakhrudeen, who is also a member of the ac, promises stringent action in future. Nephrologists and urologists in Tamil Nadu have decided not to speak to the media on the issue. “We don’t want to create more confusion on the issue. Doctors are putting their heads together to come out with positive suggestions. We have decided not to speak until then,” he added
A KIDNEY FOR A LIVING
http://www.tehelka.com/story_main27.asp?filename=Ne030307A_kidney.asp
Hospitals, brokers and doctors in Tamil Nadu cash in on the desperation of the poor who sell their kidneysPC Vinoj Kumar
Chennai
The desperately poor in Tamil Nadu, many of them victims of the December 2004 tsunami, are being lured into selling their kidneys. Chennai has emerged as the kidney transplant capital of India though the racket is also flourishing in other cities in the state. Brokers or middlemen, who work in collusion with government and private hospitals, usually never pay the promised amount to the mostly illiterate donors. What is worse, doctors and brokers often remove a ‘donor’s’ kidney without his or her consent.
When 28-year-old Suresh Raju of Namakkal approached a friend for a Rs 50,000-loan, he was advised to donate a few bottles of blood for the money. He agreed and went to a hospital in Coimbatore with his friend, where he was administered sedatives. When he woke up he realised that one of his kidneys had been removed. According to sources in the police, as many as 500 people in Kumarapalayam and Pallipalayam areas of Namakkal district have sold their kidneys in the last few years. The poor sell their kidneys for as little as
Rs 30,000
while the recipients pay around
Rs 5 lakh
to the hospital
Chennai has become the kidney transplant capital of the Subcontinent. Those familiar with the kidney trade in the city say that it is easy to get a kidney if one is willing to spend a few lakh rupees. All one needs to do is to get admitted in one of the government registered hospitals that perform kidney transplants — there are 62 in the state — and rent a house near the hospital. Brokers take care of the rest.
No wonder then that patients from north India, and from neighbouring countries like Sri Lanka and Nepal, are heading to Chennai for a kidney transplant. According to the sources in the Tamil Nadu health department, at least 50 foreign nationals have undergone kidney transplants at hospitals in Chennai and Madurai in the last couple of years. “Some hospitals offer a total kidney (transplant) package, which includes a donor kidney, for Rs 5 lakh,” a health department source who wishes to remain anonymous, told Tehelka.
Suresh Raju went to a hospital in Coimbatore to donate blood. He was sedated and his kidney removed
The kidney trade has been flourishing in Tamil Nadu despite the Transplantation of Human Organs Act (THOA) 1994, which regulates the “removal, storage and transplantation of human organs.” The full magnitude of the racket came to light only after some tsunami-affected women in north Chennai confessed at a public hearing in January that their poverty had forced them to sell their kidneys.
On January 19, 34-year-old Mallika from Tondiarpet in north Chennai lodged a complaint with the police against a broker who she said had refused to pay her the promised Rs 1.5 lakh for her kidney. She said she had been paid only Rs 30,000.
Venkatalakshmi from Namakkal district also lodged a complaint with the police saying that she was raped in Coimbatore in November 2006 by two kidney brokers and a prospective donor. She had accompanied them to pose as the wife of the donor before the members of the authorisation committee (AC), the authority which grants approval for organ transplants. She said that one of the accused recorded visuals of the rape and unsuccessfully tried to blackmail her into accompanying them again for a similar job.
In a quick survey conducted in the fishing hamlets of north Chennai with the help of a social service organisation, Karunalaya, Tehelka identified 29 people — 26 men and 3 women — who had sold their kidneys.
‘I was assured the family would look after me for the rest of my life. It was a big lie,’ says 29-year-old Bhuvaneshwari
In addition to large sums of money, brokers also dole out false promises like life-long care for the donor. Twenty-nine-year old Bhuvaneshwari of Thideer Nagar sold her kidney for Rs 45,000 in 2003. “I believed the broker who assured me that the family would look after me for the rest of my life. But it was a big lie,” she laments.
K. Murugan, who lives in voc Nagar, sold his kidney in 2005 for Rs 45,000.
His broker took him to a hospital in Tirunelveli for the operation. “The recipient’s son told me to contact him in case I need any help. He gave me his address but it was false,” says Murugan.
