Category Archives: Kidney

1994, Apollo, Chennai, Kidney, Tamil_Nadu

TRANSPLANT RACKET A KIDNEY FOR A LIVING

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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

1994, Apollo, Chennai, Kidney, Tamil_Nadu

Organ Donation and Transplantation—The Chennai Experience in India.

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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.

1994, Apollo, Cardiac, Chennai, Heart, Kidney, Liver, Tamil_Nadu

Donating lives with Heart transplantation

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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.”

1994, Abirami, Act, Apollo, Authorisation, Authorization, Bharathiraja, Bharathi_Raja, Centre, Chennai, Coimbatore, Committee, DME, Human, Kidney, Kilpauk, Organs, Renal, TOHO, Transplantation

Results of Authorisation Committee meeting Results 29.06.2007

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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 requestedto 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 Institutionsare also requested to undertake periodical review of the recipientsand donor and present the donorbefore 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 Committeemay 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

 

 Sri AbiramiHospital ,

 

Coimbatore

 

 Mr.Abdul Khalam

 

 Mr.Anilkumar

 

 ————

 

 Approved

 

 ————

 

2

 

 Sri AbiramiHospital ,

 

Coimbatore

 

 Mr.Bhola Prasad

 

 Mr.S.Shruti Saha

 

 ————

 

 Not Approved

 

 Nature and consequences of organ donation is not completely understood by the donor.

 

3

 

 Sri AbiramiHospital ,

 

Coimbatore

 

 Ms.Kumari Geethanjali

 

 Mr.Sanjay Kumar Verma

 

 —————–

 

 Approved

 

 ————

 

4

 

 Bharathi RajaHospital,Chennai

 

 Mrs.Sudha Jain

 

 Mr.Sanjay Jain

 

 ————

 

 Not Approved

 

 The Proof of relationship betweendonor andhis relative to be produced by competent authority

 

5

 

 Bharathi RajaHospital,Chennai

 

 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

 

 Bharathi RajaHospital,Chennai

 

 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

 

 Coimbatore KidneyCenter,

 

Coimbatore

 

 Mr.Ramachandran

 

 Mrs.Vijyay

 

 ———–

 

 Approved

 

 ————

 

To:

SriAbiramiHospital

 

33 Madukkarai Road

 

Sundarapuram

Coimbatore 641 024.

 

Bharathi Raja Hospital & Research Centre Pvt. Ltd.,

11,

Madley Road

,T.Nagar

Chennai 600 17

CoimbatoreKidneyCenter

738-B Puliakulam Centre

Coimbatore-641 045

1994, Cardiac, Heart, Kidney, Liver

Organ Retrieval and Banking Organisation

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What is organ donation?

It means that a person pledges during his lifetime that after death, organs from his/her body can be used for transplantation to help terminally ill patients and giving them a new lease of life.

There are two ways of Organ donation:

  • Living related donors:- only immediate blood relations (brother, sister, parents & children) can donate as per the Transplantation of Human Organ Act 1994. Living donor can donate only few organs, one kidney (as one kidney is capable of maintaining the body functions), a portion of pancreas (as half of the pancreas is adequate for sustaining pancreatic functions) and part of the liver (as the few segments that are donated will regenerate after a period of time) can be donated.

  • Cadaver Organ donor:- can donate all organs after brain death.

 
What organs and Tissues can be donated?

The major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes, heart valves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels. Therefore one donor can possibly give gift of life to many terminally ill patients who would not survive otherwise.

 
What is brain death?

It is the irreversible and permanent cessation of all brain functions. Brain can no longer send messages to the body to perform vital functions like breathing, sensation, obeying commands etc. Such persons are kept on artificial support (ventilation) to maintain oxygenation of organs so that the organs are in healthy condition until they are removed. Most cases of brain death are the end result of head injuries, brain tumours patients from Intensive care units. Organs of such patients can be transplanted in organ failure patients to provide them a new lease of life.

 

How is brain death diagnosed?

It is done by independent advice of a team of doctors whose qualification and experience is accepted by the hospital for such purposes. Doctors carry out a set of tests to confirm brain death.

The two sets of tests are carried out at the interval of at least 6-12 hrs. Legal time of death is the time at which the second set of test is carried out. Once declared brain dead, further artificial support is futile and actually is emotional and financial trauma. At this time a decision for organ donation should be taken at the earliest.

