ORGAN TRADE

Item

Title
ORGAN TRADE
extracted text
I

RF_MP_16_SUDHA

NEWS

CAN

Y O U

USE

HEALTH1

RESUSCITATING
RECIPIENTS
A nori-government organisation gives the cadaver
transplant programme a new lease of life
I ■'

THE I luman Organ and
Tissue Transplant Act
of 1994 was a non­
starter in Karnataka, (Ta..®
Jr
till May, when a group f
of individuals decided
to act.
the
Altho ugh
transplant act was
the
adopted
by
Karnataka govern­
ment in early 1995,
n 'ical specialists
Who wanted to initiate
the cadaver trans­
plant
programme
(CTP) could not. Reason: the gov­
ernment was taking its time to no­
tify the hospitals where the trans­
plant could be done. It had also not
set up a panel of neurophysicians
and neurosurgeons to certify‘brain­
death’ in patients who suffer irre­
versible brain stem damage.
Even as the government took its
time the plight of the victims, whose
only chance of survival was an or­
gan transplant, worsened. 'That is
when a group of Individuals stepped
In to help the doctors help patients,
especially those who did not have
relatives to donate organs. In Sep56

Noble gesture:
Cricketer Anil
Humble who has
pledged to donate
bls organs

tember 1996 they set
up the Foundation for
Organ Retrieval and
Transplant Education
(FORTE).
They started by
helping those patients
whose organs were
either failing or had
already been rendered useless.
“Through FORTE we wanted to help
victims of End Stage Renal Disease
(ESRD) who had no related donors,”
said Capt. V.V.K. Mani, one of tlie
trustees of the organisation. “We
also wanted to make tilings move
faster and facilitate the faster Imple­
mentation of the transplant act. (The
act shifted -the definition of death
from cardiac arrest to brain-stem
function’s arrest).
FORTE played a major role in
pushing the government to imple­
ment the act. m May the govern­
ment allowed '2 hospitals—seven
IHE WEEK R AUG. 3. 1997

>» Ry •>

rw <6-

in Bangalore—to conduct ca-'aver
transplant operations. It also
empanelled 54 neurosurgeons and
neurophysicians who cornu exam­
ine and assess whether ‘brain-stem’
death had occurred.
Today, FORTE is functioning as
a facllltatory body, helping trans­
plant teams conduct CTP. It
organises workshops on iJecoming
better ‘donor-motivators’ for social
workers. “We train two social work­
ers from each recognised institu­
tion,” says Rebecca Thomas,
FORTE’S coordinator. The
donor motivators are sup.
posed to Interact and counse* ^ie
donor’s
relatives. “Our aim is to cre­
ate awareness and moti­
vate people to come for. ward and donate their
relative’s organs instead of
letting them get buried or
burnt.
FORTE plans to main
tain a database of recipi­
ents who are asked io deposit Rs 25,000 in an es­
crowaccount. Once 1?C'RT1\
locates a donor, Hils
amount will be s pent on
the donor.
The moment consent is obtained
from the relatives of the donor, the
money will be used for a series of
blood and tissue investigations and
_____ - shifting
’lease
the —in
donor
charges
donor is lying in a ‘non-redognised’
hospital.
Recipients do have a choice. If
they want to withdraw thbir name
before the organ becomes available,
the amount will be refunded with
interest.
In another major step FORTE has
convinced all ‘recognised hospitals’
to maintain uniform donor maintonance and organ retrieval c barges
which will go a long way in Reducing
the financial burden on the recipi­
ents.
The organisation’s efforts have
made a major difference in the lives
of many End Stage Renal Disease
patients. Earlier, in the absence of a
related donor, dialysis was the only
option for them.
[ .
You can contact FORTIN at SI-7
Business Point, 137 Brigade Road,
Bangalore
Tel: 2237045.
VEENA HKARAT'TI

LORE

Doctors sure of people’s backing foir cadaver transplants
|

Meera John Chakraberty
BANGALORE: After a two-year batI tie against a cirrhotic liver condi­
tion, Rajesh died at the tender age
of 12. Doctors at the St John’s Hos­
pital in Bangalore were able to
. give him temporary relief surgical­
ly. There was nothing more they
could do for him. Except a liver
transplant, which would have him
bounce back to normal, healthy
life.
St John’s has been certified “fit
and fully equipped to perform
liver/kidney transplants" by the
government. Dr Ashley J. D’Crews,
head of paediatric surgery at St
.John’s, was confident he could
pull off the operation successfully.
But there was a nagging problem:
the law does not permit cadaver
organ transplants in Karnataka. So
I nobody could budge an inch for­
ward.
i
While several other states have
implemented the central Human
Organs Transplant Act, 199d, in
; toto and arc performing cadaver
j organ transplants, the Karnataka
government’s mule-headedness in
this matter is baffling doctors. A
suspicion is that an influential
lobby with vested interests (organs
sale) is colluding with politicians
to stonewall the process. While the

.../J’s
for liver transplants at the world's
premier organs transplant institute in Pittsburgh, USA, explains
that fathers, mothers or siblings as
donors give the best results — a
All cadavers cannot be donors and only a handful of hospitals will
guaranteed life of 17 years for the
be allowed to harvest organs from cadavers. An independent and
transplanted kidneys in 50 per
unattached panel comprising neurophysicians and neurosurgeons
cent of the cases: Organs trans­
must certify a patient “brain dead” (when a person is breathing on
planted from unrelated living
a ventilator and there is no coming back) before harvesting can
donors
or cadaver transplants may
begin. There is a scientific process for pronouncing a person brain
last for only eight years.
death.
The advantage is that cadaveric
Poison cases, old age, septicaemia and malignancy deaths, lacer­
organs are an ever-renewing
ated or infected organs don’t qualify for cadaver transplants.
source of organ availability, given
Foundation for Organ Retrieval and Transplant Education
the public readiness to pledge
i’
(FORTE) is an autonomous body of people from all walks of life in
-*—**-.
organs for transplants after death.
Bangalore, with medical persons playing only an advisory panel.
Doctors
have
no
fears
about
public
Apart from creating an awareness about cadaver transplants, the 1
body will have a*’computerised data bank on the availability of !• backing. “The overwhelming
response to eye donations is an
cadaveric organs statewide, even inter-state. The moment the avail­
indicator,” points out Dr Philip
ability of a cadaveric organ is flashed on the screen, transplant co­
Thomas.
ordinators crack down, computer matching the available kidney or
However patience’ is running
liver with patients on the waiting list also fed Into the system.
thin with a band of committed
Organs are disbursed depending on the seriousness of the case in
doctors who face a growing num­
waiting.
ber of patients everyday with
chronic kidney and liver problems,
assurance
that
nothing
would
hap
­
stalemate continues at the higher
but have nd answers to offer them.
levels, innocent victims arc paying pen to her." Thar was difficult, says Says Dr Lloyd Vincent, assistant
with their lives for government Dr D’Crews, because chances of professor, nephrology, at St
the mother developing complica­ John’s: “Every week 1 get a mini­
apathy.
“Rajesh was an ideal case for a tions later were tangible (2.5 per mum of three patients with End
liver transplant,” recalls Dr cent risk). In such cases, cadaver Stage Renal Disease (ESRD), with
D’Crews. “I spoke to his mother organ transplants arc advocated.
no donors or the resources for
Dr Philip Thomas, professor of dialysis. I have done just
t six transabout donating her left lobe. She
surgery
at
St
John's,
who
is
trained
was willing if we could give her an
plants this whole year. If cadaveric

FORTE will do the liaisonirig

organs were available 1 could have
performed atleast 150 transplants
this year."
There arc an estimated 80,000
to 1 lakh patients with chronic
renal failure in India every year. Of
them, while less than 10% can
avail of dialysis, a meagre 5% are
able to get transplants done. The
rest simply suffer and die sooner
than later.
“I treat a lot of urological prob­
lems in children,” says Dr
D’Crews. “In effect, I am building
up a large number of patients who
will survive childhood, but will
come back in their adolescent
years for transplants. Cadaver
transplants are the only hope for
this segment of patients.”
Again, there are -a number of
hereditary kidney diseases, like
hereditary nephritis or polycystic
kidneys, where a related donor is
ruled out and the chances of
recurrence in grafted kidneys are
high, explains Dr K.V. Srinivas,
nephrologist, Bangalore Kidney
Foundation.
“In such cases, if cadaveric
sources arc available, it doesn't
matter how many times problems
recur — you can keep transplanting without knocking out the
organs of family members”.

Kidney tran jplant rackets still flourish
Thanks to the loopholes in ‘'near-relative donor’;scheme

f

II

SwatlDaa
tlie committee does not have tlie proVqqr0
commiUeecommittee. Under this category the
BANGALORE: Kidney transplant v^s’on to investigate beyond tlie
in iyyb, the committee had committee has to verify the intensirackets continue to flourish. The applications submitted by the donor1 latest such racket uses the loop- recipient combine and tlie relation- received about 100 applications, ty of affection or attachment for tlie
so ’
U1G l?-lly ls nearing recipient or any other special reai a holes in the 'near-relative donor’ shiP is verified based on tlie form.
50. MosJ of the applications came
scheme. You just have to visit'some
In
• of the hospitals in Bangalore autho- ‘
rised to do kidney transplant for a 1
donor and you get one soon, no tPariiameZv Af±rnl^)and
'vherE transPlailU
^ity of feelings and g^UtuT '
- ----- from cacity of feelings and gratitude,
matter what your blood group is. ‘
1Parliamentary Affairs secretary unrelated
donors
are
accepted
The
"'’ onjy waT one can relieve
This lucrative business':has M.R. Hegde told The Sunday interrogation110^ T^veS^’f?^6 B .U1‘The
----------------1
itients hpliPVA
u,naay
jnierrogauon
is a weekly affair, this situation k hv ipnoiie;™
patients
believe fhof
that oa transplant is Times oHndia, “We call the-----donor
1held
even- Saturday. In case of hol­- er transplant In"that~caseOwe'can
an emergency, ^
and(nOt
not 3a sub
substitute,
recipient
f^r
.stiUlte’ and tlie rec
ipient separately and in idays
it is
sliifted\o
idays it
is either
'’:,u—
* ’p"reiedfnrH.olvoe
«
---------•
of
suspicion>
we
a)so
jnlerro
.
save two persons with one person’s
roirifk18’ as,d°c^)rs saT-suspicion, we also interro- ing
ing Friday
Friday or following Mondiv - kidney," said Mr Hegde.
Can the exploitation-of the poor gate their witnesses separately. We T ’ •' •
•
y‘
Under tlie transplant rule
kidney
donors and tlie rich recipients by the can go only by tlie records and ironcnhnf
L
-y
”
’
Apart from Mr Hegde, there are
transplant
agents dealing .with ‘kidney be reject suspicious cas^. We have no ansp,lant can
“n only be done‘ five doctors (including the director
through
near
relative
-spouse,
son
stopped? Perhaps not until the loop- control over what is happening outof health and family welfare depart­
holes in tlie
Uie procedure of examina- side. The rule has no provision for daughter, fatlier, mother, brother ment), and the deputy secretary to
noles
and
sister.
Anybody
outside
of
tion by tlie Authorisation Committee police investigation."
the chief minister in the committee. is considered
an The post of member-secretary, rep­
for ’
____ _ _________ of xxumcui
Transplantation,
Human
After the committee rejects an tliese relationshipslcu
u,
unrelated-donor. Yet the question resented by the undersecretary in
Organs set up in 1995 are plugged. application, tlie applicants have tlie that
hangs is how does one
Nor till the cadaver transplant is provision to appeal to the Healtli these relationships9
verify the health department is presently
vacant.
openly allowed in all hospitals.
Minister. According to a reliable
In case of unrelated donor tlie • Faceless agent has donors
For one under the transplant rule source tlie minister reverted five such
patients have to go through the
ready for asking, page 3