S. Kumar, a resident of mth Road, was immediately able to recall the names of 10 residents of a nearby slum who had fallen prey to the racket. At Bharathi Nagar in Villivakkam, almost every home has one donor. “There are about 10 brokers in our area. Most of them are hiding in the wake of the media outcry over the kidney sales,” said K. Viji, a resident.
Many were forced to sell their kidney so that they could repay their debts. N. Paul Sundar Singh, director, Karunalaya, points out that the poor in north Chennai usually borrow from moneylenders at an exorbitant rate of interest. Like many others, Devi, 35, from Kasimedu, sold her kidney over her husband’s protests to save their family from the debt trap. She was taken to a hospital in Anna Nagar, where she says she met an employee who finalised the deal. “I don’t know whether he was a doctor or an agent. But he used to come to the hospital everyday in the afternoons,” she says.
A study conducted by the Centre for Sustainable Development, iit, Chennai, on the kidney trade in Tamil Nadu, refers to “contact persons” in hospitals who “may also help potential recipients in locating potential donors.” The study, conducted by Vangal R. Muraleedharan and S. Ram Prasad notes: “Most of these middlemen literally live in the premises of those hospitals which encourage the kidney business.”
The crime branch of the Tamil Nadu police (CB-CID) arrested three brokers on January 23 on the basis of Mallika’s complaint. In most cases, the kidneys have come from “unrelated” donors. According to official sources, Devaki, Kaliappa, and Apollo hospitals in Chennai; Madurai Meenakshi Mission and the Apollo hospital in Madurai; and the Kovai Medical Centre in Coimbatore have performed the most transplants in recent years.
Sources in the CB-CID said they are not empowered to conduct full-fledged investigations into the racket. The Authorisation Committee and the Appropriate Authority (AA) are the two main bodies supposed to oversee the implementation of THOA in each state. The most abused part of the THOA is Section 9 (3), which permits donation of human organs to an unrelated recipient for “reason of affection or attachment towards the recipient.” Most women kidney sellers said they were coached by brokers to tell the committee that they had been working as housemaids for the recipient for several years. Says 44-year-old E. Thamilselvi of Thideer Nagar, who posed before the AC as Kanniammal, a recipient’s neighbour. “It was my broker’s idea. We produced Kanniammal’s ration card as residential proof.”
A health department official pleaded helplessness in checking the racket. “It is not possible for the ac to verify the addresses provided by the donors and the recipients since the verification is time consuming. Moreover, it is a matter of life and death for patients,” he said.
Surprisingly, aa has not taken action against a single hospital or doctor so far despite the powers bestowed on it by THOA. Director of rural and medical services, Bava Fakhrudeen, who is also a member of the ac, promises stringent action in future. Nephrologists and urologists in Tamil Nadu have decided not to speak to the media on the issue. “We don’t want to create more confusion on the issue. Doctors are putting their heads together to come out with positive suggestions. We have decided not to speak until then,” he added
Organ Donation and Transplantation—The Chennai Experience in India.
Organ Donation and Transplantation—The Chennai Experience in India.
Transplantation Proceedings, Volume 39, Issue 3, Pages 714-718
S. Shroff, S. Rao, G. Kurian, S. Suresh
aDepartment of Nephrology, Apollo Hospital, Chennai, India
bDepartment of Gastroenterology, Apollo Hospital, Chennai, India.
cDepartment of Urology and Renal Transplantation, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India.
Available online 17 April 2007.