 
How quickly should the organs be donated?

Healthy organs should be transplanted as soon as possible after brain death from the donor to the recipient.

 

Who can be a Donor?

Anyone, regardless of age, race or gender can become an organ and tissue donor. If he/she is under the age of 18 years, then the consent of parent or legal guardian is essential. Medical suitability for donation is determined at the time of death.

 
Who can give consent for organ donation after brain death?

Donors who have during their lifetime consented for organ donation in writing in the presence of two witnesses (at least one of whom is a near relative,) should carry their donor cards with them and also express their wishes to their near and dear ones. In case of no such consent or donor pledge form was filled before death, then the authority to give consent for organ donation lies with the person lawfully in possession of the dead body.

 

Which terminal diseases can be cured by transplant?

Here are some terminal diseases which can be cured by the transplantation:-

Heart

heart failure

Lungs

terminal lung illnesses

Kidneys

kidney failure

Liver

liver failure

Pancreas

diabetes

Eyes

blindness

Heart valve

valvular disease

Skin

severe burns

 
Who will receive your organ?

Your vital organs will be transplanted into those individuals who need them most urgently. Gifts of life (Organs) are matched to recipients on the basis of medical suitability, urgency of transplant, duration on the waiting list and geographical location.

 
Is there any charge to my family for organ donation?

No, there is no charge nor payment for organ/tissues used in transplantations. Organ donation is a true gift.

 
Does organ / tissue removal affect cremation / burial arrangements or disfigure the body?

No. The removal or organs or tissues will not interfere with customary funeral or burial arrangements. The appearance of the body is not altered. A highly skilled surgical transplant team removes the organs and tissues which can be transplanted in other patients. Surgeons stitch up the body carefully, hence no disfigurement occurs. The body can be viewed as in any case of death and funeral arrangements need not be delayed.

 
Will the doctor ask permission of donation from my family, once the signed donor card is found?

Yes. Doctor will always ask the permission of organ donation from the family if your signed card is sighted. Therefore, it is important that you discuss your decision with family members and loved ones so that it will be easier for them to follow through with your wishes.

 
What is legal position on organs donations?

It is legal by law. The government of India has enacted the “transplantation of human organs act 1994” in Feb. 1995, which has allowed organ donation and legalised brain death.

 
Is it permissible to sell human organs?

No, “The Transplantation of Human Organs Act 1994” prohibits the sale of human organs and tissues. Violators are subject to fines and imprisonment.

 
Can organs be removed after death at home?

No. It can only be removed when a person is brain dead in the hospital and is immediately put on a ventilator and other life support systems. After death at home, only eyes and tissues can be removed.
1994, Cardiac, Chennai, Heart, Kidney, Liver

Indian Cadaveric Organ Donation Programme

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http://www.indiaprwire.com/pressrelease/health-care/20060802473.htm

Indian Cadaveric Organ Donation Programme

A Distant Dream or an Achievable Goal?

 

 

Human-to-human transplantation of organs has been accepted by doctors worldwide as the best line of treatment and often the only one for a wide range of fatal diseases such as End Stage Renal Disease (kidney failure). Organ transplantation has been one of the greatest advances of modern science that has resulted in many patients getting a renewed lease of life. It would not be possible without organ donation. Organs can be donated by a living person, after natural death or after “brain death”. After natural death only a few tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain death almost 37 different organs and tissues can be donated including critical organs such as kidneys, heart, liver and lungs.

In the United States, in 2004, there were over 14,000 organ donors – an increase of 695 donors (7%) over 2003. During this time the number of cadaver donors grew by 11% to 7,152, the largest annual increase in deceased donors in the last 10 years. In 2005, the number of kidneys transplanted from cadavers was 9,914, while the number of patients who received transplants from living donors was 6,563.

