TRADING OF ORGANS NEED FOR A COMPREHENSIVE POLICY
Item
- Title
-
TRADING OF ORGANS
NEED FOR A COMPREHENSIVE POLICY - extracted text
-
TRADING OF ORGANS
NEED FOR A COMPREHENSIVE POLICY
non->.
MotC
now, would h
the Bill becomes
reading. it appeal
'
r.heBfflisanommb.'^U
Se^^tsible corna^..#-'
Rov:'' ’ ■ z<CVW
..
IT
VxO^ ,|tCf-
.nrh
f..c ;ccliny>
^’7.,
Mt
on,,^k
stable cl
^Kr’.her.bod^W -
<
which ca-
- waves'. ’
^Wattbem'''
hc
-'
>4^ B
' \
^id.foi'L^^^
-
ar&c
4-1-
■>
' X*" ‘
■-
.y1
w
('aunt 1
- .mH
nak '
me
.^.dcaii’
,.„.AXV.,.,, ,...,.-kidney by4ppf„^s;„
Kidney■ donors swell
*maybe^'^
O(
k ins’' . .
;» v."
conditions. n
v r the public in
V\ e a private i’
X
-o control
public '■
® KWS'elliri^^
if su
.lawful
Ajnssed
kji si? j
yfcl
i
4
' SF
for pt‘^
than a
we
o _ \? -/of tb'1'
lions •^'%Y ' , hil (tie head-
dealing?
standiji
^n- ■ » nimos and raAe^
VOLUNTARY HEALTH ASSOCIATION OF INDIA
TRADING OF ORGANS
NEED FOR A COMPREHENSIVE POLICY
COMMUNITV •W X' - '
Rama V. Baru
Priya Nanda
VOLUNTARY HEALTH ASSOCIATION OF INDIA, NEW DELHI
Tong Swasthya Bhavan
40, Institutional Area, Near Qutab Hotel, New Delhi 110 016, INDIA
The information contained in this book Is compiled from various sources
and every effort has been made to ensure its accuracy. However, we
cannot take responsibility for any error or omissions made due to our
having to depend on secondary sources also. It is extremely difficult to
obtain authentic information easily from reliable sources and if there are
any omissions it merely highlights the urgency and the need to ensure
easy availability of unbiased Information from official sources.
Information in this book is for dissemination and discussion. Anybody can
use and reuse it through any medium provided proper acknowledgement
is made to VHAI.
First Published February 1993
© Voluntary Health Association of India
40, Institutional Area
South of IIT
New Delhi 110016
Phone: 668071, 668072, 665018, 655871, 652953
Cover by : Boney
Layout and Composing : Burman Graphics, Janak Puri.
Production : VHAI, Communications
Pr.nted at Sona Printers Pvt. Ltd B-181 Okhla Ph-1, N.D.-20. Ph: 6811313-4-5-6
ACKNOWLEDGEMENTS
The major contribution in compilation of this report was done by the PUBLIC POLICY
DIVISION of Voluntary Health Association of India. We have used information from
newspapers as well as journals towards the compilation of this report.
Our sincere thanks to the entire Public Policy Division, specially to Dr.Unnikrishnan,
Mr.Prabhakar Rao, Ms. Jessy George, Mr. Suresh Chauhan, Ms. Fiona Dias, Ms. Mini
Sekharan, Mr. Vikramjit Singh and Mr. Sanjoy Sengupta for their secretarial and general
assistance. Our thanks to Dr. Mira Shiva, Head, Public Policy Division, for her support and
encouragement.
We would like to acknowledge the contribution of the Communication and Information
Divisions towards the production of this publication.
New Delhi
February, 1993
Rama V. Baru
Priya Nanda
1
The Trading of Organs: Need for a Comprehensive Policy
The trading of organs has received much attention in the media of late and from all accounts
the money involved in these transactions ranges from Rs 25,(XX) to over a lakh rupees. One
of the major organs being traded is the kidney. It is estimated that almost 2,000 or more
are being sold every year. There is a considerable need for kidneys since nearly 80,000
people suffer from renal failure every year in India. Although the trading of organs is not
a recent phenomenon, the last decade has seen a more prominent role of the private sector
in the commercialisation of the organ trade. It is difficult to estimate the number of
transplants done in the major cities since most of them are conducted in small nursing
homes and some large hospitals in the private sector. Similarly, in the case of comeal
transplants there have been reports of illegal sale of corneas.