Abstract
Tamil Nadu has been at the forefront of medical care in the country. It was the first state in the country that started a living kidney transplant program. It is also the first state to successfully start the cadaver programme after the passing of the “Transplantation of Human Organ Act” of 1994 and in the last 5 years has formed a network between hospitals for organ sharing. From the year 2000 to 2006 an organ sharing network was started in Tamil Nadu and the facilitator of this programme has been a non-government organization called MOHAN (acronym for Multi Organ Harvesting Aid Network) Foundation. The organs shared during the period number over 460 organs in two regions (both Tamil Nadu and Hyderabad). In Tamil Nadu the shared organs have included 166 Kidneys, 24 livers, 6 hearts, and 180 eyes. In 2003 sharing network was initiated by MOHAN in Hyderabad and to some extent the Tamil Nadu model was duplicated. with some success and 96 cadaver organs have been transplanted in the last 3 years. There are many advantages of organ sharing including the cost economics. At present there is a large pool of brain dead patients who could become potential organ donors in the major cities in India. Their organs are not being utilized for various support logistics. A multi-pronged strategy is required for the long term success of this program. These years in Tamil Nadu have been the years of learning, un-learning and relearning and the program today has matured slowly into what can perhaps be evolved as an Indian model. In all these years there have been various difficulties in its implementation and some of the key elements for the success of the program is the need to educate our own medical fraternity and seek their cooperation. The program requires trained counselors to be able to work in the intensive cares. The government’s support is pivotal if this program to provide benefit to the common man. MOHAN Foundation has accumulated considerable experience to be able to evolve a model to take this program to the national level and more so as it recently has been granted 100% tax exemption on all donations to form a countrywide network for organ sharing.
Address reprint requests to S Shroff, Managing Trustee, MOHAN Foundation, Chennai & Hyderabad & Prof & Head of the Department of Urology & Renal Transplantation, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600 116, India.
Transplantation Proceedings, Volume 39, Issue 3, Pages 714-718
S. Shroff, S. Rao, G. Kurian, S. Suresh
aDepartment of Nephrology, Apollo Hospital, Chennai, India
bDepartment of Gastroenterology, Apollo Hospital, Chennai, India.
cDepartment of Urology and Renal Transplantation, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India.
Available online 17 April 2007.
Abstract
Tamil Nadu has been at the forefront of medical care in the country. It was the first state in the country that started a living kidney transplant program. It is also the first state to successfully start the cadaver programme after the passing of the “Transplantation of Human Organ Act” of 1994 and in the last 5 years has formed a network between hospitals for organ sharing. From the year 2000 to 2006 an organ sharing network was started in Tamil Nadu and the facilitator of this programme has been a non-government organization called MOHAN (acronym for Multi Organ Harvesting Aid Network) Foundation. The organs shared during the period number over 460 organs in two regions (both Tamil Nadu and Hyderabad). In Tamil Nadu the shared organs have included 166 Kidneys, 24 livers, 6 hearts, and 180 eyes. In 2003 sharing network was initiated by MOHAN in Hyderabad and to some extent the Tamil Nadu model was duplicated. with some success and 96 cadaver organs have been transplanted in the last 3 years. There are many advantages of organ sharing including the cost economics. At present there is a large pool of brain dead patients who could become potential organ donors in the major cities in India. Their organs are not being utilized for various support logistics. A multi-pronged strategy is required for the long term success of this program. These years in Tamil Nadu have been the years of learning, un-learning and relearning and the program today has matured slowly into what can perhaps be evolved as an Indian model. In all these years there have been various difficulties in its implementation and some of the key elements for the success of the program is the need to educate our own medical fraternity and seek their cooperation. The program requires trained counselors to be able to work in the intensive cares. The government’s support is pivotal if this program to provide benefit to the common man. MOHAN Foundation has accumulated considerable experience to be able to evolve a model to take this program to the national level and more so as it recently has been granted 100% tax exemption on all donations to form a countrywide network for organ sharing.
Address reprint requests to S Shroff, Managing Trustee, MOHAN Foundation, Chennai & Hyderabad & Prof & Head of the Department of Urology & Renal Transplantation, Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600 116, India.
Donating lives with Heart transplantation
http://www.hinduonnet.com/fline/fl1522/15220920.htm
Donating lives
Heart transplantation can hold out hope for a large number of patients in India but a smooth donor mechanism will need to be put in place and the costs involved will have to become affordable to more people before the numbers of such procedures can reach levels comparable to developed countries.
RASHEEDA BHAGAT
IN a special room in Apollo Hospitals in Chennai, 36-year-old A.S. Subramaniam, who received the gift of a 'new' heart a couple of weeks earlier, spoke about the operation that gave him a new lease of life. According to him, the operation went through like a dream, the bill amounting to around Rs. 3 lakhs has been taken care of, and he is accorded "royal" treatment.
