‘Transplant surgeons are casualties in organ donation malpractices’

Nagpur: Following FIR against doctors in the recent alleged malpractices in kidney transplant involving a husband-wife performed at Pune’s Ruby Hall Clinic, the Indian Society of Organ Transplantation (ISOT) has redflagged the alleged harassment saying such coercive action will stall transplants. Dr Sanjay Kolte, vice president, ISOT, says such action leaves hospitals and doctors demoralized. The onus of verifying relation claims is on authorization committee but it is treating doctors who are at receiving end when a scam surfaces, said the transplant surgeon and urologist in an exclusive interview with TOI.
Dr Kolte, who is also secretary of the Zonal Transplant Coordination Committee (ZTCC), talks about progress of transplants in Nagpur.
Excerpts from an interview...
Q. How transplants are governed?
A. ZTCC has no role in live related organ donation. Human Organ Transplant Act (HOTA) governs related donations – involving husband-wife, brother-sister, parents, grandparents and grandchildren. Hospital authorization committee is the deciding body for related donations. Law doesn’t say ‘no’ to unrelated organ transplant but the case is referred to state authorization committee. So, there are different governing bodies for deceased and live donations. Under HOTA, the apex body for deceased donation is NOTTO (National Organ Transplant and Tissue Organisation), five regional bodies (ROTTO) and SOTTO in every state. ZTCC in Maharashtra predates NOTTO, so it was not dissolved and they are actually replacing SOTTO in the state. All waitlisted patients are given a NOTTO ID to decide the priority. ZTCC allocates as per the ID.
Q. Who has responsibility of verifying relationships?
A. Usually, doctors are not involved in any kind of malpractice. Doctors are casualty of these malpractices. Affidavit of relations and supporting documents are given by the relatives. The responsibility wrests with the relatives. If prima facie there is nothing to doubt, a doctor won’t go into details. Doctors also don’t have the powers or means to verify identity documents. Their basic and biggest job is to ensure safe and successful transplant. If there is some botch up in transplant, they you can hold a doctor responsible. Doctor already remains stressed in ensuring successful operation. But they are burdened with verification task. If someone comes saying he is a relative and willing to donate his organ, a doctor explains the process and sends the file to the committee. If the committee approves, they do it.
Q. What leads to malpractices?
A. When a patient is in dire need or risk of death is high, they fall prey to the middlemen, who have a well-oiled system. In Ruby Hall Clinic case, a similar alleged incident took place. The doctors were absolutely not involved in anyway. All these events disturb the transplant campaign.
Q. What impact such incidents have on hospitals?
A. All live related transplants are bound to have an impact if things are not corrected. HOTA doesn’t assign any assign responsibility on proving the relation. It is authorization committee which approves request and doctor performs. In the absence of this, everybody who is part of the system is booked when a malpractice surfaces. So the doctor, being vehicle of the ultimate journey, gets trapped. If doctors are unnecessarily booked or time is wasted in proving innocence, they will be discouraged from taking transplant as a specialty. Hospitals too would think twice before encouraging live related transplants. And patients would continue to linger on wait list, search in far off places or fall prey to such scams.
Q. What is the solution?
A. Patients must behave more responsibly. More and more people should pledge organs. Pledging is not difficult. Hospitals should proactively start identifying brain dead patients. ICUs should play a role in convincing relatives into organ donation. Relatives should also probe if patient is brain dead, and how the organs can be utilitized.
Q. How do you summarize this two-decade old journey of organ transplantation in Nagpur?
A. Progressive though not an ideal one. Initially, we started with one hospital and slowly other hospitals followed. Each year, we have seen an increase in number of transplants. At transplantation institution should have been a reality now. A place which stood out by being the first in doing a cadaver transplant in 2013 and encouraged other cities to take it up has lagged in carrying it forward. After 2013, we started doing liver transplant also. We have also been partners in sending heart and lungs to distant places like Delhi, Mumbai and Chennai. But we are still facing problems in transplanting these organs in Nagpur.
Q. Why heart and lungs are still not utilized here?
A. Relatives of the deceased donor are usually not willing to wait the extra 10 to 12 hours required for transplant team to reach Nagpur and retrieve the organs. They are in a hurry to carry out last rites. The region has to beat this backlog.
Q. Will a dedicated institution help?
A. We started kidney transplant at GMCH Nagpur in 2016. After that, the medical college should have acquired a comprehensive organ transplant programme. Unfortunately, it has not happened ever after six years. Even Jawaharlal Nehru Medical College at Sawangi having speciality and postgraduate courses of all subjects should have come up with a dedicated centre.
Q. What is holding them back?
A. A stable manpower is a problem in rural areas. Doctors come there for a year or two, gain experience and leave. Nagpur has viability issue. Kidney transplant is cheapest, liver is more expensive, and heart costliest among them. Some dedicated centres are being planned but I hope GMCH Nagpur also comes up with one.
Q. How many patients are on wait list?
A. About 400 are awaiting kidney transplant, more than 150 liver transplant and as many for heart and lung. But as people know these transplant are not being done, they don’t enlist. So the number maybe higher. After Covid, lung failure has become common. Successful lung transplantation is also happening in these patients. So patients have started registering in Nagpur. We are waiting for a hospital to provide this facility here.
Q. Why deceased donation rate is still poor?
A. We have done 89 transplantation from brain dead patients but not circulatory death patients. Donation by circulatory death patient is gaining recognition. When the heart stops functioning and within specified time organs are retrieved, it is known as circulatory death. It is also called donation after cardiac death (DCD). Few centres in India are performing DCD. Once law has specified guidelines, this will become more common and acceptable. Consent by relatives still remains a big problem. Overall people don’t pledge their organs. If a person has done it in his or her lifetime, then we don’t need anyone’s permission to retrieve his organs after death. In the absence of pledge, donation depends on family. Success rate is high among family members who are aware of organ donation. But if they are not aware, the rate of counselling them into donation is less.