In the light of criticism from Professionals and Foundations dealing with organ transplants,
the Government has formulated The Transplantation of Human Organ Bill, 1992, “ to
provide for regulation of removal, storage and transplantation of human organs for
therapeutic purposes and for the prevention of commercial dealings in human
organs”.
In this booklet we propose to analyse the following issues:
1.
2.
3.
4.
A review of the state of organ trade in India, which will broadly cover mechanisms of the
trade and case studies of socio-economic compulsions of donors of kidneys. In addition,
we will highlight the social and ethical dimensions of both cadaver and unrelated donor
transplants.
A discussion of the prominent features of the Bill,which is still to be introduced in the
Parliament.
Issues regarding the alternatives to organ trade.
A critique of the Bill given the various dimensions of the organ trade.
I. STATE OF ORGAN TRADE
How Does the Organ Trade Work?
The organ trade is facilitated through a well worked out circuit, in which middle
men are a key contact between doctors, recipients and donors. These middlemen
play an important role in identifying the donor as well as getting in touch with the
professionals and the recipients. In Madras, which has emerged as one of the
leading centres for kidney trade, these middlemen visit low income areas in the
suburbs, as representatives of different private hospitals in search of potential
donors. After ‘willing’ donors are identified, they are taken for routine blood and
urine tests, in order to facilitate organ matching between a donor and a prospective
recipient. When the deal is struck, middlemen take a cut which ranges from an
amount of Rs 1,000 to as much as Rs 20,000.
3
It is estimated that each year more than 2,000 live donors, who are in dire need of cash,
sell their organs. The sale price of a kidney varies between Rs 15,000 to Rs 50,000.
According to one transplant surgeon, the kidney business in India is worth Rs. 400
million.
The following graph illustrates the increasing trend in the trade of kidneys during the past
decade.
Growth of Trade in Kidneys: 1983-1991.
2000
500
50
1983
1985
1991
Costs Involved
The average cost of a kidney transplant is around $7000 (nearly Rs two lakhs) which is
about 40% cheaper than a similar operation in the West. It is estimated that almost every
agent and doctor involved in the trade of kidneys makes a profit of Rs one lakh per month.
An alternative to renal transplants is keeping the patient on dialysis. However, there are
only around 650 dialysis centres across the country, which barely support a fifth of the
estimated 80,000 cases of renal failure every' year. Additionally, dialysis is an expensive
option, with an average monthly cost in the range of Rs 5,000-8,000, which is often beyond
the reach of most.
Table I
The Price Tag For Various Parts of the Body
Organ
Price (in Rs)
Live Donor Kidney
30,000
Live Cornea
80,000
Skin (per patch)
1,000
Skeleton
10,000
Source: ‘The Organ Bazar’ India Today July 31, 1990.
4
Organ Trade and Private Hospitals
It is clear from various reports that majority of organ transplants, mainly kidney and eye,
are carried out in private nursing homes and hospitals. Earlier, many of the larger hospitals
were conducting transplants by encouraging their patients to buy kidneys. In the wake of
public pressure against the commercial trade of organs, some of these larger hospitals
agreed to undertake only donor related transplants.
Dr. P.C. Reddy, Chairman of Apollo Hospital, Madras, claims to have done 750 renal
transplants between 1984-91. As he says, his hospital relies solely on related donors
because “the paid donor system gives scope for malpractices, and when doctors are
involved in trading, the whole thing can become unpleasant.”
However the number of such hospitals is small and therefore has not succeeded in breaking
the nexus between the professionals, middlemen and patients. The trade and transplant
of kidneys is no longer restricted to either large hospitals or cities. In fact several cities
and towns have witnessed the mushrooming of private nursing homes especially for
the purpose of transplants. Majority of these nursing homes neither have the
required infrastructure nor the professional competence to undertake transplant
surgeries. In Bombay and Madras alone, over a score of such hospitals have come up in
the past two years.
What do Professionals say?
Is the trading of organs such a repugnant act? As far as medical ethics is concerned,
we know that it does serve to alleviate the suffering of a person with renal failure. The
question however is, should this suffering be alleviated at the cost of someone who
resorts to this channel for earning money?
Madras, which has emerged as the biggest centre for renal transplants, attracts
patients from all over India and abroad. Of the two main hospitals that are engaged
in this programme— Apollo does transplants with live related donors only and the
Guest Hospital accepts kidneys from paid donors as well. At the Guest Hospital
two-thirds of the patients get kidneys from paid donors. Comments Dr. K.C.