Yet, even as he speaks about his good fortune, a dark shadow clouds his face. While on the one hand he is happy that his four-year-old heart problem has been solved, Subramaniam, an executive engineer with Neyveli Lignite Corporation (NLC), is worried as to how he will raise the enormous amount of money required to maintain the foreign organ in his body.
After he suffered a heart attack in June 1994, Subramaniam required regular medical help. He told Frontline: "I was told by my cardiologist that the only remedy for my terminal heart problem was a transplant." With a take-home salary of barely Rs. 7,000, Subramaniam, who has a wife and two children aged 11 and six years to support, had no hope of raising the Rs. 3 lakhs required for a transplant. However, when a donor organ became available and the Apollo Hospitals' cardiac surgery team volunteered to perform the surgical procedure free of cost and take care of the material as well as hospitalisation costs, it was like a dream come true.
However, Subramaniam now has to raise Rs. 2 lakhs, which is required over the next 12 months for various medical tests and for immuno suppressants required to prevent rejection of the organ. The monthly expenses on immuno suppressants, such as cyclosporin, range between Rs. 4,000 and Rs. 10,000. (The dosage will come down progressively.) Subramaniam has no assets other than is ancestral house in a small town in Tamil Nadu. "Even if this house is sold," he said, "my sister has to be given her share." He has no idea about how much NLC will contribute towards his medical treatment.
BY SPECIAL ARRANGEMENT
A heart transplant procedure in progress at Apollo Hospitals in Chennai.
GAJANAND GUPTA, 39, was the first patient on whom a heart transplant procedure was performed at Apollo Hospitals in Chennai. After living with a diseased heart for 10 years, during which period he had to close down his business, he received a 'new' heart on December 24, 1995. "When I was in the hospital, I was told that my lifespan could be as short as four days or as long as 40 days. So, when the heart of a 28-year-old accident victim became available, I told myself: 'I may die after four days. If the operation is not successful, I will die today. What difference will these four days make to my life?' So I agreed to the surgery."
Three years later, Gupta, who works as a ticketing agent for a domestic airline, is fit enough to meet the rigours of his job which requires him to do a lot of running around. "This is the best treatment in the world for myocardial patients," he said, "provided you can afford it."
BIJOY GHOSH
A.S. Subramaniam, who recently underwent a heart transplant surgery at Apollo Hospitals.
Although the Apollo Hospitals' cardiac surgery team has been very supportive and he is certain that the doctors themselves pay for the investigations, Gupta still needs to raise the money for cyclosporin month after month. "Until now I have managed to get by on help from the doctors, my friends and relatives. But frankly, if I had known that it was going to require so much of money to keep breathing, I wouldn't have gone in for the surgery. Unless you have the money, you end up being a beggar," he said ruefully.
In a developing country such as India, the operative words are "afford it". Although the most positive aspect of a heart transplant procedure is that it bestows a new lease of life on its beneficiaries, the prohibitive costs involved may prove to be a deterrent to many. Ironically though, most of the patients who have undergone a heart transplant are those who could not afford it and have had to depend on charity to pay for their immuno suppressants.
There are also people such as R.S. Sudarshan, a businessman who underwent a heart transplant at the Madras Medical Mission, who are able to bear the entire cost of the treatment. But people like him are few and far between.
THE high cost of surgery, medical investigations and the prolonged post-surgical medication is not the only factor that has kept the number of heart transplant procedures in India at an abysmal low. Donor hearts are also hard to come by.
Dr. M.R. Girinath, chief of the cardio vascular department at Apollo Hospitals, pointed out that even though the surgical aspect of a heart transplant is simple, the lack of awareness and the dearth of organ donors have led to a situation where the number of heart transplants performed in India is very low. Over the past four years only 25 heart transplants have been performed in the country. Dr. Girinath said: "The few attempts that have been made to increase public awareness about organ donation have not really paid dividends. Only when a family that is about to lose its loved one is approached by doctors to donate his or her organs does the message of organ donation crystallise. Until then it is only an empty thought." He said that the most distressing aspect of waiting for donor organs is that a number of patients die before donors can be found.
T.A. HAFEEZ
Dr. K.M. Cherian of the Madras Medical Mission in Chennai.