Dr AK Bhalla, Seceratary, Delhi Nephrology Society, & a Senior Consultant Nephrologist with Sir Ganga Ram Hospital, New Delhi, opines, “As shown by the US statistics human organ donation is fast developing into a major treatment protocol. However it is yet to make any significant dent in India. A country with a population of over 1 billion people, India lags behind in the implementation of a cadaveric donation programme”. Annually, while over 100,000 Indians suffer from End Stage Renal Disease, only a mere 3,000 are recipients of a donor kidney, of which only a small percentage are cadaver organs. In fact, the total number of patients who have received cadaver kidneys in India from 1995 to 2003 is only 524 , an abysmally small figure. The major problem now facing transplant surgery is a critical shortage of available organs.

An Act was passed by the Government in 1994 to streamline various organ donations and transplant activities in the country. For years, India had the reputation of being a “warehouse for kidneys” and an “organ bazaar” as poverty forced people to sell their kidneys commercially. With a view to prohibiting the sale of organs in India, the Government introduced, in 1994, The Human Organ Transplantation Act. The Act had the following aims in mind – to curtail the kidney racket by introducing a rule that states that only a first-relative can be a living donor, to legalise the definition of “brain death”, and to encourage cadaveric organ transplants.

According to Dr Vijayakumar, Chief Nephrologist at the Kaliappa Hospital, Chennai, “The Human Organ Transplantation Act has legalised the concept of ‘Brain Death’ for the first time in India. Since the passing of the legislation in India, it has become possible to undertake organ transplants from brain dead donors. Improved infrastructure such as ventilators and other emergency measures are necessary to improve the lives of the accident victims. Also, routine ‘Brain Death’ certification in neurosurgical wards could significantly increase the number of cadaver donors. Furthermore, relatives need to be educated about the futility of keeping brain dead accident victims ‘alive’. A good motivator is needed to encourage people to donate organs.”

Until 1997, only four hospitals in India were undertaking cadaver transplants. However, now more and more hospitals are taking up the programme. The successful implementation of this programme however hinges on the education of the masses and having more trained transplant co-ordinators. According to a “Public Attitude Survey to Organ Donation”, less that 50 per cent of the population was willing to consider solid organ donation, and the concept of “brain death” was new to most people surveyed.

12 years after the Human Organ Transplantation Act has been passed, the cadaver programme in India is still in its infancy stage and there is potentially a huge pool of brain-dead patients who could meet the demands of the country for various organs.

Dr Vishwanath Billa, Hon. Nephrologist & Kidney Transplant Physician, Bombay Hospital & Medical Research Centre, Mumbai, states, “A proactive attitude towards cadaveric organ donation, counselling for relatives for organ donation in the event of brain-death, adequate hospital infrastructure, matching and distribution of the organs and co-ordination amongst hospitals will ensure that we convert the current programme to the level of Western Countries.”

– End –

Human-to-human transplantation of organs has been accepted by doctors worldwide as the best line of treatment and often the only one for a wide range of fatal diseases such as End Stage Renal Disease (kidney failure). Organ transplantation has been one of the greatest advances of modern science that has resulted in many patients getting a renewed lease of life. It would not be possible without organ donation

1994, Kidney

Call to extend scope of organ donation

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http://www.blonnet.com/2003/12/06/stories/2003120602311700.htm

Call to extend scope of organ donation

Our Bureau

Visakhapatnam , Dec. 5

ALMOST 75 per cent of the kidney transplant operations in the country are illegal, as the existing laws are unrealistic, says Dr K.S Chugh, pioneering nephrologist widely regarded as the father of nephrology in the country.

Dr Chugh, who was here to participate in the three-day national conference of nephrologists from December 4, was addressing a press meet along with Dr Brian J.G Periera, President of the National Kidney Foundation in the US.

Dr Chugh said the Human Organ Transplantation Act, 1994, permitted the donation of kidneys only among close blood relations.

“Of course, this was done to prevent trafficking in, or sale of, kidneys but I feel the scope of donation has to be expanded allowing those other than blood relations to donate kidneys. At present, almost 75 per cent of the kidney transplantations are illegal. Roughly, the number of operations taking place every year is less than 5,000,” he said.

The laws need to be amended to pave the way for easier organ donation without, however, allowing trafficking, he added.

Drawing a comparison with the US, Dr Periera said three lakh patients in the US were undergoing dialysis every year out of a population of 25 crore in comparison with 20,000 in India out of a population of 100 crores.

“As many as 12 lakh people are suffering from kidney diseases in India and the infrastructure for kidney transplantation is not there. The Government should build up the facilities,” said both the experts.