Reddy, a leading Urologist , at Guest Hospital “Of course I would like to take
kidneys from related donors but what do I do for patients who have no willing or
suitable donors? Do I sit in judgement over the moral and ethical issues involved,
while my patient is condemned to die”. This justification for a paid donor
programme is reiterated by many other doctors, but they are careful to add that,
prior to the removal of a kidney from a donor, a systematic screening, psychiatric
assessment and counseling programme should be adhered to. At an International
Conference of Nephrology, a surgeon from a team of expert transplanters is quoted
to say, “—the values gained greatly overshadow the values lost------ ”. However,
there are other doctors who feel that commercial trafficking in human organs
cannot be justified under the garb of medical ethics. It is shameful that there is a
section of the medical community that is complying with unauthorised transplants
that are promoted by advanced technology, professional middlemen, and
impoverished donors.
5
DO YOU KNOW THAT:
*There are 80,000 cases of renal failure in India every year.
*The common causes of renal failure are:
. Infections of the urinary tract and kidney.
. Presence of kidney stone.
. Toxic chemicals like mercury, lead, arsenic which are poisonous to the kidney.
. Certain hazardous drugs which are toxic to the kidneys.
. Diabetes.
. Injuries to the kidneys.
Each of the Cases of Kidney Donations has a Story to Tell
It is a tale of economic compulsions for men and women, from the poorer sections, of both
rural and urban areas in this country. There are certain areas of this country, where a large
number of persons from a community have sold their kidneys for a fairly large sum of
money. The major reason for selling their kidney is, their poor living conditions. The case
studies also reveal the nexus between the vulnerable patient, who is in dire need of a kidney
and is willing to pay any amount for it, the hospital which performs the transplants, and the
middlemen who identify the donors who sell their kidney.
Villivakkam, Madras: Vicious Cycle of Debt and Poverty
The case of Villivakkam personifies the extent of commercialisation of organ trade with
its strong roots into the socio-economic fabric of the residents of this shantytown. This poor
suburb of Madras is now associated with a market of kidney sellers. It has become a site
of thriving business for the middlemen, who liaison with donors, recipients, and doctors
to carry out this trade. During the last three years nearly 100 families in Villivakkam have
shown signs of relative, although moderate prosperity as a result of a member or two selling
their kidneys. Touts now are believed to be hanging around this town enticing the
unemployed youth with the lure of easy capital. This money, averaging about Rs 25,000,
is used by most to payoff previous debts. It may enable them further to buy a bicycle or
a TV set and in some cases, where two family members have traded their kidneys, it may
give them sufficient money to convert their mud-walled houses to brick ones.
In general, majority of kidney donors fall in the age group of 20-40 and are illiterate
or unemployed. This is a cause of concern for the senior residents of Villivakkam, as
it is becoming a trend for the unemployed youth to seek this channel of trade rather
than a serious search for jobs. While there is the case of Balan, a watchman in a local
cinema theatre, who says “ it would have taken me three lifetimes to get as much
money as I did when I sold my kidney”, there are other cases which cast a shadow on
this voice of contentment. Venkat, a nursing assistant, initially bought a cycle, a TV
set and gambled a sum of Rs 10,000 with the returns from his kidney. He later
gambled even the money from selling off his cycle and TV. He is now trying to
persuade his wife to sell her kidney too.
6
If there was a channel to sell other paired organs, the residents of Villivakkam may be sadly
compelled by their impoverished circumstances to pursue that too.
Source : India Today. July 31, 1991.
Cheated of a Kidney: Case of Sanaullah Khan, Bombay
While some have sold their kidney for a price there arc others who have been cheated of
their kidney, as in the case of Sanaullah Khan, a 19 year old youth from Bombay.
Sanaullah Khan was suffering from minor stomach ailment and was persuaded by
Govind, a supplier of electrical goods, to undergo a blood-urine test at a shady clinic, for
his stomach problem. At the clinic, Govind, whois believed to be an agent for supplying
kidneys, registered Sanaullah’s name as Abdul Khan, brushing the latter’s protest. Later
on he took Sanaullah to Nanavati Hospital and made him sit on a bench for a few hours.