Dr. K.M. Cherian, director of the Institute of Cardio Vascular Diseases run by the Madras Medical Mission in Chennai, where six heart transplants were performed over the last four years, is unhappy that even among the medical community, there is a near-total lack of commitment to the cause of transplant surgery. He said: "It seems that 40 cadaveric kidney procedures were done last year. Surely all those 20 people had hearts. I would like to know what happened to those 20 hearts? The MGR Medical University in Chennai established a Central Organs Registry last year. How many institutions that had cadaver kidneys contact this Central Registry to say 'We have a donor with such a such blood group?' If they didn't contact the Registry, we should ask why."
According to Dr. Cherian, the reason for this apathy is "jealousy and counter-productive competition" in the medical fraternity. He said that the All India Institute of Medical Sciences (AIIMS) had stopped performing heart transplants, and added that it was probably because of lack of coordination among the neurology, accident and cardiac departments. "We are not a centre where accident or neuro cases come," he said. "We have to depend on other hospitals to get donors. We have been certified by the Tamil Nadu Government for performing heart, lung and kidney transplants and when we get a donor we are willing to extend our facilities to anybody who wants to perform a kidney transplant." (A kidney transplant procedure was performed at his institute by a team from the Sri Ramachandra Medical College Hospital in Chennai.)
According to Dr. Cherian, the majority of the 79,000-odd people who die in road accidents in India every year are potential organ donors. Apart from the reluctance of the dying person's relatives to donate the organs (organs such as kidneys, liver and heart have to be removed when the heart is still beating), another stumbling block is the requirement to constitute a panel of neurologists which has to certify that a patient is brain dead before his or her organs are removed. Dr. Cherian questions the logic behind appointing government doctors as members of these panels.
Of the six cases in which heart transplant procedures have been performed at the MMM, five patients are alive and doing well. September 23 marked the third anniversary of the first heart transplant procedure performed at the MMM. The recipient was Maimoona Beevi, a bangle seller. MMM observes this day as Organ Donation Awareness Day.
Dr. M.R. Girinath of Apollo Hospitals.
While Maimoona Beevi was the first woman on whom a heart transplant procedure was performed in India, the MMM has another first to its credit. The country's first paediatric heart transplant was performed at the MMM about 18 months ago on an 11-year-old boy who suffered from cardio myopathy. The Pallavan Transport Corporation paid a part of the costs since the boy's father was its employee. The remaining costs were borne by the MMM.
SINCE donor hearts are difficult to get, doctors have to be careful about the choice of recipients. Dr. Girinath said that he would choose patients "who have a life expectancy of less than six months without the operation." "This means that they are in an advanced stage of heart failure and there is nothing else you can do for them." In addition, the patients should not have very high pressure in the lungs and the arteries of the lungs and their other vital organs should be functioning well.
Dr. Cherian's team does not use steroids. Dr. Cherian said: "Compared to others who perform heart transplants in India, we use a smaller quantity of immuno suppressants and have stopped using steroids, which is a conventional method of treatment." According to him, non-use of steroids is the latest development in heart transplantation techniques. Dr. Cherian said that the 10-year survival rate for heart transplant patients is around 45 to 50 per cent.
Dr. P.V. Rao, a cardiac surgeon at Apollo Hospitals, who performed the transplant procedure on Subramaniam, said that despite the fact that the number of heart transplant procedures performed in India was only a fraction of those performed in the United States and Europe (each of which witnesses about 2,000 procedures a year), the future looked optimistic. "Heart surgery started in a very small way in India," he said, "but today over 50,000 open-heart operations and one lakh closed-heart operations are being done. Tomorrow, if the costs come down or some technological advance takes place, we can make rapid strides in this area."
However, until such a scenario emerges, most of the patients who need to undergo this procedure to survive will not be able to afford it. Dr. Girinath said: "We can waive the surgical and hospitalisation costs, but the biggest problem is to keep the patients going on the immuno suppressants after the surgery."
Donating lives
Heart transplantation can hold out hope for a large number of patients in India but a smooth donor mechanism will need to be put in place and the costs involved will have to become affordable to more people before the numbers of such procedures can reach levels comparable to developed countries.