BANGALORE

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THE SUNDAY TIMES OF INDIA, JUNE 8, 1997 3
—aamwBMHiwqiimi.M*iiiihb h iiuiiin hifiih

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mu,,|||||||WII iumwi, ,11,1,

Faceless’ agent has donors ready for asking
BANGALORE: Following a lead, a corre­
spondent from STOI, impersonating as a
kidney failure patient's relative, had
approached a reputed hospital off Queen's
Road. A warden directed the visitor to the
family of an 18-year-old girl who'had under­
gone a transplant three days ago for advice
on how to acquire a kidney.
r
The father of the girl promised
to a
get in
touch with the agents. He would leave with
them the blood group required as well as the
correspondent's contact number. He said he
had paid them Rs 70,000 for a kidney and
Rs 1 lakh to the doctor for the transplant
transplant,
"You will have to pav anywhere between Rs
65,000
j,. and
, Rs 1 lakh
. . depending
•
J on the age
and blood group of the recipient." he said.
This correspondent was warned against
going into the donor's room. He was sleeping

KIDNEY TRANSPLANT “
"
in the next room. "We are not supposed ton
talk to him. He is from Tamil Nadu but
presently residing with some relative in Ban­
galore. We do not know how much he is
being paid." said another relative of tlie girl.
Four days later, an agent, identifying himself as Mohamed Yusuf, called up at the contact number saying that he had found a
donor and insisted on meeting the 'party' at
her house. However, a meeting was fixed at
the same hospital.
XVaiting for the agent, who had gone to
bring the 24-vear-old kidnev donor, this cor­
]respondent
r..._L__1 quizzedd the girl's parents on the
procedures \o be followed^ They" said
Mohammed Yusuf would take an advance of

Rs 5.000 and keep demanding more. "Do not
give the entire money until the whole transplant is over. If not, you might end up paying
more," warned the father.
Mohamed Yusuf, wearing dark glasses,
insists on the money being paid only to him.
.After matching the blood group and doing
other tests, the donor has to give in a joint
application with the patient (along with pho­
tographs) to the Authorisation Committee.
.uvucuiu^u
auouj then
men sits with
wim the
me uuuur
Mohammed Yusuf
donor
and the recipient to "tutor" them on how to
tackle the committee's queries. "Nowadays
the committee’s scrutiny is not strict enough.
They do not go by the rulebook and don't
bother to check whether the donor and reciplent are related," said the girl's mother.
Mohammed Yusuf did not turn up. But his
associate did, along- with a dono^from
------ ---- 1

Dharmapuri in Tamil Nadu.
On the pretext of not being sure if the
transplant would be taking place in Banga­
lore, this correspondent was able to get a PP
number of Mohammed Yusuf. The number
was registered in the name of Noor Ahmed
Pasha on 13, M. Majid Road in J.C. Nagar.
When the number was called, someone at the
other end said Mohammed Yusuf did not
stay there, but visited an electrical shop on
that road. Any message would be communi­
cated to him.

Surely,IV Mohammed
Yusuf
is hot
the onlv
. 1 • 1
• 1 • •
««
*j
agent selling kidney's, violating all norms and
hoodwinking the government scrutiny panel,
There are many more smooth operators like
™ the city who are going scot-free.
'
. -S.D.

f

DECCAN HERALD, FRIDAY. OCTOBER 30. 1998

SPECTRUM

Even in her death, she saved lives
-r "FSHA Gowri. an MBBS stuJ
dent, was barely 22 when
she died in a road accident
in Bangalore. But even after her
death, this bright student of the
Government Medical College in
Mysore brought a new lease of life
to two persons suffering kidney
failure. The young girl became the
first cadaver kidney donor in
Karnataka, after the Human Or­
gan and Tissue Transplant Act
was passed in 1995.

In February this year, Usha Gowri became the first cadaver
kidney donor in Karnataka under the Human Organ and Tissue
Transplant Act. VEENA BHARATHI writes about the young,
extraordinary girl and her tragic death

I

Bom on December 31, 1976, in a
small village near Thirthahalli in
Shimoga District. Usha was a
topper in her class and used to
swim fearlessly in the Tunga river
when she was barely eight years
old. "When Usha was four years
old. she used to climb the
Kodachadri hill with me," recalled
Seetharam. When she was in the
Seventh Standard. Usha had the
honour of presiding over the
Akhila
Karnataka
Makkala
Sammelana held at Shimoga.
Later on, when she joined the
Kasturba National Girls’ High
School, her academic and extra­
curricular activities always placed
her ahead of many other students.
In a letter which she wrote to her
maternal aunt Lalltha, (who Is a
..............at Vivekananda
. .
volunteer
Kendra,

were struggling to record her BP.
With her body temperature hav­
ing gone down to 13 C, most of the
veins in her body had collapsed,
the vital I/V Quid was struggling
to find its way at a rate of at least
On January 25 this a drop a minute. Though stricken
year. Usha. who had by the ultimate truth that his
come to Bangalore to daughter was saying an eternal
buy a few medical
■good bye', Seetharam requested
books, had stayed at
Thimmappa
Hegde
of
her cousin’s place. The Dr
next day, on her way NIMHANS to retrieve Usha’s kid­
to the railway station. neys for the benefit of two other
As a gesture of acknowledge- ,
Usha was riding pil­ individuals. Then, he was told that ment of Usha’s undaunted spirit
NIMHANS
had
the
provision
to
lion on the bike of her
and her family's sacrifice in pro ‘
cousin. A sudden extract only corneas, and that for viding the gift of life to two other
brake to avoid a head- other organ retrieval. Usha had to persons. Dr Sudarshan Ballal, Dion collision with an­ be required to be shifted to any of rector of Nephrology Unit.
other vehicle resulted the 'donor-recognised hospitals'.
Manipal Hospital. Bangalore, has
in Usha’s fall. The girl
Dr Vineeth Nair, who is in declared a day in a month as
sustained extensive
'Usha’s Day'. On that day every
head injuries. She was charge of critical care at the
month, a kidney transplant is
admitted to NIMHANS Manipal Hospital in Bangalore,
in an unconscious tried all the essential resuscitative carried out at the Manipal Hospi­
state. She had to be measures to revive Usha, after she tal at a subsidised cost (without
kept on a ventilator, got shifted to the hospital. Dr any professional fees). The prac­
along with other criti­ Vineeth Nair's efforts for ten con- tice began in March 1998.
cal care measures.
Usha was declared brain-dead
when she showed no signs of ira­
provement, despite the best of
critical-care treatment. Her father
Seetharam was not willing to accept the futility of the situation,
"I instantly felt that Usha would
have coerced me to donate her kid­
neys to the young and the needy
had she been able to communicate.
Usha. who was an optimist to the
core, would have advised me to
realise the positive side of our Ir­
reversible personal tragedy. Thus,
even In a heart-wrenching situ­
ation, I could discuss the probabil­
ity of 'organ donation' with the
concerned specialists," he said.
On February 3, 1998, Usha’s
mind and body gave up fighting
for her survival. When Seetharam
Crick»t«r Anil Kumbl«, who haa algnad th* cadavar donor card
saw his daughter at 8 a.m., doctors

day. I was terribly
shaken on hearing the
unbelievable
news
that Usha was on her
death bed."

"We were four members in our
family, now we are only three,"
said Seetharam. the father of
Usha, on the occasion of the anni­
versary of FORTE (Foundation for
Organ Retrieval and Transplant
Education), which honoured the
families of cadaver donors. After
he received a memento from Gov­
ernor Khurshed Alam Khan.
Seetharam tearfully recalled his
daughter's life and her tragic end.

Usha Gowri

things, of which I am ignorant, in
a simple manner! We were at Myte celebrate her 21st birthday
on December 31, 1997. which was
__________
destined to become her last birthday. T will have to get two or three
gold medals in my final exams.’
Usha told me before we started
back to Shimoga. That academic
ambition of hers, however, re­
mained unfulfilled."

Kanyakumari), Usha had stated
that In the 35 Inter-school competltlons that she had participated In
an academic year, she had stood
first in 33 events! Says mother

Her friend Divya, who was her
junior In the Mysore Medical Col­
lege and knew her since school,
reminisces: "Her leadership qualItlej and multiple Interests were a
role model for all of us. She be­

Nethravathi Seetharam. "An in­
born quality in my daughter was
her tolerant and affectionate atti­
tude. She had tremendous pa­
tience to explain many scientific

came a guide to me when I joined
the Orst MBBS. In our ladies' hos­
tel, we would seek her advice on
so many things. When I reached
my hostel after a month-long holl-

tinuous hours went in vain. Usha
was declared brain-dead by a team
of neurophysicians at 11.30 p.m. ,
After her father signed the con­
sent form, both her kidneys were
retrieved while the cadaver was
still on a ventilator, thus main­
taining the viability of the organs.
And around 2.30 a.m.. one of the
cadaver kidneys thus extracted
was transplanted to an end-stage
renal disease (ESRD) patient at the
Manipal Hospital and one more
kidney was sent to St John's Medi­
cal College and Hospital, where '
one more successful kidney
transplant was carried out. Rebec­
ca Thomas, Coordinator of '.
FORTE, helped Usha’s father in
the post-mortem fonnalities.
j

I qfigfec

; kictoeytransplaut
HP f

1 's
BANGALORE, April 9 (DHNS)
Thirty-two year old Susheela (riot
her real name), a mother of two
children, must be thanking provi­
dence and of course the donor fam­
ily who gave her a new lease of
life. Susheela was suffering from
kidney failure and needed a
transplant.
On Friday afternoon, a 48-year
old KEB employee who had suffer­
ed massive head injuries was
rushed to St John’s Hospital
where efforts to save him failed.
He was declared ‘brain dead’ on
Saturday. His family was keen on

donating one of the kidneysJ <'?i >

Meanwhile Forte, (Foundation
for
Organ
Retreival
and
Transplant Education) which
keeps a waiting list of patients
who need organs, in all hospitals
in Bangalore, alerted the doctors
of two emergency cases, which
matched the blood group of the de­
ceased. After medico-legal pro­
cedures, the donor’s kidney was
removed at the hospital after
which the body was sent for post
mortem. On April 5, the transplant
was successfully performed on
Susheela who is fast recovering.

