Strict implementation of law and a change in the mindset of the people are essential for promoting organ transplants in the country. Amendment to the Human Organ Transplant Act can make both cadaver and live donor transplants easier, but as far as organs are available for a price and strict action is not taken against the violators of the law, the malpractices will continue. This was stated by Dr M Mohan Rao, Senior Consultant Transplant Surgeon, the Queen Elizabeth Hospital, Adelaide, Australia. Dr Rao did the first kidney transplantation in India at CMC Vellore in the year 1971.

Talking to Pharmabiz.com, Dr Mohan Rao, who was in Hyderabad to participate in and deliver a lecture at the 14th conference of the Indian Society of Organ Transplantation (ISOT), said in India organ transplants had moved away from government institutions to private hospitals where money seemed to be the prime criterion. There were also some unscrupulous people who brought disrepute to organ transplants. In other countries they would lose the licence, get even a jail term, and could never practise again. In India, the Medical Council of India was totally ineffective and did not seem to have the power to bring the culprits to book.

He said in India, on an average, 3,000 organ transplants were being performed. The hospitals claimed almost 99 per cent success, but nobody had an idea about how many were really successful. There were no records maintained by any official or independent agencies.

He said in Australia it was mostly cadaver transplants, which formed almost two-thirds of the total transplants, and one-third of the organs came from live donors. In his hospital in Adelaide, about 70-80 transplants were being performed every year, of which two-thirds were cadaver and the rest live.

Dr Rao said in India mostly the rich and the middle class, who could afford the costly operation, go in for organ transplants. Even though, the law permitted organ donations only from close relatives, very few people come forward to donate their organs even among the close relatives. The fact is, why should they part with their organs if they can buy them?

He said live donor programme among unrelated donors was also important. If the blood group was not matching and no suitable relatives were available for organ donation, then unrelated donors should be encouraged. But money should not be the motive.

Dr Rao said presently the relatives accepted the inevitability of death and were not aware that they could still live with one kidney or a part of their liver even after the donation to save a life. At least the next generation should be persuaded and educated on the need for organ donations either live or after their death. The hospitals should also have facilities to preserve the brain dead so that the organs could be successfully retrieved. There should also be proper networking among hospitals, NGOs and other organisations and no organ should be wasted for want of modern facilities and information. If one particular hospital had no suitable patient to receive the organ, it should be gifted to somebody else in another hospital waiting for a matching organ.

Underscoring the need for promoting cadaver transplants, Dr Rao said the law should be made easy to procure organs from the brain dead. In Singapore and some East European countries there was a ‘opt in’ and ‘opt out’ clause in the driving licence giving voluntary permission to retrieve the organs in case of accidental deaths. That provision should be incorporated in the driving licences as cadaver transplants were still cumbersome owing to several factors in India.

Asked about the procedure in Australia, Dr Rao said road accident deaths had drastically come down there, though it was still the main source of supply for cadaver transplants. The new sources were the people bleeding into the brain resulting in strokes, attempted suicides and asthma patients gasping to death.

Don’t you think liberalisation of the Act and making retrieval of the organs easier, pave way for further scandals? Dr Rao said ‘brain death’ certificates were being issued by specialists who were not connected with the transplants. The transplant team would have nothing with the donor. When it came to allocation, it was based on the blood group, tissue typing etc, he said.

In the case of live donor, he should be healthy and should have both kidneys functioning well, Dr Rao said.