RASHEEDA BHAGAT
IN a special room in Apollo Hospitals in Chennai, 36-year-old A.S. Subramaniam, who received the gift of a 'new' heart a couple of weeks earlier, spoke about the operation that gave him a new lease of life. According to him, the operation went through like a dream, the bill amounting to around Rs. 3 lakhs has been taken care of, and he is accorded "royal" treatment.
Yet, even as he speaks about his good fortune, a dark shadow clouds his face. While on the one hand he is happy that his four-year-old heart problem has been solved, Subramaniam, an executive engineer with Neyveli Lignite Corporation (NLC), is worried as to how he will raise the enormous amount of money required to maintain the foreign organ in his body.
After he suffered a heart attack in June 1994, Subramaniam required regular medical help. He told Frontline: "I was told by my cardiologist that the only remedy for my terminal heart problem was a transplant." With a take-home salary of barely Rs. 7,000, Subramaniam, who has a wife and two children aged 11 and six years to support, had no hope of raising the Rs. 3 lakhs required for a transplant. However, when a donor organ became available and the Apollo Hospitals' cardiac surgery team volunteered to perform the surgical procedure free of cost and take care of the material as well as hospitalisation costs, it was like a dream come true.
However, Subramaniam now has to raise Rs. 2 lakhs, which is required over the next 12 months for various medical tests and for immuno suppressants required to prevent rejection of the organ. The monthly expenses on immuno suppressants, such as cyclosporin, range between Rs. 4,000 and Rs. 10,000. (The dosage will come down progressively.) Subramaniam has no assets other than is ancestral house in a small town in Tamil Nadu. "Even if this house is sold," he said, "my sister has to be given her share." He has no idea about how much NLC will contribute towards his medical treatment.
BY SPECIAL ARRANGEMENT
A heart transplant procedure in progress at Apollo Hospitals in Chennai.
GAJANAND GUPTA, 39, was the first patient on whom a heart transplant procedure was performed at Apollo Hospitals in Chennai. After living with a diseased heart for 10 years, during which period he had to close down his business, he received a 'new' heart on December 24, 1995. "When I was in the hospital, I was told that my lifespan could be as short as four days or as long as 40 days. So, when the heart of a 28-year-old accident victim became available, I told myself: 'I may die after four days. If the operation is not successful, I will die today. What difference will these four days make to my life?' So I agreed to the surgery."
Three years later, Gupta, who works as a ticketing agent for a domestic airline, is fit enough to meet the rigours of his job which requires him to do a lot of running around. "This is the best treatment in the world for myocardial patients," he said, "provided you can afford it."
BIJOY GHOSH
A.S. Subramaniam, who recently underwent a heart transplant surgery at Apollo Hospitals.
Although the Apollo Hospitals' cardiac surgery team has been very supportive and he is certain that the doctors themselves pay for the investigations, Gupta still needs to raise the money for cyclosporin month after month. "Until now I have managed to get by on help from the doctors, my friends and relatives. But frankly, if I had known that it was going to require so much of money to keep breathing, I wouldn't have gone in for the surgery. Unless you have the money, you end up being a beggar," he said ruefully.
In a developing country such as India, the operative words are "afford it". Although the most positive aspect of a heart transplant procedure is that it bestows a new lease of life on its beneficiaries, the prohibitive costs involved may prove to be a deterrent to many. Ironically though, most of the patients who have undergone a heart transplant are those who could not afford it and have had to depend on charity to pay for their immuno suppressants.
There are also people such as R.S. Sudarshan, a businessman who underwent a heart transplant at the Madras Medical Mission, who are able to bear the entire cost of the treatment. But people like him are few and far between.
THE high cost of surgery, medical investigations and the prolonged post-surgical medication is not the only factor that has kept the number of heart transplant procedures in India at an abysmal low. Donor hearts are also hard to come by.
Dr. M.R. Girinath, chief of the cardio vascular department at Apollo Hospitals, pointed out that even though the surgical aspect of a heart transplant is simple, the lack of awareness and the dearth of organ donors have led to a situation where the number of heart transplants performed in India is very low. Over the past four years only 25 heart transplants have been performed in the country. Dr. Girinath said: "The few attempts that have been made to increase public awareness about organ donation have not really paid dividends. Only when a family that is about to lose its loved one is approached by doctors to donate his or her organs does the message of organ donation crystallise. Until then it is only an empty thought." He said that the most distressing aspect of waiting for donor organs is that a number of patients die before donors can be found.