A nurse came and gave him an anesthetic injection, before he was wheeled into the
operation theatre. Sanaullah does not remember what happened after that. He regained
consciousness only late in the night. The nurse told him ‘‘your stomach problems are over
now.” Sanaullah noticed that he had a long cut on his waist with several stitches. The
doctors told him that he would be released in ten days time. The discharge report had a
lot of discrepancies about his age and the test reports had also been tampered with. The
final report said that he had undergone a donor kidney operation. Shocked by this
revelation, Sanaullah’s family approached the Superintendent of Nanavati Hospital to
complain about the loss of the kidney but were not given any explanation at all.
Source : Indian Express, March 22, 1989.
Job for a Kidney: Case of Nihar Ranjan, Hyderabad
The story of 24 year old Nihar Ranjan Parida, who bartered his kidney for a job, which
he ultimately did not get, is heart rending. Nihar Ranjan was the eldest son of a poor
school teacher from Balasore in Orissa. He quit his studies after the 12th class, for
economic reasons, and tried looking for a job. Meanwhile, his parents got him married,
as a result of which his search for a job became even more desperate. He went to
Hyderabad to look for a job. While he was there, he came across an advertisement, in
one of the local papers, for a kidney donor. He got in touch with the advertiser, who
turned out to be a fairly senior official of the Defence Ministry’s Bharat Dynamic
Limited. He underwent a number of tests for compatibility. He was then housed in the
official’s residence for a period of three months, during which he was given excellent
food and some cash. Meanwhile, Nihar started asking for some kind of surety about
getting a job after his kidney was removed. At this point the official gave him a signed
promise, that not only would Nihar get a permanent government job in Bharat Dynamic
Limited, but would also get an amount of Rs 30,000 in return for his kidney. The
operation was finally performed at Apollo HospitaL Hyderabad, on August 14,1991.
However, after the surgery was over, the attitude of the recipient changed and he refused
to give Nihar any monetary compensation or the job that he promised him before the
surgery. In the end Nihar had neither a job nor a kidney!
Source : Indian Express, July 1st, 1992.
7
A Review of the Western Experience with Respect to Organ Trade
In several Middle Eastern countries there arc strict laws against the trading of live organs,
which is considered to be a criminal act. Both in UK, USA, and several European countries
transplants arc carried out only through cadaver donations. Although, there is no trade of
organs within these respective countries, there arc increasing numberof cases ofintemational
trafficking of organs mostly with relatively poorer countries. There are about 7,000 people
with renal insufficiency, in Germany, awaiting life saving kidney transplants. In the light of
this, agencies dealing in this trade have initiated efforts to identify potential donors in the
Muscovite region. These organs will come from living persons for monetary considerations.
Given this scenario, there has been concern at the international level which has
prompted WHO ( World Health Organisation) to formulate a directive to all its
member states, to frame necessary laws banning trafficking in human organs.
In the light of these reports about commercial dealing of human organs, especially kidneys,
there has been considerable pressure on the Indian government, from the WHO, to prohibit
this unethical practice. At present, there is no comprehensive legislation to regulate the
removal of organs from both living as well as deceased persons, for the purpose of
transplantation. The government introduced The Transplantation of Human Organs
Bill, in August 1992, in order to curb the trade of human organs as well as to promote
cadaver transplants in this country. The Bill also provides some guidelines for registering,
as well as, regulating private hospitals which have erstwhile been involved in conducting
organ transplants.
II. SALIENT FEATURES OF THE BILL
Objectives of the Bill
This Bill was formulated to provide for the regulation of removal, storage and transplan
tation of human organs for therapeutic purposes and for the prevention of commercial
dealings in human organs. The Bill also defines the provisions for a) coverage b) an
authority for the removal of organs c) regulation and registration of hospitals which will
carry out transplants and d) penalties and offences.
a)
Coverage
This Bill applies in the first instance to the states of Goa, Himachal Pradesh, and
Maharashtra, as well as, all the Union Territories. Any other state can adopt this Bill by
passing a resolution in their respective legislatures.
b)
Authority for the Removal of Human Organs
Human organs can be removed from a donor under the following conditions:
1.
Anyone who wishes to donate any organ of his/her body before his/her death, may do so,
under proper authorization.
8
2.
Anyone who wishes to authorize the removal of any organ of his or her body, fortherapcutic
purposes, may do so through a written consent in the presence of two or more witnesses
(at least one of whom is a near relative of such a person). The person, who is lawfully in
possession of the dead body of the donor, should get in touch with a Registered Medical
Practitioner for the removal of the specified organ from the donor’s body.