The conference of nephrologists was formally inaugurated by the State Health Minister, Mr K. Sivaprasada Rao, on Friday.

1994, Kidney

Against the organ trade

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Against the organ trade

http://www.hinduonnet.com/fline/fl1910/19100840.htm

A group of professionals, brought together by a media workshop, pool their insights on human organ donation, examine strategies to end the trade in kidneys, and suggest ways to make the relevant laws more efficient.

PARVATHI MENON
in Bangalore

A GROUP of citizens – doctors, lawyers, journalists, and government representatives – has decided to join forces in a many-sided initiative to halt the commerce in kidneys, which continues to flourish in India in defiance of existing laws and humanitarian values. At a day-long media workshop organised by the BKF-NU Trust and the National Law School of India University (NLSIU) on April 27 in Bangalore on “Human organ donation: medical, legal, social and ethical dimensions”, this group of concerned professionals pooled their information and insights on the complex issue of human organ donation and examined strategies to end the inhuman trading in kidneys.

Renal disease is a major, though largely unrecognised, public health issue in India, one that cuts across the regional and socio-economic divide. An estimated one lakh people develop End Stage Renal Disease (ESRD) each year. This is in addition to a pre-existing pool of an estimated 20 lakh persons who suffer from this affliction. A person with ESRD requires renal replacement therapy in the form of either dialysis on a continuing basis or a renal transplant. Both are expensive options that require recurrent expenditure over the person’s lifetime. Furthermore, treatment for renal disease is still largely in the private health care sector where the costs are high. A large number of ESRD patients – those from rural areas and small towns where treatment is not available, and those who cannot afford the costs even where treatment is available – thus remain outside the pale of any kind of medical care. There are no accurate figures for the number of kidney transplants done in India, as there is no national registry for organ transplants in place, a practice that is mandatory in most Western countries where transplant procedures are performed routinely. Thus estimates of the number of ESRD patients against the actual number of transplants performed are guesstimates at best. According to these guesstimates, fewer than 5 per cent of the ESRD patients in India actually receive some form of renal replacement therapy, and of these an even fewer number have renal transplants. It is estimated, or rather guesstimated, that fewer than 3,000 transplants are performed in the country each year. This represents a fraction of the total number of patients who require transplants.

K. GOPINATHAN
Professor B.K Chandrashekhar, Karnataka Minister of State for Information Technology (second from right), speaks at the media workshop on “Human organ donation: Medical, legal, social and ethical dimensions.” Others in the picture are (from left) Dr. Venkatesh Krishnamoorthy, Medical Director of the BKF-NU Trust, Dr. Mohan Gopal, Director of the NLSIU, N. Ram, Editor, Frontline, and Dr. H. Sudarshan, Chairman of the Karnataka Task Force on Health and Family Welfare.

With the demand for kidneys being met by poor donors who are desperate enough to sell parts of their bodies in order to escape indebtedness and hardship, the Government of India, in keeping with international covenants and progressive legislation in place in other societies, banned the practice of organ trade. The Transplantation of Human Organs Act, 1994, was enacted to stop the trade and clear the legal decks to enable a cadaver-based human organ donation programme to be put in place. Seven years later, there is ample evidence in the public domain that the law has singularly failed in stopping the trade.

The workshop was able to draw together the many threads of the issue of human organ donation and its dominant feature, namely the trade in kidneys. Besides being illegal and violative of basic human rights, the trade in kidneys impedes the growth of a programme of cadaver organ donations, which is a humane and necessary alternative that could meet a good part of the burgeoning demand for kidneys. Less recognised and acknowledged is the negative impact that the trade has had on public policies in healthcare. The dimensions of renal disease in the general population make it a major public health issue that should become part of a government-subsidised public health care programme. Yet the constant supply of kidneys to patients of ESRD from poor donors has resulted in transplants and dialysis remaining within the expensive and exclusive ambit of private health care. The trade has muddied the real picture, thus taking the onus of addressing this public health issue off the government health care sector.