T.A. HAFEEZ
Dr. K.M. Cherian of the Madras Medical Mission in Chennai.
Dr. K.M. Cherian, director of the Institute of Cardio Vascular Diseases run by the Madras Medical Mission in Chennai, where six heart transplants were performed over the last four years, is unhappy that even among the medical community, there is a near-total lack of commitment to the cause of transplant surgery. He said: "It seems that 40 cadaveric kidney procedures were done last year. Surely all those 20 people had hearts. I would like to know what happened to those 20 hearts? The MGR Medical University in Chennai established a Central Organs Registry last year. How many institutions that had cadaver kidneys contact this Central Registry to say 'We have a donor with such a such blood group?' If they didn't contact the Registry, we should ask why."
According to Dr. Cherian, the reason for this apathy is "jealousy and counter-productive competition" in the medical fraternity. He said that the All India Institute of Medical Sciences (AIIMS) had stopped performing heart transplants, and added that it was probably because of lack of coordination among the neurology, accident and cardiac departments. "We are not a centre where accident or neuro cases come," he said. "We have to depend on other hospitals to get donors. We have been certified by the Tamil Nadu Government for performing heart, lung and kidney transplants and when we get a donor we are willing to extend our facilities to anybody who wants to perform a kidney transplant." (A kidney transplant procedure was performed at his institute by a team from the Sri Ramachandra Medical College Hospital in Chennai.)
According to Dr. Cherian, the majority of the 79,000-odd people who die in road accidents in India every year are potential organ donors. Apart from the reluctance of the dying person's relatives to donate the organs (organs such as kidneys, liver and heart have to be removed when the heart is still beating), another stumbling block is the requirement to constitute a panel of neurologists which has to certify that a patient is brain dead before his or her organs are removed. Dr. Cherian questions the logic behind appointing government doctors as members of these panels.
Of the six cases in which heart transplant procedures have been performed at the MMM, five patients are alive and doing well. September 23 marked the third anniversary of the first heart transplant procedure performed at the MMM. The recipient was Maimoona Beevi, a bangle seller. MMM observes this day as Organ Donation Awareness Day.
Dr. M.R. Girinath of Apollo Hospitals.
While Maimoona Beevi was the first woman on whom a heart transplant procedure was performed in India, the MMM has another first to its credit. The country's first paediatric heart transplant was performed at the MMM about 18 months ago on an 11-year-old boy who suffered from cardio myopathy. The Pallavan Transport Corporation paid a part of the costs since the boy's father was its employee. The remaining costs were borne by the MMM.
SINCE donor hearts are difficult to get, doctors have to be careful about the choice of recipients. Dr. Girinath said that he would choose patients "who have a life expectancy of less than six months without the operation." "This means that they are in an advanced stage of heart failure and there is nothing else you can do for them." In addition, the patients should not have very high pressure in the lungs and the arteries of the lungs and their other vital organs should be functioning well.
Dr. Cherian's team does not use steroids. Dr. Cherian said: "Compared to others who perform heart transplants in India, we use a smaller quantity of immuno suppressants and have stopped using steroids, which is a conventional method of treatment." According to him, non-use of steroids is the latest development in heart transplantation techniques. Dr. Cherian said that the 10-year survival rate for heart transplant patients is around 45 to 50 per cent.
Dr. P.V. Rao, a cardiac surgeon at Apollo Hospitals, who performed the transplant procedure on Subramaniam, said that despite the fact that the number of heart transplant procedures performed in India was only a fraction of those performed in the United States and Europe (each of which witnesses about 2,000 procedures a year), the future looked optimistic. "Heart surgery started in a very small way in India," he said, "but today over 50,000 open-heart operations and one lakh closed-heart operations are being done. Tomorrow, if the costs come down or some technological advance takes place, we can make rapid strides in this area."
However, until such a scenario emerges, most of the patients who need to undergo this procedure to survive will not be able to afford it. Dr. Girinath said: "We can waive the surgical and hospitalisation costs, but the biggest problem is to keep the patients going on the immuno suppressants after the surgery."