I Third successful cadaver transplant
Health Correspondent
<convinced the grieving family to
BANGALORE: The third cadaver giveAe jgo-ahcad for the noble act
transplant in the state was success­ and help save another life. •
Following permission from the
fully performed on Sunday at St
family, the Foundation for Organ
John’s hospital here.
_______
The
donor was a 48-year-old Retrieval and Transplant EducaKEB employee who had been
(FORTEX which maintains a
..^a
rushed to the hospital after suffer- waiting list of all patients awaiting

ing serious head injuries on Friday
1 iiUay transPlanT was contacted. Working
nati#»nt with
wnttj
last week. He was declared ‘brain. through the. nioht aa patient
suitable match for*the donated
dead’ on Saturday.
Th°ugh . initially reluctant to organ was found at 4 am.
___ ___________
The donor’s kidney was removed
allow
the transplant, senior KEB
officials and th'<Tstaff of St John’s at the hosPit^ in a surgical procedure after which the body had to be

sent for post mortem.
The recipient was a 32-year-old
mother of two children. She was
brought
andthe
_ into the hospital
_r--------kidney was successfully transplanted into her.
Today she lives a new,
i__ , and
.J
healthier life, thanks to the’good
deed of the KEB employee and his
family.

Making organ donations easy
I
!

:

!

|
l

N illegal trade in human of accident victims are retrieved, it is
organs can be nipped in the sufficient to meet the demand.
jl^RBbud if there is cooperation
FORTE came into being two
from the people," said Rebecca years ago, after the government
Thomas, honorary secretary of passed the Organ Transplant Bill in
Foundation for Organ Retrieval 1995. FORTE acts as a coordinating
Transplant and Education (FORTE), agency between the donor and the
a cQord.inatincj._agen.cy Jpr organ recipient and has successfully
transplant in Bangalore.
undertaken eight cadaver kidney
“There are a lot of cases where transplants in Bangalore. Its functhe person is brain dead but his or lions include evaluating potential
her vital organs like heart, liver and donors, assisting with donor mainte­
kidneys can be used for transplanta­ nance, arranging for speedy post­
tion. But co-ordination between the mortem and police permission, dis­
donor and the recipient need to be tribution of organs and tissues and
arranged," Rebecca added. A win­ providing educational programmes.
dow period of six to 12 hours after a
FORTE wants to venture into
person is brain dead is sufficient to retrieval and transplant of heart, liv­
cany on the transplantation. Doctors er, pancreas, intestines and lungs.
say that if the organs of 50 per cent “It is like donating eyes. Anybody

can become a donor and register
with us. The person has to sign a
form granting his willingness to use
his organs after his death," said
Rebecca. Donor cards are available :
free and any healthy person can >
become a donor. The recipient
needs to fill an application form and
clear all legal formalities. Rs 25,000
is taken to arrange for all medical
tests during the transplant.
Members of FORTE include Dr
Kishore Phadake, nephrologist in
Manipal Hospital, Dr Elizabeth
Zachariah, Capt Mani, Dr Latha
Jagannathan,
Mr K.N. Prabhashankar. For details contact
FORTE office, SF-7, Business
Point, 137, Brigade Road, Banga­
lore 560025. Phone: 2237045.

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Former Test crickcler B.S. Chandrasekhar and actress Sudharani at a function in Raj Bhavan, where
they signed donor curds for kidney transplants on Friday.

Celebrities pledge their kidneys
Staff Reporter

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BANGALORE: Kannada film­
stars Srinath and Sudharani,
danseuse Vani Ganapathy, former
test cricketer B.S. Chandrasekhar
and editor of Frontline magazine
N. Ram were among those who
signed donor cards for kidney
trar
ats on the occasion of the
Foundation for Organ Retrieval
and
Transplant
Education’s
(FORTE’s) second anniversary
on Friday.

Among others who signed the
donor cards were well known eye
surgeon Dr M.C. Modi, painter
S.G. Vasudev, educationist Dr
Ramdas Pai, film artist Ashok
Rao and advertising professional
S.M. Nair.

At a function held al Raj Bha­
van. the families of cadaver organ
donors in the state were hon­
oured by Governor Khurshed
Alam Khan. Among them was the
father of 22-year-old Usha Gauri.

°nour
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'over.
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Suclha pndra^ekar ’ at^tc'

Snna^ofth nse^cuhu M- t
iT,I, Pan
^Patl;.hes'nai>SCKe^d /

a medical student who died in a
road accident in February this
year. She became the first cadaver
donor of kidneys in the state.

The five other cadaver donors
of kidneys so far in the state have
been former Professor of Urology
in Bangalore Medical College Dr
A.K. Annamalai, K.EB employee
Veerabhadraiah, a housewife
Saroja, 10-year-old R.K. Prasad
and 16-year-old student Shivaprasad.

DECCAN HERALD, SATURDAY, SEPTEMBER 5, 1998

B

Cadaver organ donors’families’ felicitated
DH News Service

BANGALORE, Sept 4
"May your tribe increase” was the
consfaii I refrain al a ruhetion In
which six families who donated '
the organs of their dear ones
inspite of their own personal
tragedy were honoured by Gov­
ernor Khurshed Alam Khan in the
City today.
The programme was organised
by the Foundation for Organ Re­
trieval and Transplant Education
(FORTE), a non-profit organis­
ation which has been striving for
the last two years to make the gift
of life possible.

Families of Usha Gowri (22), a
medical student who died in a
road accident. Dr A K Annamalai,
a renowned urologist, who had an
—" untimely death, Veerabhadraiah,
a KEB ofTicer who died while on
duty, Saroja a house wife who had
a sudden death, Prasad (10) who
was fatally injured while playing
and Shivaprasad (16) who died In
a road accident were honoured.
The occasion was also marked
by the signing of donor cards by
eminent personalities like N Ram
(journalist), Vasudev (artiste),
Vani
Ganapathi
(danseuse),
Chandrashekar (cricketer), Sudha
Rani (Kannada actress), Srinath
(actor), Dr M C Modi (eye sur-

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Governor Khurshed Alam Khan honouring cadaver organ donor, father of 22-year-old Usha Gowri,
a medical student who died in an accident at a function organised by FORTE at the Raj Bhavan on
Friday. Dr S Kanta, Vice-chancellor, Rajiv Gandhi University o^Health Science, is also seen.
DH photo

geon). Dr Ratnadas Pai (education­
ist) and many others.
The Governor in his address
lauding the families and the ser­
vice rendered by FORTE said that
this must take the shape of a

peoples' movement which would
involve a large number of donors.
Mr N Ram, pointing out the
loopholes in the legal system said
tliat there Is 'brisk commerce' in

the kidney transplantation within
the state and across states.
Dr S Kanta, vice-chancellor
Rajiv Gandhi University of Health
Sciences was also present on the
occasion.

/

^/EMBER 11, 1999

B

Honoured for their noble act
of saving unknown lives

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DH News Service
BANGALORE, Nov 10

“I have received many gifts in my
life, but the most unexpected and
noblest came at the most
unexpected time — on my death
'! bed. I pray for them more than I
do it for myself.” With these
words, Shailaja, recipient of a ca­
daver kidney, summed it all at a
function organised here to felici­
tate the family members of the cai daver organ donors.
j
Family members of five donors
I of cadaver organs (vital organs
i| harvested from brain-dead perI sons for transplant in needy pa­
tients) were honoured for their Former Chief Justice of Supreme Court M N Venkatachaliah talk­
noble act of saving unknown lives, ing to Ms Rani, wife of late Perumal, a cadaver organ donor, at
at a function organised by Forte the felicitation function organised by Forte to felicitate cadaver
(Foundation for Organ Retrieval
organ donors in Bangalore on Wednesday.
and Transplant Education) here
DH photo
today.
For Kamalamma, it was a blend of happiness and the award. Ms Nagalakshmi, wife of late
■ sadness as she received the Forte award on behalf of Vishweshwaran (58), had readily agreed to donate
i her son Suresh, whose kidneys and eyes were donat­ her husband’s kidneys and eyes, when he died in a
ed after he died in a road accident. “I feel that my road mishap. The family members of Suchitra (18),
son is still alive as his pair of eyes have given sight and Lobu (26) also received the awards.
to two people, and his kidneys have given life to two
Mr Venkatachaliah, speaking after presenting the
more," she said.
awards, said awareness regarding cadaver
Former Chief Justice of the Supreme Court M N transplantaiton was ver}' less in the country. More
Vcnkatachalaih presented the awards to the family than 85 per cent and 60 per cent of transplantions in
Europe and America, respectively, were cadaver
members on behalf of the donors.
transplantions, but, its percentage in India was a
—i—Ms Rahi, wife of late Perumal, a construction- meagre one per cent, he lamented. Several celebrities
I worker from Dharmapuri in Tamil Nadu who died including sports personality Ashwini Nachappa, ACP
I of head injuries in the City last year, received the K C Ramamurthy, IGF (Prisons) Vijay Sasanur, a
' award on behalf of her husband. Suchitra, an 18 year visually impaired bank employee Paul Mudda pledg­
old, also had donated kidneys. Her mother received ed to donate their organs after their death.

Family members of persons who donated their organs,
who were felicitated by FORTE and Rotary Club at a function
in Bangalore on Wednesday.

FORTE honours families
of organ donors

I

groups in conflict with each other.
bangalore, NOV. 10. The families of
26-year-old I>ogu a factor}' work­ Citing the example of U.S., he said
er, Suresh; 18-year old Suchitra; 60 to 70 per cent of the trans­
Perumal, a construction worker, plants came from cadaver sourc­
and 65-year old Visweswaran es. In Europe too, 85 per cent
were on Wednesday felicitated by came from cadaver and only
the Foundation for Organ Retriev­ about 15 per cent from live do­
al arid Transplant Education nors. “But in India, 99 per cent of
(FORTE) and Rotary Club of Ban­ transplants are from live donors,”
galore. All the five were injured in he said.
accidents from which they did not
Mr. A.Sengupta, Secretary,
recover and their organs were do­ Health and Family Welfare, Gov­
nated by their family members.
ernment of Karnataka, released a
Mr. Justice Venkatachaliah, for­ newsletter of the organisation.
mer Chief Justice of India, who
Ms. Aswini Nachappa, athlete,
gave away the awards, said the Ms. Kiran Masumdar Shaw, en­
families deserved “unstinted re­ trepreneur, and her husband, Mr.
spect and support”. He hoped the John Shaw, Mr. Vijay Sasnur, JGP
act of charity of donors “inspired (Prisons), Mr. K.C.Ramamurthy,
the rest of us”.
ACP, and Mr. Prasad Bidapa,
Regretting that society in the fashion choreographer, were the
country was a fractured one, he “11 celebrities who signed cards
said it was made up of heteroge­ today pledging to donate their or­
neous assemblage consisting of gans.
----------------------------------------------------- [-

