Organ transplants easier said than done

With the advances in medical science, there is no dearth of hospitals trying what is considered the pinnacle in medical care "" organ transplants.

Though hospitals are going ahead full steam in setting up infrastructure to conduct organ transplants, the system and rules have not kept pace. The infrastructure is hurdle enough, the red tape does not help.

Dr Douglas Hanto, (transplant surgeon) Boston, Massachusetts, who was in India sometime ago told Business Standard, "A legislation on brain death is the key to organ transplant catching on."

About 25 per cent of potential organs "" heart, kidney, liver, lungs, intestine, eyes, pancreas, bones, bone marrow, skin, connective tissue, middle ear, blood vessels - that can be transplanted are lost due to delays in cadaver organ retrievals. In most cases, time is lost while getting patients certified 'brain dead'.

Lack of guidelines on cadaver organ transplant and the lack of awareness are said to blame. The government seems to be taking steps towards solving the first problem by laying down guidelines for cadaver transplants.

Even as there are a good number of people on the organ recipient waiting list, the red tape often trips the efforts to harvest the organs. The lack of an agency to co-ordinate efforts of organ donation has not helped matters.

According to an expert in organ transplant, "Government hospitals are best placed to conduct organ transplants as they get most medico-legal cases. But, the red tape ensures the organs are either not retrieved on time or that there is no one at hand to harvest the organs."

He speaks of a government institution that wouldn't allow anyone other than its own doctors to harvest organs though it has no such expert at hand.

"The lack of awareness and the low rate of cadaver transplants, hospitals being wary of legal implications and high cost of setting up transplant facilities are the main hurdles to expanding organ transplant programmes," said Sandeep Sinha, Industry Manager, Healthcare Practice, Frost & Sullivan.

Dr Ramcharan of Manipal Hospital, Bangalore, said, "We have a long way to go. There are far too many hurdles, right from the law which needs amendment."

The Karnataka Medical Council, lamented a doctor who returned from the US, has set stringent guidelines to get a licence for a transplant expert. Dr Mohd Rehan Sayeed, senior consultant and cardio-thoracic surgeon, Apollo Hospitals, said, "Many of these guidelines are extremely difficult to meet for the doctors here as they will take years to be exposed to that many cases."

The council specifies the minimum requirements for a heart transplant surgeon to get a licence. It specifies a heart surgeon to have done 200 or so bypass surgeries for instance, "skills don't matter". This, despite a central legislation on the matter.

The biggest hurdle seems to be the lack of a nodal agency to co-ordinate organ harvesting and transplant efforts. The United Network for Organ Sharing in the US keeps data on organ receivers. It identifies donors, makes the required request and required notification. The organisation has to be called and family contacted.

Hence, the decision of organ transplant is taken out of the hospital and given to the organisation. Computer matches donor with recipient based on the policy as required by law on who gets priority. Through tissue typing, the priority list is drawn.

A start seems to have been made at the All India Institute of Medical Sciences (AIIMS), New Delhi. The Organ Retrieval Banking Organisation (ORBO), a nodal centre for the country, has been set up at AIIMS, New Delhi, to "encourage organ donations, fair and equitable distribution and optimum utilisation of human organs".

ORBO has over a dozen hospitals in its network, but it is localised to hospitals in Delhi and couple of other cities in the North.