3.
In case a person has not given consent for the removal of an organ prior to his/her death but
has not expressed any objection to the removal of organs, after death, then the person who
is in legal possession of the dead body of such person may authorize the removal of any
organ of the deceased, provided there is no objection from any near relative.
4.
Only a Registered Medical Practitioner can remove the specified organ from the body of
the deceased after ensuring that life is extinct or where it is a case of brain-stem death. If
it is a brain-stem death it needs to be certified by a board of medical experts, which consist
of the following:
i.
the RMP in charge of the hospital in which brain-stem death has occured.
ii.
another RMP who is a specialist, and has been nominated by the RMP specified in the
previous clause, from a pre-specified panel of names.
iii.
a neurologist or neuro-surgeon surgeon nominated by the RMP specified in clause (i).
iv.
the RMP treating the person whose brain-stem death has occured.
In case of unclaimed bodies, in prisons orhospitals, the authority for the removal of organs
lies with the management/administration of the institution.
In case of bodies, which have been sent for post-mortem (both medico-legal and
pathological cases), organs can be removed for therapeutic purposes by authorised persons
under this Act.
The Registered Medical Practitioner has to take the necessary steps for preservation of the
organs.
5.
c)
Regulation and Registration of Hospitals
Regulations :
1.
No hospital, unless registered under this Act, shall conduct or associate with the removal,
storage or transplant of any human organ.
2.
The removal, storage or transplant of human organs should be conducted only at a hospital
registered under this Act.
3.
Organs should only be removed, stored or transplanted for therapeutic purposes.
4.
The recipients as well as the donor should be informed about the side effects as well as the
complications of removal and transplantations.
9
The State governments and Central governments, in the ease of Union Territories, must
appoint appropriate authorities to :
a.
grant, suspend or cancel registration of hospitals.
b.
to enforce standards for hospitals engaged in removal, storage and transplantation.
c.
to inspect hospitals periodically for quality of transplantations and follow-up medical care
to recipients as well as donors.
Registration :
d)
1.
A hospital conducting removal, storage and transplantation of organs has to be duly
registered under this Act within a period of 60 days of its commencement.
2.
A hospital conducting removal, storage and transplantation in the past shall have to cease
such activity three months after the commencement of the Act, unless, they have applied
for registration during this period.
3.
An appropriate authority set up under this Act shall hold an inquiry to determine whether
the applicant satisfies all the criterion for registration. The authority has the right to reject
applications on the basis of the same criteria.
4.
The authority has powerto review the conditions of hospital periodically. If there is breach
of any of the provisions, the authority can cancel or suspend the registration.
Offenses and Penalties
Professionals, middlemen as well as donors who abet the illegal removal, i.e. the storage
and transplantation of organs without proper authority, are liable to be punished with
imprisonment upto seven years with a fine of not less than Rs 10,000.
III. ALTERNATIVES TO ORGAN TRADE
Alternatives to Organ Trade
The major problem in dealing with the trading of kidneys is that much of the kidney
transplants are being done in the private sector. It is pretty clear that there is a well worked
out network between some of these hospitals, middlemen, and the donors, who belong to
the poorer sections of society. Dr. M.K.’Mani, a leading nephrologist in Madras, is of the
opinion that:
“ No money should be involved in organ donation. For that automatically makes it
a trade in flesh. Since large sums of money is involved it tends to draw brokers,
middlemen, as well as entrepreneurs.”
10
Therefore, any effort to control the trade of organs, cannot be done without identifying
alternative sources for procuring organs for transplants, as well as. regulating institutions
in the private and voluntary hospitals, which perform such transplants.
Cadaver Donation as an Alternative
Cadaver donations is the common practice that is followed in most Western countries for
organ transplants. In all these countries organs can be removed only after brain-stem death
has occurred, as required by law. However, a good deal of infrastructure is required to
support a cadaver transplant. In the case of a renal transplant, the dead body has to
be first moved into a hospital and kept on a respirator so that the blood continues to
circulate and the kidneys do not degenerate. This procedure can be followed only in
the cases of sudden death. Once the kidneys are removed they can be frozen and kept
for a maximum of three days before it can be used for transplants. A computer is used
for tissue typing kidneys for donor matching.