Brain-dead man gives Heart
heart to needy one
k.
Diam-ueaa

I

Karnataka’s first transplant could give Bangladeshi a new lease of life
Health Correspondent

out heart transplants.
Home were keen to donate his organs. The team
BANGALORE: Mujibur Rehman, the
A team led by MHF Vice- of experts appointed by the state government cerBangladeshi patient who was written about in
President Devi Prasad Shetty tified the person brain-dead a few hours later.”
these columns on Sunday {Does anyone have a
earned out the transplant on
With this having been done, the MHF surheart to give?) finally received a heart the same
the 36-year-old patient. While ^geons removed his heart and with the help of
morning. Thanks to the goodwill and express de­
the mam surgery itself took police escort reached MHF in about 10 minutes
sire of the family of 48-year-old Preetranjan
about four hours, the team was and began work on the transplant.
Singh, who had died of a stroke. With this, the
r . - : IB in the operation theatre beOn chances of the transplant turning out to be
first heart transplant has been carried out in i
tween 9 P-m-on Saturday and 6
a success, Shetty explained: “The next few days
Karnataka.
Preetranjan Singh a m- 011 Sunday as part of the are going to be critical. All organ functions will
preparations and follow-up for have to be monitored. There are possibilities of
It may be recalled that Rehman had been
waiting for a donor heart at the Manipal Heart the state’s pathbreaking medical event.
rejection. Also, the transplant has come almost a
Speaking to reporters after the marathon year late as he kept waiting for a donor heart to
Foundation (MHF) for over a year. Even as his
condition worsened, he saw two others succumb . surgery’ Shetty said: “We received a call from come through. In that period, his kidneys, lungs
to <end-stage heart ailments. The transplant Rebecca Thomas of FORTE (Foundation for and liver have taken a serious beating.”
. . a half
r. after three
, hospitals
. .
---------comes
a year and
—Organ Retrieval and Transplant Education) yes­
Rehman apparently woke up after the surgery
MHF, Jayadeva and St John’s.— were recog­ terday evening saying that the relatives of a 48- around 8.30 a.m. and obeyed oral commands.
' 1 man who had died at Mallige Ntirsing
nised by the Karnataka government for carrying year-old
► Tears of pride, page 3
-b..
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&

DECCAN HERALD, MONDAY, FEBRUARY 21, 2000

First heart transplant in State a success
Even after the State Govern­
ment recognised MHF, Jayadeva
Institute of Cardiology and St
John’s Medical College Hospital
for performing heart and heart­
lung transplatations one year ago,
this is the first such heart
transplant in the state. The main
reason
for
the
lack
of
transplantations, Dr Shetty says,
is due of the lack of donors and
proper awareness among the pub­
lic.

DH News Service

BANGALORE, Feb 20
A team of heart surgeons from the
Manipal Heart Foundation (MHF)
here have successfully performed
a heart transplantation, said to be
the first such operation conducted
in the State.

The generosity of the family of
a 48-year-old man to donate the
heart of their loved one has pro­
vided a new lease of life to Mr
Mujibur Rahman, a Bangladeshi
national, who had been waiting
for a donor to gift him a heart for
the past one year.

MHF Vice-President Dr Devi
Prasad Shetty told reporters that
the patient made a smooth recov­
ery after the five-hour operation,
which was conducted in the wee
hours of today. The patient woke
up at 8:30 am and responded to
oral commands. The operation
was conducted at 3 am. However,
the next few days are going to be
critical period where various
issues like organ function and con­
trolling the rejection have to
monitored, he added. The patient
suffered from cardiomyopathy dis­
order and had reached “end stage
heart failure and compromise
liver and kidney function”.
Explaining the sequence of
events, Dr Shetty said that at
around 6 pm on Saturday the MHF

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“Heart transplantation is in fact
among the simplest of heart oper­
ation. It is much more difficult to
repair a damaged heart,” says Dr
Shetty.

r J. '

“Not many persons are ideal do­
nors and the brain dead person
should be in a nursing home or a
hospital where they can put him
on a heart lung machine”.

Heart surgeons of the Manipal Heart Foundation conducting the
first heart transplant in the State, in Bangalore on Sunday.
DH photo

received a call from Ms Rebecca
Thomas of Foundation for Organ
Retrieval and Transplant Educa­
tion (FORTE), a social organis­
ation, explaining about a 48-year
old man who had a massive stroke
causing brain death.

The relatives of the deceased ex­
pressed their desire to donate his
organs.

At 7:30 pm, the team of experts
appointed by the government, to
clarify brain death, gathered at
Mallige Nursing Home and declar­
ed him brain dead. The team of
heart surgeons from the MHF re­
moved his heart and reached
Manipal Heart Fundation in 10
minutes and successfully perform­
ed the heart transplantation at 3
am.

Only about 10 heart transplants
have been done in the country.
Karnataka is the third State after
Delhi and Tamil Nadu to conduct
heart transplants. More than 2,000
heart transplantations are carried
out every year in the United States
alone.
Dr Shetty said in an ideal heart
transplant, the patients have a 60
to 70 per cent chance of survival
at the end of five years, which is
quite significant given that with­
out the transplant their chance of
survival is negligible.

ORGAN DONATION:
WISH MORE HAVE
HE HEART TO HELP
organisation that makes sure that
Ar*—»Chowdary
I
nuggy Saturday morning did the organs donated are used in best
not ueter the 2,000-odd supporters possible manner. Allocation of
who thronged the steps of Vidhana organs is entirely on a point scoring
Soudha for the walkathon organised system where the most medically
by Forte (Foundation for Organ needy person will be given the
retrieval and transplant education). organ first."
Dr. R. Prabhakar, who was a con­
Their message: Life can be a relay
race, so be an organ donor. The sultant CT surgeon at Royal Perth
relay race concept was created to hospital in Australia and is an expe­
enforce the importance of team rienced cardiovascular surgeon
work for victory which is the pivot of says what is important in a trans­
plant procedure is timing and organ­
any transplant procedure.
Organ donation is suddenly in the isation. “I once had a patient who
news again. The shock waves fol- attempted suicide by jumping off the
lowing the death of Mujibur nth floor of a building," he says.
“He fell head first and was soon
Rehman, heart transplant patient,
brought with it speculation and declared brain dead. Since there
skepticism about heart transplant was no-one to match his blood
possibilities in the city, but the hope group in that city, we had to fly to
for success in the future has not another city on a chartered plane.
been entirely squelched. The All this required networking with the
walkathon by Forte came as a gust traffic police, the airports, the hospi- J
of fresh air, dispelling pessimism tals and everyone else involved."
and reiterating the enormous need
According to Rebecca Thomas,
for organ donation in the city.
there is both infrastructure and net“One body that is donated can working already available in Bangagive eyesight to two people, a heart lore. “We have delivered organs in
a liver to another person and less than ten minutes from one point
.ays and lungs to two more peo­ in the city to another with police
ple," says Dr Devi Shetty of the escort,” she asserts.
“In fact, we have flown organs to
Manipal Heart Foundation.
“But for a successful transplant, neighbouring state hospitals like
the recipient has to be in optimum CMC Vellore and other hospitals in
shape. Mujibur Rehman had been a Chennai when recipients of the
terminal heart patient for over a year same blood were not available.
and after the transplant, he suffered Today, there are three hospitals in
from multiple organ dysfunction."
the city that are certified to conduct
According to Dr Devi Shetty, there heart transplants."
Vishal Bali, General Manager of
are between two to three lakh peo­
ple in the country waiting for a heart Wockhardt, says that there are more
transplant. More than 100 brain religious and sentimental issues
deaths occur a day in the country involved in India where transplants
due to accidents on the road, but are concerned. “Are we ready emo­
tionally as a city for heart trans­
there are still no donors.
"The reason why heart trans­ plants?” he asks.”l also believe we
plants have taken so long to happen need a system where institutes work
in Bangalore is because we had to together and leverage from the
wait for a donor to come forward. If strength of the other.”
The irony lies in the fact that even
there had been enough donors,
there would have been over 100 in the west where transplants have
been happening for so long, only 12
transplants by now," he says.
“We constantly need the support per cent of the people asked for
of society,” says Rebecca Thomas, donations actually consent. Doctors
Honorary secretary and transplant observe that if we in India have at
co-ordinator, Forte. “Besides which, least a 10 per cent response it
a transplant programme also would be enough, to cater to the
requires the timely co-operation of needs of most of our patients. The
neurosurgeons and neurophysi­ walkathon was the beginning of a
cians who diagnose and certify brain crusade that should have begun
deaths. Forte is the co-ordinating long ago.

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ABOUT FORTE

FORTE
GIFT

OF

LIFE

FOUNDATION FOR ORGAN RETRIEVAL
AND TRANSPLANT EDUCATION

SF-7, Business Point, 137,
Brigade Road, Bangalore 560025

Ph: 2237045, Fax: 2241284

After 5 pm
Rotary-TTK Blood Bank,
Ph: 5287903
Or 5533254
Page: 9624-210261
Chairman
Dr. K D Phadke

Foundation for Organ Retrieval and Transplant Education (Forte)
is a voluntary, not-for-profit, not-hospital-based organization in
Bangalore.
It serves all recognized transplant centers and Jo
coordinates the cadaveric transplant activity, i.e identification of
potential cadaveric donors, assist in donor maintenance, grief
counseling, securing consent from the donor family for organ
retrieval, selection of the suitable recipient based on allocation
criteria etc. It is also involved with spreading the message of
organ donation through various educational and awareness
programmes taking help from the media. The board of trustees
consists of eminent people from different walks of life (legal,
police, rotary, chartered accountant, media etc.) who are known for
their dedication, integrity and transparency.
The cadaveric programme and similar coordinating bodies have
been in existence abroad for many years. However, for our
country, FORTE is the only one of its kind and serves as the role­
model for the rest of the country.

Hon. Secretary
Mrs. Rebbecca Thomas

Hon. Treasurer
Mr. KN Prabhashankar
Trustees
Justice Kedambady Jagannath Shetty
Capt.VVKMani
Dr. Elizabeth Zachariah
Mr.RRamalingam
Dr. P Sriram
Dr. Latha Jagannathan

THE CURRENT TRANSPLANT SCENE AT BANGALORE
Human Organ Transplant bill was passed by the Indian Parliament
in 1994. This defined “brain-death” and paved the way for
cadaveric organ donation. Also, it laid down penalties for the
criminal offences related to organ-trafficking.
Unfortunately, the Bangalore transplant scene continues to be
pathetic with the live unrelated donor programme, ie. Paid Organ
Donation in full swing with unethical practices, appearance of
touts etc. etc.
Clearly the monitoring of transplant activity with the Appropriate
Authority, the Authorisation Committee has failed miserably. The
data about number of transplants and kind of transplants done etc.
is simply not available.
If nothing is done about this, it is only a question of time before
another major scandal breaks bringing shame to Bangalore!