The primary purpose of the workshop, which was attended by around 35 media professionals drawn from different media streams and from all over Karnataka, was: to strengthen the important role of the media in investigating the many dimensions of the trade; to create public awareness; to clear popular misconceptions on renal disease and the medical options available for treating it; and to promote viable and humane alternatives to a paid donor programme. In addition to media professionals, the workshop was attended by journalism educators and students, lawyers and students from the National Law School, and a core group of renal transplant surgeons and nephrologists committed to clearing this vital area of medicine of illegal and unethical practices. The workshop was inaugurated by B.K. Chandrashekhar, Karnataka Minister of State for Information Technology. Dr. H. Sudarshan, the highly regarded Chairman of the Task Force on Health and Family Welfare, Dr. Venkatesh Krishnamoorthy, Medical Director – BKF-NU Trust, Mohan Gopal, Director of the NLSIU, and N. Ram, Editor, Frontline, also addressed the inaugural session.

THE centrepiece of the day-long workshop was the presentation of the facts about the organ trade in Karnataka by Dr. H. Sudarshan, who gave a clear picture of the dimension of the trade in Karnataka and discussed the failure of the State government to confront and stop the trade. According to Dr. Sudarshan, out of the 1,000-odd cases of unrelated transplants that were put up for approval before the State Authorisation Committee between 1995 and March 2002, only 22 were rejected. This, he argued, indicated gross misuse of Article 9(3) of the Transplantation of Human Organs Act, 1994, which permitted a person to donate his or her kidney out of love or emotional attachment to the recipient. He said that in almost all cases of unrelated transplants that had taken place in Karnataka, it was reasonable to assume that money had changed hands. The uncovering of a major racket in kidneys by the Mandya police, in which a network of agents was involved in sourcing the kidneys of the poor to patients in certain Bangalore hospitals, is a clear pointer to this.

Dr. Sudarshan’s statistical analysis of data from the Authorisation Committee’s files shows that a majority of donors in Karnataka were in positions of socio-economic dependence on the recipients. The majority of them were employed as casual labourers in different segments of the unorganised sector. Most of the donors, according to Dr. Sudarshan’s data, were in the 20 to 30 year age group, and transplants largely took place from male donors to male recipients, although women also constituted a significant segment of the donors. Both the donors and the recipients came largely from within Karnataka, although there were a significant number of patients coming to Bangalore from other States as well.

A GOOD part of the workshop revolved around the infirmities of the present Act, especially Section 9(3), the clause that defeats its very purpose. There was unanimity amongst participants on the need either to scrap the clause or to seek ways in which its misuse can be prevented. Chandrashekhar made several suggestions in respect of the law and its implementation. He suggested amendments to the Act to restrict the scope of 9(3). He also stressed the need to define the legal scope of the Authorisation Committee under the Act. He suggested that an independent body of experts of unimpeachable integrity, set up by the government, could review once in three months the cases approved by the Authorisation Committee. He offered the full cooperation of the State government in any effort to strengthen the law and improve the functioning of the bodies appointed under the Act.

There was unanimity amongst the workshop participants on the need to stop the organ trade, described fittingly by Mohan Gopal, Director of the NLSIU, as a practice that “cannibalised” the poor. He said that the goals of a viable transplant programme in the country were incompatible, whether on medical or ethical grounds, with those of a paid donor programme. N. Ram drew pointed attention to the Iran experience, where paid organ donation has been legalised and ‘regulated’ under the law. A survey done on Iranian organ donors (see Frontline April 12, 2002) revealed that these kidney donors had lost their jobs, earnings, health and self-esteem following the transplants. The majority of those interviewed regretted the act of paid donation.

The faculty and students of the NLSIU, drawn from the Institute of Law and Ethics in Medicine, presented an analysis of the Act and its many shortcomings. Apart from the obvious legal giveaway represented by Section 9(3), the Act has several other weaknesses. Organ commerce, made illegal by the Act, is still a non-cognisable offence under it. The inclusion of “spouse” under the category of “near relatives” as defined under the Act could give rise to the sort of misuse the Act seeks to check. The wide discretion provided to the Authorisation Committee is also subjected to misuse. A suggestion made by several doctors was to stop the practice of personal interviews by the Authorisation Committee as the sight of patients put enormous pressure on them to clear the applications. They said that the Committee instead should take a decision based on the documentation that the two parties submitted.

