Wanted, better awareness

Published : Oct 25, 2002 00:00 IST

The kidney-for-money racket has underlined the necessity to create public awareness about voluntary organ donation, especially cadaver-based donation.

CONSULTANT Nephrologist Georgy K. Ninan was a member of the transplant team at the Medical Trust Hospital in Kochi (where he used to work earlier), which did the only four cadaver transplants in Kerala in the past six years. He says that at the PVS Hospital in Kochi, where he works now, nearly 40 cases of brain death occur every year. Relatives of just five to eight among them come up to the stage of agreeing to the donation of organs, mainly kidneys. But by the time they agree and the medically and legally required processes for cadaver donation are initiated, the brain-dead patient gets caught in his/her own medical problems and dies.

Dr. K. Vinodan, spokesperson for the Medical Trust Hospital and chief of its Critical Care Unit, told Frontline: ``We could not do more because of lack of public awareness and public motivation.''

According to Dr. Ninan, though Kerala society is highly literate, it is difficult to convince people that cadaver donations are noble acts that help someone else live. ``Somehow this message has not percolated down in our society,'' he said.

Why does Kerala lag behind in this? Says Dr. Roy Chally, Consultant Urologist at the Baby Memorial Hospital in Kozhikode: ``People are not aware, not properly educated on this. Public education is very poor.'' The other reason, he said, was that the care given to accident victims in most hospitals was not ``excellent''. Dr. Chally said: ``The care should be excellent, with no room for complaints. If that is not given, then there is no right, and no way, for a hospital to approach a family and get the sanction for organ donation.''

Dr. Ramdas Pisharody, a leading nephrologist and Professor of Nephrology at the Government Medical College Hospital in Kozhikode, said: ``Two things stand against it. One is the lack of motivation on the part of hospitals. They are not interested in keeping a brain-dead person alive [for a variety of reasons, importantly, the demand for life support systems from patients who are waiting and who could be saved]. The second is the hospital's fear of a scandal.''

Dr. Vinodan explains what happens at the Medical Trust Hospital when a person is declared brain-dead: ``What we try to do, of late, is to get grief counsellors in the hospital to break the news to the patients' relatives and suggest to them about such a possibility of saving another life. People who have had this idea earlier, some of them may agree... Once they agree, then immediately a vigorous criterion comes into operation, again as per the law. We get neurologists and physicians from outside the hospital to go through an entire gamut of investigations and criteria to certify brain death. Only after brain death is declared is the transplant unit allowed to move in to do the real test for cross-matching [of the tissue of the donor and the recipient of a kidney].''

According to Dr. T.L.P. Prabhu, physician and a member of a committee of professional doctors in Kochi formed to certify brain death (the committee is yet to get the formal approval of the State government as required under the Transplantation of Human Organs Act), two doctors from outside the particular hospital are required to carry out a series of tests to confirm that a patient is brain-stem dead. The standards are strict and are accepted medically, legally and ethically all over the world. ``This series of tests may take between seven to 12 hours, during which the patient would be kept in the life support system,'' he said.

How quickly should the transplant of an organ from a brain-dead patient take place for it to function in a kidney patient? Dr. Ninan said that once life support systems were disconnected, the vital organs would collapse within hours, beginning with cardiac arrest, and that it was crucial that the organs were transplanted from the donor to the recipient as quickly as possible.

What has been the real-life experience at the Medical Trust Hospital? Dr. Ninan said: ``Once the relatives give their consent for the donation, we take the patient to a different ICU [Intensive Care Unit], use more medicines to make sure that other organs do not die, because we can't any longer do anything to the brain. But we can at least make sure that the other organs do not die and that way we can hold on for some time. We have had patients in that state for two or three days and had gone ahead and done it. It is important that the hospital also should have the right recipient. Our problem until recently was that the cross-matching facility was not available in Kochi. Certainly, hospitals in Kerala are equipped to do cadaver transplants. Each city now has two or three hospitals that are definitely able to do it.''

According to Dr. K.M. Mehboob, Medical Director of the National Hospital in Kozhikode, his institution, which boasts of the largest number of live transplants (about 200 done in the private sector in Kozhikode), has taken a decision ``not to get into it'' (cadaver transplantation) because they believed that ``brain death is a very controversial area''.

A positive outcome of the expose on Kerala's first major kidney racket has been a renewed interest among transplant professionals in the State in creating public awareness about voluntary organ donation, especially about cadaver organ donation. In Kochi, which is fast growing into a major transplant centre in the State, the Society for Organ Retrieval and Transplantation-Cochin (SORT-Cochin), an orgnisation that had not been active for two years since its formation, has suddenly come alive. Its activities are now getting a renewed vigour. It recently launched a website and has decided to hold weekly meetings to discuss future programmes.

According to Dr. Ninan, a key organiser, SORT's main objective is to create social awareness about and change social attitudes towards organ donation. He said: ``We intend to link all transplant hospitals in Kochi and possibly, later, in the entire State, so that cadaver organs harvested in one hospital are made available to a common pool and distributed to kidney patients in any hospital based on a transparent system of prioritisation. SORT also issues `donor cards', on which any person can give his or her consent for the harvesting of his or her organs after death. SORT will also maintain a list of patients awaiting transplant, who could be helped when organs are available.''

But, such plans are difficult to execute, as SORT and another agency, the Society for the Promotion of Organ Transplantation (SPOT) in Kozhikode, have found out in the past two years. Both have not been successful in helping conduct a single cadaver organ transplant in the State.

According to Dr. Unni Balakrishnan, chief of the nephrology unit at the superspecialty Amrita Institute of Medical Sciences, Kochi, and a member of SORT, most developed countries that now boast of a live cadaver programme started exactly like this, with no takers. Dr. Balakrishnan said: ``It may take time. I had a chance to speak to the secretary of the National Kidney Foundation in Singapore recently. He told me that it took them 12 years after the foundation was established to do finally the first cadaver transplant. Similarly, in the U.S., it took them 15 years to do the first cadaver transplant after such an organisation was formed.''

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