.... 2,

A NONPROFIT MEDICAL SERVICE

J*

: 2:

RECOMMENDATIONS
1) It is suggested that Transparency in the process of
Transplantation must be established at the earliest,
The
establishment of the Transplant Registry with a longitudinal
follow-up is a must. The data should be available and
accessible at all times.
2) Tracking down of middlemen and touts is an urgency. It
should not be a one-time task but an ongoing activity so that
they do not surface again.
3) The government could help in creating awareness about organ
donation with the help of mass media etc. A television
clipping is ready in English and Kannada to be telecast

frequently.
4) The Authorisation committee should consist of people with a
background of “Psychosocial Counseling”also. FORTE could
accredit these people with the help of experts.
The
Authorisation should be made public to invite objections if any
5) FORTE is willing to take up an advisory role to the
government on issues related to transplantation. It may give
guidance regarding policy matters on this subject. This rble
may be considered as similar to the one played by the “The
Public Affairs Committee”.
6) Within the task force, there should be a cell which will monitor
the Appropriate Authority and the Authorization Committee
and give them guicjelines from time to time

1), 2), and 3) can be taken up immediately.

(DrX D PJaadke)
Chairman, Forte

(Mrs Rebecca Thomas)
Hon. Secretary, Forte

np'/6-

FORTE
FOUNDATION FOR ORGAN RETRIEVAL & TRANSPLANT EDUCATION
GIFT

November 1999

OF

FORTE

CADAVER TRANSPLANT
WORKSHOP AT PUNE

Chairman

On 7th May 1999, the K.E.M. Hospital and ihe

Dr. Kishore .D. Phadke

Pune Transplant Society organised a workshop on
Cadaver Transplantation at the Turf Club.

Hon. Secretary
Mrs. Rebecca Thomas

Hon. Treasurer
Mr. K.N. Prabhashankar

Trustees
Justice Kedambady Jagannath Shetty
Capt. V.V.K. Mam
Dr. Elizabeth Zachariah

Mr. R. Ramalingam
Dr. P. Sriram

Dr. Latha Jagannathan

Medical Director
Dr. Philip G. Thomas

Advisory Panel
Dr. L. Thirunavukkarasu
Dr. K.V.R. Shastry
Dr. Vineet Nayyar

Dr. A.Mohan

Member Panel of Participating Hospitals
Bangalore Hospital,

Bangalore Kidney Foundation,

Command Hospital, CSI Hospital,
Lakeside Hospital, Mallya Hospital,
Manipal Hospital, Manipal Heart Foundation,

Sri Jayadeva Institute of Cardiology,
St.John's Hospital,

Mallige Medical Center

Five hospitals in Pune are recognised for
Transplantation. Thirty five delegates consisting of
doctors and social workers representing these
hospitals took part. Dr. E F. Wadia, Director of
the K.E.M hospital made the introductory speech.
Dr. K. Rajamani, Neurologist at the Jehangir
Hospital spoke about the diagnosis & certification
of Brain Death. Mrs. Rebecca Thomas, the
Secretary of FORTE, spoke on grief-counselling
and Donor family motivation. Dr. Anil Godbole,
transplant surgeon at the K.E.M. hospital sppke
on Donor maintenance in the Intensive Care Unit.

The afternoon session was devoted to sharing the
experience gained in working the programme.
Ms.Arti Gokhale & Ms. Roliini Sahastrabuddhe,
social workers, spoke on their experience in the
Government hospitals and Ruby Hall. They were
handicapped by the paucity of networking among
hospitals, and related an instance when a donor
was available but the organs could not be placed
for want of suitable recipient. Mrs. Rebecca Thomas
shared with the participants the Bangalore
experience in organising the programme and setting
up an Organ Procurement Organisation.

A Public Relations firm had been involved in the
activities. Ms. Sheetal Pinto, who was handling this
work at the firm, participated in the deliberations.
The Pune Transplant Society will be bringing out
Donor Cards and brochures in consultation with
this firm. They will also be undertaking public
awareness campaign.

1

The concluding sentiment at the
workshop was that a non-hospital based organisation should be
set up to conduct these activi­
ties, and the Transplant society
would remain in the background,
only providing technical inputs
and support whenever needed.

^EDITORIAL
"How is the Cadaver Transplant
Programme going?" is the
question we are asked often
nowadays. Quite understandably
so, considering what FORTE
stands for. Answering this with
the expected degree of honesty
is more than a mere matter of
words. We need to introspect a
great deal on the answer.
That several thousand patients in
the country have end-stage
organ failure is well known. Most
of them die eventually for want
of transplants. This unpleasant
truth is banished from our
collective conscience by refusing
to acknowledge it exists. We have
to introspect, and find solutions.
Such introspection could be
agonising, for it is bound to
throw up very unpleasant truths.

The most unpleasant truth is the
lack of motivation among organ
donors. It is common knowledge
that there is a flourishing Bazaar
in Kidneys - Transplant Act, or
no Act. Its ethical ramifications
do not seem to bother anyone
any more. Even the live related
programme
in
several
institutions languishes as
"market forces" prevail. So much
for the kidneys, but what of the
liver, the heart, etc.?

This is the area in which we need
to work most. The recognition
granted to the National Institute
of
Mental
Health
&
Neurosciences, as a Donor
Institution, is path breaking. This
should lead to the recognition
of more such centres that
provide excellent facilities for the
care of Neurologically injured
patients. This should be
combined with the availability of
motivated grief-counsellors who
can enable the families make the
decision to donate. The number
of organ donations is bound to
increase. Our experience to date
tells us that this counselling is the
key to a successful donation.
While there is considerable
interest evinced by various
sections of society in all this, the
number of donations is still
abysmally low. This is what we
feel needs to be done to improve
matters:

• Keep the issue of organ
donation in the public mind and
eye through a sustained,
multi-pronged
awareness
programme
• Work hard towards providing
counselling services in all
transplant centres (something
that most still do not have in
place).
• Bring pressure on the
government to be part of the
campaign promoting organ
donation, as it has been in the
case of Eye donation, Pulse­
polio programme, etc.
•Build-up a countrywide
network of organisations
working for this cause, so that it
gains more acceptance and

2

awareness spreads
• Above all, convince doctors,
medical institutions and public
that ’’Organ Bazaars” are a short­
sighted and hazardous solution.

CADAVER
TRANSPLANTATION
WORKSHOP AT
CALICUT .J
The Department of Nephrology,
Calicut Medical College and the
Calicut Nephrology Club jointly
organised a workshop on
Cadaver Transplantation at
Calicut on 24th April 1999. The
aim of the workshop was to
familiarise prominent sections of
the public with different aspects
of Cadaver organ donation and
transplantation.

Mr. Jacob Punnoose, I.G. of
Police (Northern Range)
inaugurated the workshop.
Calicut Medical College was one
of the earliest to start a Kidney
Transplant programme in Kerala
and appropriately, Dr. Roy
Chally, the founding figure of
that programme, introduced the
theme of the workshop to the
gathering. Dr. Thomas Mathew.
Head of Nephrology made the
introductions.
Dr. Philip Thomas, Medical
Director of FORTE, went over
the
history
of
Organ
Transplantation in the inaugural
talk. Dr. Sanai Kumar,
Neurosurgery Professor, spoke
on the diagnosis and certification
of Brain Death. Dr. Philip
Thomas
spoke
on
the
management of brain dead
donors in the Intensive care

setting.
This was followed by the a talk
on grief-counselling for the
donor families and the
psychological and emotional
nuances of obtaining consent for
organ donation. Mrs. Rebecca
Thomas, the Secretary of
FORTE, spoke on the
experience gained in setting up
an
Organ
Procurement
Organisation in Bangalore. Dr.
Georgy Ninan from the Medical
Trust Hospital spoke on the
experience in setting up such an
organisation in Cochin. This was
followed by a talk on Organ
Allocation Criteria.
The final session was devoted to
discussing the possibility of
networking transplant centres in
Kerala. The four centres in
Calicut would first come
together followed by a network
covering the cities of Calicut,
Cochin and Trichur.
Over 50 participants attended
the workshop. They included
Police officers, members of the
Clergy,
Social
workers,
Presspersons and prominent
members of the public. Besides
these, Nephrologists, Transplant
surgeons,
Neurologists,
Neurosurgeons,
Anaesthesiologists
and
Postgraduate students from
different disciplines attended.

recipients and their families from
all over Kerala, besides others.
At this function too, the concept
of Cadaver organ donation was
introduced and discussed.

The transplant community and
public in Kerala confirmed their
preference for a neutral
procurement organisation.

Z

\

f " "Do not takey
organs to heaven;
heaven knows
we need the
I organs here 7

Recipient registration:
Anil Kumble, the world-renowned spin bowler, launched Forte's
recipient registration on 29th June 1997 and became the first vol­
untary organ donor in Karnataka. It was a symbolic act which
was to herald the beginning of a systematic Cadaver Transplant
Programme in India. A public awareness programme was also
launched by Forte in partnership with Rotary District 3190.

Dr Kishore D Phadke, Chairman - Forte, felicitating Anil Kumble on
becoming the first voluntary organ donor in Karnataka

CADAVER ORGAN TRANSPLANT
The workshop was followed in
the evening by a public function
attended by Kidney transplant

The first organ donation in Karnataka from a cadaver came from
the parents of Usha Gowri, a medical student from Shimoga, who
sustained fatal head injuries in a road accident. The heightened

3

awareness resulted in a number of cadaver donations. On 4th
September 1998, Shri Khurshed Alam Khan felicitated the fami­
lies of the year's donors at a touching function at the Karnataka
Raj Bhavan. Donor cards were signed by celebrities like N. Ram
(Editor, Frontline), Vani Ganapathy (Danseuse), Sudharani (Film
actress), Ashok Rao (Film artiste), B.S.Chandrasekar (legendary
Indian leg-spinner), Srinath (Film actor) and Dr. MC Modi (Eye
surgeon).

Shri Khurshed Alam Khan felicitating a donor family.

Mankuul

Veerabhadriah: A 44-year-old
KEB employee who sustained
a severe head injury due to a fall
during the course of his work.
Although devastated by his
accident and the news that there
was absolutely no chance of
survival, his wife and grown-up
sons took the decision to permit
one of his kidneys to be used to
give another person a new
chance of life. KEB colleagues
were also very supportive
of the family's decision and
encouraged the organ donation.
Sivaprasad: This impulsive
teenager fell prey to a
situation that all youngsters are

to-

susceptible to - the thrill of
riding a two-wheeler without a
valid license. He decided to
borrow his father's bike and his
inexperience led to a fatal
accident. As always, it was an
irreparable loss to the family.
But they could look beyond
themselves at other lives that
could benefit from the donation
of his kidneys, corneas and
even his heart and gave consent
for all his organs to be
retrieved and transplanted,
A truly generous family.
Unfortunately, there was no
suitable recipient for his heart
and hence it was not retrieved

4

but both his kidneys and
corneas were transplanted
successfully.

Vishweswaran: The reckless
driving of somebody else took
the life of this gentleman at the
prime of his life. His wife also
suffered serious injuries in the
accident but despite the fact that
life had dealt them this severe
blow through no fault of their
own, the family wanted to give
to society and help someone
else in need. This noble gesture
on their part made a world of
difference to two individuals
with end-stage renal failure and
brought the gift of sight to two
others.