Several other aspects of organ donation were discussed in the workshop. These included the need to create public awareness on the importance of building a cadaver-based organ donation programme, for which the media can play a central role; the role of professionals such as doctors and lawyers in presenting accurate information on treatment and its costs; and the need to involve non-governmental organisations to act as watchdogs in the implementation of the Act.

Looming large on the organ donation scene is the organ trade, an unconscionable and unethical practice that needs to be stamped out. There is ample evidence on the mechanics of this trade; its existence has been acknowledged by the National Human Rights Commission, which on the basis of a recent report in The Hindu has issued a show-cause notice to the Government of Karnataka, the Union Health Ministry and the Medical Council of India asking them to show what action they have taken to stop the trade.

The workshop participants agreed that the time was ripe to initiate a public interest litigation (PIL) in the Karnataka High Court seeking amendments in the law, while also asking for an interim direction to the State government asking it to implement the Act firmly. On the recommendation of Mohan Gopal, the workshop decided to set up an inter-disciplinary working group, which would work on the details of the PIL. The group will try to isolate the weak points of the Act and seek amendments to it, while trying to develop and provide an alternative legal framework.

1994, Cardiac, Heart, Kidney, Liver

Transplant of Human Organs – Forms

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As Published In

 

The Gazette of India
Extraordinary
Part-II Section 3- Sub Section (i)

Published by authority

Issue No. 39- New Delhi

Saturday, February 4, 1995

Magha 15, 1916

THE GAZETTE OF INDIA: EXTRAORDINARY
(PART II Sec. 3-Sub-sec (ii))
MINISTRY OF HEALTH AND FAMILY WELFARE

 

NOTIFICATION
Published by Authority
No.71, New Delhi Saturday February 4, 1995 / Magha 15, 1916
S.O.80(E) – In exercise of the powers conferred by sub-section (3) of section 1 of the Transplantation of Human Organs Act, 1994 (42 of 1994), the Central Government hereby appoints the Fourth day of February, 1995, as the date on which the said Act shall come into force in the States of Goa, Himachal Pradesh and Maharashtra and all the Union Territories.
(No. S, 12011/2/94-MS)

O.P. NIGAM, Chief Controller of Accounts

 

MINISTRY OF HEALTH & FAMILY WELFARE NOTIFICATION
New Delhi, the 4th February 1993

 

G.S.R. 51 (E) – In exercise of the powers conferred by sub-section (1) of Section 24 of the Transplantation of Human Organs Act. 1994(42 of 1994), the Central Government hereby makes the following rules, namely –

1. SHORT TITLE AND COMMENCEMENT

(1) These rules may be at the earliest be the transplantation of Human Organs Rules, 1995.
(2) They shall come into force on the date of their publication in the Official Gazette

2. DEFINITIONS

(a) Act” means the Transplantation of Human Organs Act, 1994 (42 of 1994);
(b) “Form” means a form annexed to these Rules;

(c) “Section” means a section of the Act;
(d) Words and expressions used and not defined in these Rules, but defined in the Act, shall have the same meanings respectively assigned to them in the Act.

 

 

3. AUTHORITY FOR REMOVAL OF HUMAN ORGAN

Any donor may authorise the removal, before the death, of any human organ of his body for therapeutic purposes in the manner and as such conditions as specified in Form 1.

4. DUTIES OF THE MEDICAL PRACTITIONER

(1) A registered medical practitioner shall, before removing a human organ, from the body of a donor before his death satisfy himself –

(a) that the donor has given his authorization in the Form 1

(b) that the donor is in proper state of health and is fit to donate the organ, and shall sign a certificate a specified in Form 2.

(c) that the donor is a near relative of the recipient and shall sign a certificate as specified in Form 3 after carrying out the following tests on the donor and the recipient, namely:-

(i) tests for the antigenic products of the Human Major Histo-compatibility system HLA-A, HLA-B and HLA-DR using conventional serological techniques;
(ii) tests to establish HLA-DR beta and HLA-DQ beta gene restriction fragment length polymorphism;

(iii) Where the tests referred to in sub-clause(i) and sub-clause(ii) do not establish a genetic relationship between the donor and the recipient further tests to establish DNA polymorphism using at least two multi locus gene probe;
(iv) Where the tests referred to in sub-clause (iii) do not establish a genetic relationship between the donor and the recepient further tests do establish DNA polymorphisms using atleast 5 single locus polymorphic probes.