Results of Authorisation Committee meeting Results 29.06.2007
Friday, June 29, 2007
Under Certificate of Postings
K.Dis No.46603/ MEII/2/2007 Office of the Chairman Authorisation Committee and Directorate of Medical Education Kilpauk,Chennai .600 010
Dated: 29.6.2007
Sub: Human Organ Transplantation Act 1994 – Authorisation Committee Meeting for Renal Transplantation held on 29.6.2007– Decision of the Authorisation Committee for Renal Transplantation - Regarding
----------
The decision of the Authorisation Committee during the Meeting with recipients, donors, and the dependents of the donors along with the supportive documents forwarded by the recognized hospitals for renal transplantation held on 29.6.07 is described in the enclosed report of the Committee and an extract of the report as it relates to the hospital concerned is mentioned below:
The Heads of Institutions are requested to send a report giving details such as date of surgery of each approved case, name and designation of the surgeon who performed renal transplantation and the present condition of patient and donor , one week after the date of surgery.
The Heads of Institutions are also requested to undertake periodical review of the recipients and donor and present the donor before the Authorisation Committee every three months for examinations by the Authorisation Committee as per the instructions of the Government .
The authenticity of the approval of the cases by the Authorisation Committee may be verified with the WEB SITE :www.tnhealth.org to avoid any foul play by the anti social elements.
| S.N | Name of the Hospital | Name of the Patient | Name of the Donor | Reconsideration | Result | Remarks |
| 1 | | Mr.Abdul Khalam | Mr.Anilkumar | ------------ | Approved | ------------ |
| 2 | | Mr.Bhola Prasad | Mr.S.Shruti Saha | ------------ | Not Approved | Nature and consequences of organ donation is not completely understood by the donor. |
| 3 | | Ms.Kumari Geethanjali | Mr.Sanjay Kumar Verma | ----------------- | Approved | ------------ |
| 4 | | Mrs.Sudha Jain | Mr.Sanjay Jain | ------------ | Not Approved | The Proof of relationship between donor and his relative to be produced by competent authority |
| 5 | | Mrs.A.Bhatahi | Mrs.S.Rani | ------------ | Not Approved | 1.Nature and consequences of organ is not fully understood by the donor. 2.The purpose for which the inspector of Police, Mambalam Police Station has signed across the photo of the patient and recipient |
| 6 | | Mr.A.Shiva Prasad | Mrs.Jayama | ----------------- | Not Approved | 1.Consequences of organ is not understood by the donor. 2. .The purpose for which the inspector of Police, Mambalam Police Station has signed across the photo of the patient and recipient |
| 7 | | Mr.Ramachandran | Mrs.Vijyay | ----------- | Approved | ------------ |
To:
Sundarapuram
Bharathi Raja Hospital & Research Centre Pvt. Ltd.,
11,
Chennai 600 17
738-B Puliakulam Centre
Coimbatore-641 045
'Organ Transplant Act needs to be rectified'
http://timesofindia.indiatimes.com/articleshow/1327155.cms
Even as the world debates this issue, doctors say the decade-old Organ Transplant Act will first have to be rectified before the face transplant surgery can be performed.
Technically, the Indian micro surgeons are competent enough to perform this surgery, and although the present transplant laws allow cadaveric transplantation (organ retrieval from a brain dead but beating heart donor), lot of issues are unresolved, says Dr Sunil Choudhary, Plastic Surgeon, Max Healthcare.
The Transplantation of Human Organs Bill, 1994 redefines death to include the concept of brain stem death making retrieval of organs possible after proper consent.
It permits transplantation of various cadaveric organs including the kidneys...
Even as the world debates this issue, doctors say the decade-old Organ Transplant Act will first have to be rectified before the face transplant surgery can be performed.
Technically, the Indian micro surgeons are competent enough to perform this surgery, and although the present transplant laws allow cadaveric transplantation (organ retrieval from a brain dead but beating heart donor), lot of issues are unresolved, says Dr Sunil Choudhary, Plastic Surgeon, Max Healthcare.
The Transplantation of Human Organs Bill, 1994 redefines death to include the concept of brain stem death making retrieval of organs possible after proper consent.
It permits transplantation of various cadaveric organs including the kidneys...
Organ Retrieval and Banking Organisation
Subscribe to:
Posts (Atom)