Suresh: He was another young
victim of a road traffic
accident - a problem that has
reached mammoth proportions
in Bangalore and needs urgent
attention. This 25-year old
gave a new lease of life to two
renal failure patients and the
gift of sight to two others as a
result of the courageous
decisions taken by his wife and
other family members.
Sujithra: Families such as
Sujithra's are indeed rare and
one does not cease to be
amazed at the goodness
in peoples' hearts. Sujithra
was the victim of a tragic
accident that left her family
inconsolable. However, this
young student had a vision
problem in early childhood and
although this had been
corrected, the parents knew
how difficult it was for a child
with visual impairment to
manage in society. When her

father realized that her life
could not be saved and the
counselor made the request for
eye donation, he had no
hesitation whatsoever in giving
his consent. The thought that
another child would be able to
see through the eyes of their
beloved daughter was enough
motivation for this family.
They also gave consent for their
kidneys to be transplanted..

Dr. Sanjay Nagral, Consultant
Surgeon at the Jaslok Hospital
made a very interesting slide
presentation giving an overview
on Brain Death & Organ
Donation. Subsequent speakers
dealt with diagnosis &
certification of Brain death,
I.C.U. management of donors,
etc. Mrs. Rebecca Thomas
spoke on the Bangalore
experience.

CHDHV6R
trhnsplhnthtion

An interesting sidelight that
emerged was the fact that the
Zonal Co-ordination Committee
set up by the government had
proposed huge monolithic
organisational structure for the
co-ordinating agency. This
included setting up of a 40member committee to prepare
"detailed concrete proposals"
like recruiting office staff,
procuring office space, allotting
a budget, etc., for submission to
the Government.

secOINHR
IN G3UO3BHI
The National Organ Donation
Campaign is an umbrella
organisation constituted by the
Liver Transplant Group at Jaslok
& Bombay Hospitals, the
Narbada kidney Foundation, the
Eye Bank Association of India,
the Social Workers' Association
and the All India Society for
Voluntary Donation of Human
Body & Cadaver Organs after
Death for Transplantation.

This group and the Appropriate
Authority of the State of
Maharashtra organised a
Seminar in Mumbai on May Sth
1999. The Assistant Director of
Health Services, Govt, of
Maharashtra, delivered the
keynote address and inaugurated
the seminar. He spoke at length
about the steps taken to
implement all the provisions of
The Transplantation of Human
Organs Act in his state, including
setting up of the Zonal
Co-ordination Committee.
JH

I
|

MB BM BM BBB

BBB BM MB I

"Do not burn or bury
organs, donate them. tt

I
I

J

Fortunately, at the Open Forum
held at the conclusion (chaired
by Dr. S.K. Mathur from
Bombay Hospital and Dr. Mohit
Bhatt from Jaslok hospital),
the sentiment was for setting-up
a non-hospital based co­
ordinating agency, which
hopefully will be more effective.

York Regional Transplant Pro­
gram published the views of
major religions on the subject.
Here are those positions.
Amish: Approved if there is a
definite indication that the
health of the recipient would
improve, but reluctant if the
outcome is questionable.

Buddhism: Donation is a mat­
ter of individual conscience.

Catholicism: Transplants are
acceptable to the Vatican tnd
donation is encouraged as an
act of charity
I

Christian Science: no position,
leaving it to the individual.
Greek Orthodox: No objection
to procedures that contribute to
restoration of health, but dona­
tion of the entire body for experimentation or research is not
consistent with tradition.

Hinduism: Donation of trans­
plant is an individual decision.
Islam: Donation of transplant
is a individual decision.
Jehovah’s Witness: Donation
is a matter of individual con­
science with provision that all
organs and tissues be com­
pletely drained of blood.

Does my religion
approve of organ
donation?

Judaism: Jews believe that if
it possible to donate an organ
to save a life, it is obligatory/to
do so. Since restoring sight is
considered life saving, this ineludes cornea organ transplan­
tation.

Compiled by Stan Simbal

Protestantism: Encourage and
endorse organ donation.

/

"

\

An often-heard question when
organ donation is being dis­
cussed is "Does my religion
approve?" Recently the New

Mormon: Donation of trans­
plants is an individual decision
Quaker: Donation or trans­
plants is an individual decision.

Edited by : Dr. A. Mohan, Co-Editors : Mr. K.N. Prahhashankar, Mrs. Rebecca Thomas

5

'Even after Iam gone,
a part ofme can
come back for a secondspell'

my organs. What about you?
Heart, lungs, kidneys, liver, pancreas, heart valves and eyes can be donated after death.
You too can pledge your organs, or help donate those of a brain dead loved one, so that another
human being can get a new lease of life. Quite truly, the most valuable gift you can ever give.

FORTE
Foundation for Organ Retrieval
and Transplant Education

Be an organ donor. Give life a chance.
If you wish to know more about FORTE and its activities, kindly write to:

The Secretary, FORTE (Foundation for Organ Retrieval & Transplant Education),
SF-7, Business Point, 137, Brigade Road, Bangalore 560025.
Phone: 2237045/5533254 Fax: 2241284 Hotline.,98450-06768
Website: www.forteindia.com

(For private circulation only)

=

UROLOGICAL SOCIETY OF INDIA
33rd - ANNUAL CONFERENCE

USICON200Q

| HYDERABAD I

January 20 - 23, 2000.

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33rd ANNUAL CONFERENCE OF

USICON 2000
20th - 23rd JANUARY 2000
HOTEL KRISHNA OBEROI & HOLIDAY INN KRISHNA
HYDERABAD

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UROLOGICAL SOCIETY OF INDIA
33rd ANNUAL CONFERENCE
HYDERABAD

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President
S.C.Mathur
Jaipur

President Elect
A.RPandey
Vellore

Hony.Secretary
N.P. Gupta
New Delhi,

Immediate Past-President
S.D.Bapat
Mumbai

UROLOGICAL SOCIETY OF INDIA
33rd ANNUAL CONFERENCE
TH
HYDERABAD

Hony.Treasurer
Mahesh Desai
Ahmedabad
Council Members
S.S.Ambasta
Patna

A. K. Hemal
New Delhi

1

V.D.Joshi
Rajkot

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J.N.Kulkami
Mumbai

D.Thanikachalam
Chennai
N.Krishnamurthy
Madurai

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Mahendra Bhandari
Lucknow

Ex.Officio Members
East Zone
ArunavaChoudhary
Calcutta

ORGANISING COMMITTEE
A. RANGANADHA RAO,
(Chairman)

B. V. RAMA RAJU
(Organising Secretary)

North Zone
D.N.Kalla
Jaipur
South Zone
K.M.Krishna Rao
Visakhapatnam
WestZone
D.Pardanani
Mumbai

SCIENTIFIC COMMITTEE
V. RAJAGOPAL

P. VLN MURTHY
T V. NARAYANA RAO

R. SREENiVAS

M. S. SARANATH

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Complicated &
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DR. ANANi. J1AKHAR, DR. K. RAMESH, DR. K. SUNIL,
DR. M. VENKATRAMAN, DR. DURAI SWAMY, DR. THACHIL

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DEPT. OF UROLOGY
APOLLO HOSPITAL, CHENNAI.

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INTRODUCTION: Organ donation by live related subjects is the predominant mode
of kidney transplantation in India. The protocol of donor investigation is organised
primarily around safety aspects of the donor and secondly on the suitability of the organ
for transplantation. However certain complications are observed which lead to
continuous improvements in this protocol and makes it more elaborate and complete.
There is a controversy regarding the frequency of hypertension and focal segmental
glomerulosclerosis and hyperfiltaration injuries occuring in these patients.
MATERIAL & METHODS: We retrospectively reviewed our result of the renal
donors since 1985. These donors were perfectly healthy normotensive and had no
evidence of infection. They underwent donor nephrectomy through the standard
supracostal flank approach with resection of the 11th rib. The immediate and delayed
post operative surgical complications were studied.

/

-

Over and above a detailed pre operative work-up including GFR, these patients were
checked for their blood pressure, blood urea and urine protein excretion 3 months later,
and subsequently once every year. Three patients who had donated their kidneys else
wherereported to us with renal com plications.

■

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RESULTS: The incidence of post operative fever, wound infection were studied, the
respiratory complications including upper respiratory infections and their caused are
studied the postoperative stay in the hospital was 7 days. Three donors developed acute
renal failure in the post operative period. Two donors hacfnephrotic syndrome, and five
donors 'Have reported to our institute witlTcKromc renal failure out of whom one
required transplantation himself and one is on hemodiajysis, three are; on consejyative
iffanagement. The causes and management of these complications are studied.

The guarantee to get well soon

CONCLUSION: Although renal donor surgery is a safe procedure, it is not devoid
of complications, and a detailed explanation regarding these possibilities as well
as improvements in the pre and post operative donor management protocols is
a primary responsibility of the treating physician.
For the treatment of recurrent DTI

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A surgical feat
Doctors ot the Chennai-based Madras Medical Mission Hospital
perform a second heart-lung transplant procedure.
ASHA KRISHNAKUMAR

age and sex, it is more prevalent among
women in the 20 to 45 age group and
its incidence is low, affecting only eight
f I *WO years after conducting its first in 100,000 people. While its exact cause
JL heart-lung transplantation, the is not known, it manifests itself in the
Chennai-based
Madras
Medical form of increased resistance to blood
Mission has performed the complex flow. Diffused narrowing of the pul­
surgical
procedure
once again. monary arterioles enlarges the right side
Coimbatore-born
Balamurugan of the heart owing to the increased work
Williams received a new heart and lungs load of pumping blood against the resis­
c September 21, a day after he turned tance to flow, and progressively dam­
ages the heart. Says Balamurugan’s
What a relatively simple surgical mother Kannamma: “His whole body
procedure to close a hole in the heart would turn blue now and then and he
could have corrected, had, after 30 would have to be rushed to the hospital
years, left Balamurugan’s heart and for emergency treatment.”
According to Dr. K.M. Cherian,
lungs so damaged that only a trans­
plantation could save him. He was diag­ Director, Institute of Cardio-Vascular
nosed as having a hole in the heart when Diseases, Madras Medical Mission, who
he was hardly three months old. From has performed seven heart, one lateral
then on life became difficult for the lung and two heart-lung transplants in
poor family, ofwhich Balamurugan was the last six years at MMM Hospital,
the only son, after four daughters. His there is no treatment for such a condi­
parents consulted faith-healers and tion except a heart-lung transplanta­
quacks, para-medics and doctors, and tion.
Two years ago at a free health camp
had to contend with such absurdities as
“the hole will close by itself as the boy conducted by KG Hospital in
grows”, and “surgery cannot be done on Coimbatore, Balamurugan was advised
He was
was
the small boy”. Balamurugan’s condi­ a heart-lung transplantatb on. He
directed to MMM.
tion became increasing­
As in the case of From then on MMM
ly unstable as he grew
the first heart
took him under its care
up and he could not
until a donor was
id school regularly.
transplantation
found. The hospital
Vvnen he was 13,
the Madras
did not charge him for
Balamurugan lost his
Medical Mission the surgery. Says
father.
The hole in the ven­
did in 1995, this Dr.Cherian: “As in the
case of the first heart
tricular septum led to
heart-lung
transplantation we did
the reversal of shunt,
transplantation
in 1995, this surgery
causing the mixing of
was also fully spon­
impure and pure blood
was also fully
sored. The idea is to
in the heart. This was
sponsored. The
initiate such proce­
followed
by
idea, according to dures in India and
Eisenmenger’s
Syndrome, a disorder
Dr. Cherian, is to show that they can be
a success.” Neverthe­
more commonly known
initiate such
less, he says the hole in
as primary pulmonary
procedures in
the heart could have
hypertension, in which
been cured by a simple
the blood pressure in
India and show
the pulmonary (lung) that they can be a surgery early on if it
had been attended to
arteries is abnormally
success.
by
a
specialist,
high. Although its
Balamurugan needed a
occurrence cuts across
82

■

. ................