(d) in case recipient is a spouse of the donor, record the statements of the recipient and the donor to the effect that they are so related and shall sign a certificate in Form 4;

 

(2)A registration medical practitioner shall, before removing a human organ from the body of a person after his death satisfy himself –

(a) that the donor had in the presence of two or more witnesses (at last one of whom is a near relative of such person) unequivocally authorized as specified in Form 5 before his death, the removal of the human organ of his body, after his death, for therapeutic purposes and there is no reason to believe that the donor had subsequently revoked the authority aforesaid
(b) that the person lawfully in possession of the dead body has signed a certificate as specified in Form 6 or Form 7.

(3) A registered medical practitioner shall before removing human organ from the body of a person in the event of his brainstem death satisfy himself –

(a) that a certificate as specified in Form 8 has been signed by all the members of the Board of medical experts referred to in sub section (6) of section 3 of the Act
(b) that in the case of brain stem death of a person of in less than eighteen years of age, a certificate specified in Form 8 has been singed by all the members of the Board of medical experts referred to in sub-section (6) of Section 3 of the Act and an authority as specified in Form 9 has been signed by either the parent of such person.

5. PRESERVATION OF ORGANS

 

The organ removed shall be preserved according to current and accepted scientific methods in order to ensure viability for the purpose of transplantation.

6. The donor and the recipient shall make jointly an application to grant approval for removal and transplantation of a human organ, to the Authorization Committee as specified in Form 10

 

7. REGISTRATION OF HOSPITAL

 

(1)Anapplication for registration shall be made to the Appropriate Authority as specified in Form 11. The application shall be accompanied by a fee of rupees one thousand payable to the Appropriate Authority by means of a bank draft or postal order.
(2) The Appropriate Authority shall after holding an inquiry and after satisfying itself that the applicant has complied with all the requirements, grant a certificate of registration as specified in Form 12 and shall be valid for period of 5 years from the date of its issue and shall be renewable.

 

8. RENEWAL OF REGISTRATION

(1) An application for the renewal of a certificate or registration shall be made to the Appropriate Authority within a period of three months prior to the date of expiry of the original certificate of registration and shall be accompanied by a fee of rupees five hundred payable to the Appropriate Authority by means of a bank draft or postal order.
(2) A renewal certificate of registration shall be as specified in Form 13 and shall be valid for a period of five years
(3) If, after an inquiry including inspection of the hospital and security of its past performance and after giving an opportunity to the applicant, the Appropriate Authority is satisfied that the applicant, since grant of certificate of registration the under sub-rule (2) of Rule 7 has not complied with the requirements of this Act and the rules made there under and conditions subject to which the certificate of registration has been granted, shall, for reasons to be recorded in writing, refuse to grant renewal of the certificate of registration.

 

 

(9) CONDITIONS FOR GRANT OF CERTIFICATE OF REGISTRATION

 

No hospital shall be granted a certificate of registration under this Act unless it fulfills the following requirement of manpower, equipment, specialised services and facilities as laid down below –

 

GENERAL REQUIREMENT

 

1. Surgical Staff
2. Cardiology Staff
3. Nursing Staff
4. Communication System
5. Intensivist
6. Medical Social Worker
7. Perfusionist

VARIOUS DEPARTMENT

1. Microbiology
2. Mycology
3. Pathology
4. Virology
5. Nephrology
6. Neurology
7. Psychology
8. G.I. Surgery
9. Anaesthesiology
10. Imaging Facilities
11. Paediatrics
12. Physiotherapy
13. Immunology
14. Haematology
15. Blood Bank
16. Clinical Chemistry
17. Cardiology

 

NON-TRANSPLANTATION PROGRAMME TEAM

 

1. Neurologist
2. Neurosurgeon
3. Medical Superintendent
4. Any other hospital Staff

 

BASIC EQUIPMENT

 

Operating Room facilities for routine open heart surgery which includes heart-lung machine and accessories.