Role of Foundations in Promoting Cadaver Donations
Tissue Bank
The Tata Memorial Hospital in Bombay established a tissue bank, in 1989. which provides
skin, amniotic membrane, nerves, muscle, bone, cartilage and micro vascular grafts. This
bank was established in collaboration with the International Atomic Energy Agency in
Vienna. The tissues which are obtained from cadavers, are preserved by freeze drying and
sterilising through radiation. The preserved tissues can be stored indefinitely since 95%
of the moisture in them is removed under vacuum. This process is very similar to that used
for dehydrating food products. Radiation further destroys any micro organism that could
transferdisease. These tissues can be stored at normal temperatures and can be conveniently
mailed to potential users.
Cornea Transplant
Out of 12 million bilaterally blind persons in the country, there are almost 2 million who
suffer from comeal blindness. Corneal blindness can be cured by replacing the damaged
cornea with another clear and healthy human cornea. This is only possible through eye
donation. The eyes must be removed within six hours of death and the Eye Bank should
be informed immediately. Following this, the doctor will undertake the simple procedure
of removing the eye. After removal, the eyes are analysed, preserved and the cornea is
transplanted within 72 hours into the recipient’s eyes.
Although, there are Foundations which have an organised cadaver programme to
collect corneas, the response is still quite poor. In most hospitals there is a long waiting
list for corneal transplants, due to shortage of corneas.
Times Eye Research Foundation (TERF), founded in 1983, has made pioneering efforts in
setting up Eye Banks and Eye Collection Centres. In 1983 there were 45 Eye banks in the
country, while currently there are 154 Eye Banks and Eye Collection Centres. However,
not only is the outreach of these Eye banks limited, there is also a clear inadequacy of people
Hp-icro
who pledge their eyes after their death. This lack of donor eyes is primarily due to lack of
information, false beliefs and misconceptions.
The following table reflects the poor response as well as paucity of eye banks/collection
centres across major states in India.
Major Eye Donors
from across States
Table II
Number of eyes
State
Gujarat
3381
Maharashtra
2186
Delhi
644
Punjab
(only one Eye Bank)
450
Karnataka
(Lion’s eye Hospital,
Bangalore)
445
Tamilnadu
396
Andhra Pradesh
(L.V.Prasad eye Institute,
Hyderabad)
224
Source: Health For The Millions,
October, 1992. VHAI.
IV. CRITIQUE OF THE BILL
Most Western countries have banned the trading of organs and only recognize cadaver
donations. It has been well documented that there is a flourishing trade of organs in several
Third World countries like India, Philippines, Egypt and HongKong. The WHO has called
upon its member countries to frame laws banning the trafficking and sale of organs in Asian
countries. They have also called for an active promotion of cadaver donations in these
countries. In response to international pressures, the Government of India has formulated
a Bill for Transplantation of Human Organs.
This Bill is meant to check trading of organs through promotion of cadaver donations in
the country. Although efforts to promote cadaver donation are positive steps, it is important
to look into the adequacy of infrastructure available to carry out cadaver transplants.
Additionally, one needs to review whether there are adequate provisions in the Bill, to
regulate and check organ transplantations that are being conducted in the private medical
sector.
Inadequacy in Coverage
There are several drawbacks to the Bill which need to be delineated, in order to have a
comprehensive and effective piece of legislation. Firstly, the Bill does not apply to the
entire country and it is left to the discretion of individual states to adopt it. However, states
like Goa, Maharashtra, Himachal Pradesh and the Union Territories will automatically fall
under the purview of this Bill. The major problem with this is, that it ignores the fact
that there is inter-state, as well as, international trading of organs. It is well known
that Madras and Bombay are the nerve centres for trade of kidneys and the doctor
broker nexus is so widespread, that some brokers are said to have even inter-state
businesses.
The case studies of donors reveal economic compulsions, as well as, the organised network
between the donor, doctors and middlemen. It has been well documented that a large
amount of money changes hands in the process of organ trade and therefore it is going to
be very difficult to eliminate this trade through mere legislation. The inter-state dimen
sions of this trade, coupled with the inadequate coverage of this Bill, will render this
piece of legislation ineffective. This is because, it could lead to a situation wherein,
those states which are not covered by the provisions of this Bill, may become
alternative centres for organ trade.