Dr. K.M. Cherian, Director, Institute
of Cardio-Vascular Diseases,
Madras Medical Mission.

donor. His wait ended when the family of Sankari (41), road accident victim,
decided at the Apollo Speciality
Hospital to donate all her organs after
declared
brain-dead,
she
was
Balamuruga:n was one of the six recipi­
ents of Sankari’s organs. Her corneas
and kidneys were donated to four per­
sons in Chennai, and liver to a patient
at the All India Institute of Medical
Sciences, New Delhi.
As soon as the MMM Hospital got
a call from the Apollo Hospital at 2-30
a.m. on September 21, a team of doc­
tors comprising N. Madhu Shankar,
Vijit K. Cherian and N. Kanagarajan
(anaesthetist), went there to harvest the
heart and lung after identifying; the
blood group and the size of the lungs for
compatibility. The most crucial aspect
of the procedure, said Dr. Madhu
Shankar, was time, as the harvesting of
the organs and their transplanting took
place in different hospitals and the latter procedure had to be completed with­
in four hours of the former.
Even as the team was heading back
to MMM with the donor heart and
lungs kept in cold saline solution,
another team, headed by Dr. Cherialn,
was removing Balamurugan’s diseased
lungs and heart. He was put on the
heart-lung machine. First the donor
lungs5 were sewn in place in
Balamurugan’s chest cavity, followed by
the heart, which was attached to the
opened back walls of the atria. The
blood vessels were then connected and
blood allowed to flow through the heart
and the lungs. As the heart warmed up,
FRONTLINE, OCTOBER 26, 2001

overlooks a building site.
found this reawakening
Ciona’s
installation
timely, especially as it was
reminds one that contem­
set in scenes of everyday
porary art is a public state­
life. And the last thing 1
ment of a private
saw in my hotel room in
perception that is deeply
Tokyo was television
rooted in the ongoing
images of the World
processes of daily life, but
Trade Centre towers in
that the parcelling out of
New York collapsing and
different spheres of our
the Pentagon burning.
existence into different
And I realised how the
pigeon-holes has broken
expression of art in the
the links between these.
exhibition hall rang true
She restores the links to
in the reality of the world
the viewer as he or she goes
as well. Indeed, the televi­
through her installation.
sion images reminded one
It is this role of the
that truth is stranger than
artist as the restorer of our
fiction.
lost humanity and the
Other strange truths
overtly political nature of
were reflected in two
this process that we come
works. One is the Aust'- ’
to appreciate them. One is
artist Franz West’s coi
not surprised to come to
orative sculpture with an
this understanding in
Italian
artist,
Ettor
Yokohama, for it is pre­
Spoletti, outside the
cisely over the question of
Intercontinental Hotel. It
rhe political nature of art
was a red Isamu Noguchi
that the Japanese artist
circle surrounding a white
Okakura Kakuzo differed
Pentagon, reflecting the
from his U.S. mentor
curious relationship of
Ernest Fennolosa. It also
Japan with the U.S. with
reminds one that though
all its tensions intact. The
contemporary art deals
other is Yoko Ono’s
with universal truths, the
German railway coach,
way we deal with them in
with bullet holes and a
different places reflects
An inflatable six-storey-high figure of a cricket at the Yokohama Grand beam of light disappearing
the circumstances in
into the sky on top, called
Intercontinental Hotel.
which we wake up to
“Love and Peace”. Both
them.
Wodiczko’s “Tijuana Projection” show­ seem to indicate that suppression is unnat­
This is evident from three video films ing how people, the only commodity not ural and has to end, however complex the
one could just pass over; but at the end allowed to move freely in a liberalised process by which that happens. And it did
of this journey, rhe films seem more world, are degraded and oppressed when breed a sort of hope in one.
important than most others. There is they are forced to migrate from areas of
Still, not everything was hunky-d
Vietnamese
artist Jun
Nguyen- surplus labour to those of surplus capital The individual vision of an artist ol^.i
Hatsushita’s Memorial Project Nha (in this case from Mexico to the U.S.) by conflicts with institutional necessities. For
Trang, Vietnam “Towards the Complex- the force of an economic law that is twist­ example, Anita Dubey was not allowed to
For the Courageous, rhe Curious and the ed by capital to squeeze the maximum out bring dust from India for her installation,
Cowards”. It shows rickshawpullers ped­ of the working class while preaching free Qai Guo-Qiang was unable to present his
alling rickshaws under the sea, rising up trade to them.
fireworks display because of the rules gov­
periodically to take a breath of fresh air.
The answer is forcefully given in the erning safety and Katya Guerrero could
Can one not see in them the plight of the Swedish artist Mars Hjelm’s mix of the not block the roads with old cars in her
vast mass of humanity that is condemned documentaries taken by his father and performance. In such situations the artist
to being marginalised on the “level play­ himself, which reminds us that many of may modify the perspective, as Dubey and
ing field” of finance capital? How indeed the things the media with their own type Guerrero did. Others may opt out. That
does a man selling brute labour power of virtual reality have declared obsolete is the artist’s prerogative. But the fact that
compete with those using all that tech­ are still very relevant. One realises the rel­ the vast majority were able to create works
nology has to offer? The image of rick­ evance of Stokeley Carmichael’s speech of quality reflects on the wisdom of the
shawpullers pedalling under the sea to on how the violent preach non-violence four curators of the exhibition and their
make some kind of a living shows both to those they oppress and how one has to capacity to generate participation. And
their determination and helplessness - an understand that violence is and can be that, no doubt, will help give the
image that is perhaps the most represen­ used to end oppression just as it can be Yokohama Triennale a lasting character
tative one of capitalist society.
used to oppress; and of the confessions of among international exhibitions of con­
There is the Polish artist Krysztof U.S. airmen captured in Vietnam. I temporary art. ■
FRONTLINE. OCTOBER 26, 2001

81

§ the incidence of infection and rejection.
The drug regimen is expensive. But
| It is important to guard against infection Dr. Madhu Shankar is sure of getting
x as lungs, unlike the heart, are directly sponsors for Balamurugan.
exposed to the atmosphere. Says Dr.
The first heart-lung transplant ever
Madhu Shankar: “It is because of infec­ was performed in 1981. Since then there
tion that we lost our fi rst heart-lung trans­ have been 2,698 such procedures across
plant patient in 1999, 36 days after the the world. In South Asia only two heartprocedure was performed. But this time, lung transplants have been performed till
we are very careful." Balamurugan will be now, and both were at MMM.
on medication for protection against
The survival rate of the recipients is
infection and may remain in the hospital encouraging - 90 per cent of them sur­
for about four months.
vive for over one year, 85 per cent for
Chronic lung rejection, which five years and 75 per cent over 10 years.
comes in the form of a progressive nar­ One recipient is alive 16 years after the
rowing of the small airways, is another transplant. With developments in drug
major problem. Left unchecked, the and technology, the survival1 rate is sure
auto-immune cells, which recognise to improve.
transplanted organs; as a foreign body,
According to Dr. Cherian there is no
will damage the cells of the grafted heart dearth ofexpertiseor technology in India,
and the lung tissues and eventually but the problem lies in the lack of initia­
Dr. N. Madhu Sankar, cardiothoracic
destroy them.
tive among doctors, the high cost of the
eon, Madras Medical Mission.
The incidence of rejection is moni­ procedure and patient care, and the diftored by a lung biopsy using a fibre- ficulty in finding do:•nors. The donor had
it began to pump blood. The doctors optic bronchoscope. As rejection can to be a non-smoker and the size of the
checked all the connected blood vessels occur anytime after the transplant, lungs should match that ofthe recipient’s.
and the heart chambers for leaks before immunosuppressive
drugs
lt
A -o-are
— _ adminis- The lungs of accident victims are usually
taking Balamurugan off the heart-lung tered to transplant patients for the rest damaged or tend to contract infection
machine. Sankari’s heart began to beat of their lives. Balancing the dosage of while receiving emergency care.
in Balamurugan
immunosuppressants is crucial''because
_ ’s body at 5.30 a.m.
The organ registry set up in 1999 by
Says Dr. Madhu Shankar: “The though the grafts need1 to be protected the MGR Medical University in Chennai
transplant, which took about three hours, against the immune system, care must is yet to take off. There are 140 people
is technically demanding as care imust be be taken to ensure that the immune sys- waiting for heart and heart-lung trans­
taken to preserve important nerves and tern does not shut down completely as plant at MMM. There is an urgent need
to control bleeding."
bleeding. The success of that would leave the recipient open to to generate public awareness on organ
heart-lung transplants is determined by infections.
donation. There is also an added prob­
lem for speciality hospitals such as MMM
z as they do not get trauma cases. They rely
|| on other multi-speciality hospitals for the
| supply of organs from the brain-dead.
L> Government hospitals, says Dr. Madhu
Shankar, do nor have enough ventilators
to sustain the brain-dead until the organs
can be harvested.
In order to reduce post-transplan­
tation costs, Dr. Cherian suggests that
the government abolish import duty on
nitric oxide, a well-known mediator of
biological functions and an important
,4
therapeutic agent.
MMM is one of the few institutions!
in the country that attempt complex sur­
gical procedures. It set up the Chennai
Transplantation Centre in 2000 and sent
its coordinator, A.R. Krishnaswamy, for
training in transplant management in the1
United States. Its transplant team has
trained in several well-known medical
centres of the world. According to Dr.
Cherian, the government, philan­
thropists and the public can do a lot to
sustain the hospital’s initiative and help
patients like Balamurugan who wait for
Balamurugan Williams, recuperating after surgery.
a fresh lease of life. ■

-A

FRONTLINE, OCTOBER 26, 2001

83

I DEVELOPMENT

Planning with software

. ...

.

..

r

■

.

, .... ....