 

ADDITIONAL EQUIPMENT REQUIRED FOR TRANPLANTATION PROGRAMME

1. Cell Saver
2. Assist devices like IABP, Centrifugal Pump and various assist devices, both pneumatic and electric operated.
3. Mobile C-arm image intensifier for routine biopsies in the street operating room
4. Euct /Alert system for early detection of any infection
5. Radioimmunoassay for measuring Cyclosporin levels.
6. Routine Laboratory facilities for detection of HIV, Australia antigen, CMV, Toxoplasnosis and other Mycology Tests

 


EXPERTS
(A) Kidney Transplantation

M.S. (Gen.) Surgery or equivalent qualification which three years post M.S. training a recognized center in India or abroad and having attended to adequate number of renal transplantation as an active member of team

(B) Transplantation of Liver & Other Abdominal Organs

 

M.S. (Gen.) Surgery or equivalent qualification with adequate post M.S. training in an established center with reasonable experience of performing liver transplantation as an active member of team

 

(a) Cardiac, Pulmonary Cardio-Pulmonary Transplantation.
M.Ch Cardio-thoracic and vascular surgery or equivalent qualification in India or abroad with at least 3 years experience as an active member of the team performing an adequate number of open heart operations per year and well-versed with coronary by-pass surgery and Heart valve Surgery.

10. APPEAL

 

(1) Any person aggrieved by an order of the Authorisation Committee under sub-section (6) of section 9, or by an order of the Appropriate Authority under sub-section (2) of section 15 and Section 16 of the Act, may, within thirty days from the date of receipt of the order, prefer an appeal to the Central Government

 

(2) Every appeal shall be in writing and shall be accompanied by a copy of the order appealed against

1994, Kidney

Features of the 1994 Act

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Features of the 1994 Act

THE Transplantation of Human Organs Act, 1994 is meant to “provide for the regulation of removal, storage, and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.” The Central Act illegalises the buying and selling of human organs and makes cash-for-kidney transactions a criminal offence. The law establishes an institutional structure to authorise and regulate human organ transplants and to register and regulate, through regular checks, hospitals that are permitted to perform transplants. It recognises, for the first time in India, the concept of brain-stem death, paving the way for a cadaver-based kidney transplant programme.

The Act details actions that amount to direct participation in or abetment of the organ trade; these offences are punishable under Section 19 of the Act.

Section 19 of the Act states: “Whoever (a) makes or receives any payment for the supply of, or for an offer to supply, any human organ; (b) seeks to find a person willing to supply for payment any human organ; (c) offers to supply organs for payment; (d) initiates or negotiates any arrangement involving the making of any payment for the supply of, or for an offer to supply, any human organs; (e) takes part in the management or control of a body of persons, whether a society, firm or company, whose activities consist of or include the initiation or negotiation of any arrangement referred to in clause (d); or (f) publishes or distributes or causes to be published or distributed any advertisement (i) inviting persons to supply for payment any human organ; (ii) offering to supply any human organ for payment; or (iii) indicating that the advertiser is willing to initiate or negotiate any arrangement referred to in clause (d) shall be punishable with a term of imprisonment ranging from two to seven years or with a fine not less than Rs.10,000 and not greater than Rs.20,000.”

The Act defines two categories of donors. First, it permits a near relative, defined as a patient’s spouse, parents, siblings, and children, to donate a kidney to the patient. Secondly, in Section 9(3) of the Act, live donors who are not near relatives but are willing to donate kidneys to the recipients “by reason of affection or attachment towards the recipient or for any other special reasons,” are permitted to do so, provided that the transplantations have the approval of the Authorisation Committee, established under the Act.

The Act makes the offence of kidney trading non-cognisable. In other words, the police cannot look into complaints of kidney trading independently but must wait for a complaint to be made by the Appropriate Authority set up under the Act or by an officer authorised by it or by an individual who has given prior notice of not less than 60 days to the Appropriate Authority.

It is not clear whether Section 9(3) was deliberately meant – under pressure from special interests – to provide a loophole that could be exploited in practice, or whether the law-makers thought they were sympathetically making provision for donations from second-degree relatives and others who might act out of genuine love and affection or altruism.

But whatever be the reasoning and motivation behind the provision of a loophole, the practical operation of Section 9(3), combining with the non-cognisability of the offences to be prosecuted, has rendered the 1994 Act virtually unenforceable. (These features of the 1994 Act were critically analysed in the article “Kidneys still for sale” published in the December 26, 1997 issue of Frontline.)