Private Hospitals and Organ Trade
A major loophole of this legislation stems from the fact that, it fails to
understand the dynamics of the private sector, where a majority of these
transplants are carried out. It is well known that, in this country there is a large,
unregulated private sector in medical care, which comprises of institutions of
varying sizes, facilities as well as outreach. Given this scenario, the efficacy of a
clause in this Bill to regulate the private hospitals and nursing homes conducting
organ transplants, is questionable. Firstly, it is only the larger, more well equipped
13
hospitals, located mainly in big cities, which are publicly known to carry out organ
transplants. Apart from these larger hospitals, there are also a number of smaller,
ill equipped nursing homes which have mushroomed in the past few years, for the
purpose of transplants. Most of these opcrate under cover for buying, selling, and
transplant of organs. Additionally, due to lack of a proper registration process,
there is inadequate information of the numbers and magnitude of such institutions
involved in this trade.
The Bill proposes to make mandatory the registration of all institutions conducting
transplants, as well as, setting up authorized bodies to enforce registration and prescribe
minimum standards. But the crucial question that arises is - how effective can such an
authority be, when to date, the private sector has resisted any form of regulation or
control, either in terms of checking its growth, or quality of services it renders?
This heterogeneity of size and facilities in the private sector raises the following concerns:
1. There is very limited information on the number of institutions conducting organ trans
plants. Nor is there adequate information available on whether they are meeting the
necessary requirements for removal, storage and transplantation of organs. The Bill does
not spell out the requirements for surgical removal, transplant, post-operative care and
professional competence. Since there is very little information on institutions conducting
transplants, the question that arises is - how docs the Bill propose to regulate these
institutions?
2. The Bill states that only a Registered Medical Practitioner (RMP) can remove an organ from
a deceased body. However, the term RMP is a non-specific title and can even include
unqualified persons. Therefore, it is essential that the required qualifications of the
professional arc clearly spelt out in the provisions of this Bill.
The issues concerning regulation of private institutions conducting transplants needs
to be dealt with more effectively because it is the key for curbing the trade of organs.
It is also important to be in the know of institutions conducting transplants, in order to
promote as well as encourage cadaver donations.
The importance of a sound legislation need not be understated in the face of the
various loopholes, that have been highlighted in the Bill. On the contrary, we do
need an effective piece of legislation, which would curb organ trade. This can be
effected by ensuring total coverage and adopting stringent measures to regulate
and monitor hospitals, in the public as well as private sector, which carry out
transplants.
Is Cadaver Transplant a Viable Alternative?
This Bill is basically concerned with cadaver donation and does not adequately address
the prevailing practice of trading of organs for unrelated donor transplants. In fact the
Bill seems to assume that, by promoting cadaver donation, it will serve to eliminate organ
trade. This in our opinion is a simplistic understanding of the situation.
14
In this Bill, cadaver donation is being posed as an alternative to trading of organs. The
question is, whether hospitals have the required inputs for the process of organ
transplants. This includes removal and storage of organs, the required tests for tissue
matching, expertise for surgical procedures and post-operative care. Several doctors
who want to encourage the cadaver donation programme are of the opinion that its success
is contingent on ensuring required provisions in the hospitals which will be authorised to
carry out such transplants. In addition, one needs to strengthen organisations like the Times
Eye Foundation, Kidney Foundation of India and others which have been trying to
encourage cadaver donations.
Mere legislation, in the absence of informed public opinion, will be a meaningless
exercise. There is a need for debate, among professional and legal bodies, founda
tions, health and consumer action groups, regarding the future of organ transplants
in this country. The government must provide information regarding all the institu
tions it recognizes for the purpose of transplants in order to promote better network
ing. Professional medical bodies need to play a critical role in monitoring the success
and failure rates of transplants in the country.
15
The Voluntary Health Association of India (VHAI) is a secular, non-profit
federation of over 3000 organisations working in the field of health and
community development. VHAI strives to make health a reality for all,
especially the unreached and the oppressed.
VHAI fulfils these objectives primarily through training and by providing
information to the target groups. In support of its objectives, VHAI also
develops and distributes appropriate educational aids to the organisations
serving at the grassroots. Linking up these organisations through its newsletters
and journals also constitutes an important activity of VHAI.
VHAI researches into and campaigns on relevant and important health issues
to ensure that a people-oriented health policy is brought about and effectively
implemented. VHAI also works to sensitise the large public towards a scientific
attitude to health.
Voluntary Health Association of India
Tong Swasthya Bhavan
40, Institutional Area, Near Qutab Hotel
New Delhi 110 016, INDIA
Phones: 652953, 655871,665018, 668071, 668072
- Media
2531.pdf
Position: 1173 (7 views)