A software package to promote the application of spatial data
technologies in village-level planning, adopted in West Bengal's
Bankura district, meets with some success.

i

demonstrated in the two pilot districts Kolar in Karnataka and Bankura - cov­
ered under the project. The two districts
J
'1- have different geological terrain and
A BROKEN road links the ~
Teghori
vilig settlements in
-Zllage with the adjoining
ir hydro-meteorological characteristics. The
Bankura district of West Bengal.’ The> project does not assume that there is a sinroad, which passes the hutments of the gle method to address local contingencies table and the recharge zones. The time­
few thousand inhabitants of Teghori, anddevelopmentneeds.Nordoesitenvis- consuming process, some experts say, is
leads to the one-room office ofa local non- age that guidelines have been produced by the drawback of the programme.
Said Dr. Debapriya Dutta, Prine
governmental organisation. Here one the pilot projects that can be applied
finds the spatial resource profile of the vil- throughout the country. Rather, it wants Scientific Adviser, Ministry of Science
from Bankura and Kolar to and Technology: The software prolage on digitised maps. The maps are tthe responses
r. .
...
.
.<<
•
tr«
•
WZmade using
the Geo-Referenced
---- o —
------------------- -Area
— be
-- used
---- by district committees, villages Lgramme itself is not time-consuming. We
Management (GRAM++) software pack- and community groups to formulate their would, however, like ! to strengthen our
age, which enables storage and analysis of own approaches to rural development.
data-capturing facilities. Technology
spatial data on a personal computer.
In Bankura the GRAM-GIS propro­ would not be sufficient to cut time but
Evolved from experience gained in the gramme
succeeded in its primary motivating the people who collect data
gramme has
1
Natural Resources Data Management objective, that of developing spatial data is the keyword here.”
Indeed, efficient implementation of
System (NRDMS) Project of the management tools. For instance, in
Department of Science and Technology Teghori a well and a pond were dug using GRAM++ depend:Is on prudent data col­
(DST), GRAM++has been developed to GIS technology to identify recharge zones lection. Hence considerable time and
monetary resources are channelled
promote the application of spatial data and water table levels respectively.
technologies to problems of resource
“The digging of the well has benefit­ towards the collection of data. The
Bankura project generated its
its data from
management at the panchayat level.
ed 500 to 600 plots, said Sumit Roy, Bankura
GRAM++ has been developed as a member of the School of Fundamental nationalagencies, including the Survey of
United
Nations
Development Research, an NGO. However, one of the India, the National Atlas and Thematic
Programme (UNDP)-assisted initiative questionable features ofthe programme is Mapping Organisation (NATMO),
to use Geographic Information System­ the time involved in identifying the areas Kolkata, and the Census of India. Other
based technologies for local-level plan­ of action. For instance, in Teghori it took national institutions such as the Indian
o developed
r ... one year to identify the spot to dig a pond. Council ofAgricultural Research (ICAR),
ning. GIS is a software r
package
handle large quantities of spatial and During this period, the project managers the National Bureau of Soil Survey
attribute data. It aims to integrate data for spent a considerable amount of time col- Land Use Planning (NBSSLUP) ) anc
natural resource assessment, rural and leering and scrutinising data on the water India Meteorological Department also
assisted. The gaps in data were filled with
urban planning, image analysis of remote­
statistics provided by local NGOs.
ly sensed data, watershed management
The strength of the programme lies in
and impact assessment studies.
identifying the missing elements in the
In the 22 blocks of Bankura district,
data, which means there is no repetition
the GRAM-GIS expertise has been in use
BANGLADESH
of tasks and data are collected only for
since November 1996 in areas such as
areas where they will be used for planning.
water conservation, energy management,
The data are collected in analog
land use planning and infrastructure
Bihar
form and then converted into digital
development.
maps. The GRAM++ software is
Said Asit Pal, member, Teghori pandesigned to digitise maps of any size. Its
chayat: “With the results ofthe date analy­
vector
to raster conversion facility
sis we know where to dig a pond, what
Bankura
enables the analysis of geographic data
the level of underground water is, and
in a raster environment. The attribute
what crops to grow during the year. At the
link of the programme helps in linking
panchayat office we take a collective deci­
the digitised map to various associated
sion on how to use the data from the com­
data,
the terrain module helps generate
puter in planning for the future.”
Orissa
digital terrain modules that can cater to
GRAM++ has been tested and

NAUNIDHI KAUR
in Bankura

84

FRONTLINE, OCTOBER 26, 2001

■ HEALTH CARE

A protocol to prevent
kidney failure
A project implemented in Tamil Nadu yields the encouraging
finding that end stage renal disease, which leads to the total failure
of the kidneys, can be prevented at an affordable cost.
and managing trustee of the Kidney Help
Trust, the alarming rise in the incidence of
UNIQUE epidemiological study, diabetes and hypertension can be halted on^$h combines survey, treatment and ly by primary prevention methods; lifestyle
i.
roring, has helped draw up a validated changes do not prevent the diseases, they
low-cost protocol for the prevention of only postpone their onset,
chronic kidney diseases. The eight-year
A serious fallout of diabetes is end stage
study, the first of its kind in the world, was renal
renal disease
disease (ESRD)
(ESRD) or
or kidney failure,
done at Sriperumpudur Taluk, 40 km from Chronic kidney disease is a silent epidemic
Chennai, by the Kidney Help Trust.
of the 21st century. Its occurrence is not
The state of a person’s health is often confined to developed countries; it is uni­
direcdy linked to his or her lifestyle. With versal. Every year, over one lakh people in
more and more people aping Western cul- India are diagnosed with ESRD, necessiture, which means a sedentary lifestyle and rating a kidney transplant or continual dial­
diets high in salt, fat and calories but low on ysis.
fibre, vitamins and proteins, obesity is on
The progression to ESRD usually hap­
the rise. This, in turn, is leading to a high pens over time through the following
incidence of hypertension and diabetes. A stages:
third of India’s population is obese, over
Incipient (sub-clinical) nephro­
half suffers from hypertension and nearly a pathy: It is the stage of a persistent increase
third has diabetes. Diabetes and hyperten­ above normal in the urinary albumin excresion are the primary causes of kidney and tion rate, also known as microalbuminiuria;
heart diseases, stroke and blindness. Nearly in the absence of proteinuria, it may be
a third of the cases of kidney failure are accompanied by hypertension.
linked to diabetes and over a tenth to
Clinical (overt) nephropathy: In
'
rtension.
this stage there is the presence of persistent
The World Health Organisation proteinuria (>200 ug/minute or >
(WHO) has predicted that if the current 300mg/24 hours); and is usually accompatrend continues, India will become the nied by hypertension.
“diabetes capital of the world” by 2025
Advanced nephropathy: In this stage
with over 57 million affected people. Al­ there is a significant deterioration of renal
ready, according to the International Dia­ function, with a severe decline in the glo­
betes Federation, India has over 33 million merular filtration rate (GFR) and the ap­
diabetics, the largest number in any coun­ pearance of symptoms of uraemia and/or
try.
nephrotic syndrome.
If in the 1950s 1-3 per cent of the
End stage renal disease: ESRD nepopulation was hypertensive, recent studies cessitates dialysis or renal transplant.
show that this figure has risen to 25-40 per
Screening, detection, treatment and
cent, particularly in the urban areas. It is the regular monitoring can help in reducing
most serious risk factor for kidney and car­ significantly the onset of ESRD.
diovascular diseases. A diabetic is two-four
Chronic kidney diseases, regardless of
times more prone to heart disease and 30 the diagnosis (that is, the type of kidney
times more susceptible to renal problems disease), include progressive kidney failure,
than a non-diabetic. Seventy per cent of complications from decreased kidney func­
diabetics also suffer mild to severe nerve tioning, and development of cardiovascular
damage and vision impairment.
diseases. There is increasing evidence that
According to Dr. M.K. Mani, chief ne­ early detection and treatment prevents or
phrologist in Chennai’s Apollo Hospitals delays some of these adverse outcomes.

ASHA KRISHNAKUMAR

A.

52

At a school in the project area,
waiting for the medical check-up.
Renal disease remains a major, though
largely unrecognised, public health issue in
India. An estimated one lakh people devel­
op ESRD every year. This is in addition to
a pre-existing pool of about 20 lakh suf­
ferers. A person with ESRD requires renal
replacement therapy in the form of either
dialysis on a continuing basis or a renal
transplant. Both are expensive options that
require recurrent expenditure over the per­
son’s lifetime. Further, treatment for renal
disease is still largely in the private health
care sector, where the costs are high,
A large number of ESRD patients those from rural areas and small towns
where treatment is not available, and those
who cannot afford the costs even where
treatment is available — thus remain outside
the pale of any kind of medical care.
In fact, 90 per cent of ESRD patients
never see a nephrologist. A mere 9,000 are
staned on haemodialysis every year. But a
whopping 60 per cent of them do not come
back for dialysis, as they are unable to afford
the programme. Nearly 20 per cent of die
remaining die because of complications or
inadequate dialysis. Only a small set of pa­
tients continues on maintenance dialysis.
Some 20 per cent of the patients who consuit a n<icphrologist opt for transplantation
FRONTLINE, MARCH 25,, 2005

allows us to compete in the Indian bid, we
will beat the Mirage 2000. We have never
lost a competitive bid to Mirage.”
Fhe surprise member of the quartet is
the JAS-39C Gripen, which is the only truly
multi-role aircraft among the four conten­
ders. According to Anders Annerfalk, com­
munications
manager
of
Gripen
International, die aircraft is a more modern
machine when compared to the others.
While it was developed in the late 1980s, all
the others date back to the 1970s. The Gri­
pen is powered by the Volvo Aero Corpora­
tion RM 12 modular power plant, which is
based on the General Electric F-404-400
engine.
The four aircraft are currendy being
evaluated for their operational capabilities in
areas such as radars, computers, navigational
attack systems, the range of die missile'- ‘kat
could be carried, and so on. Odier a.
1erations - the kind of technical support and
technology transfer that would be given,
whedier there would be a buy-back arrange­
ment, what advantage the Indian manu­
facturer (HAL) and die nation as a whole
could derive from the deal, whedier the
manufacturer would be dependable (for
| technology as well as spares), and whether
political compulsions would affect the deal
- would also be factored in before a final
decision is made. Moreover, the LAP already
(Above) The French Mirage 2000-5
operates a variety of combat aircraft of both
Mk2. (Left) The Russian MiG-29 M2.
Western (mainly French and British) and
Eastern (Russian) origin, each with its own
poration’s director-general, is not worried distinct design and operating philosophy.
that the aircraft is still only in the prototype The question is whedier inducting a Gripen
stage. He said: “The MiG-29 M2 has com­ or an F-16 would further exasperate the
monalities widi the [much heavier, 38- situation, leading to increased infrastructu­
tonne] Su-30MKI. It is more advanced ral expenses and wastage of time while try­
than the Mirage 2000. The avionics and ing to make them compatible with the
t
weapons systems will be of Russian, French lAF’s present training methodology,
and Indian origin. With the F-16 too in the inventory and maintenance.
fray it will be a stiff competition.” CurrentSpokespersons of all the companies said
ly, MiG fighters are not designed to be mul- diat they had replied to the RFI and it was
ti-role aircraft. Bur Fedorov says that the now up to the Indian government to call for
MiG-29M/M2 will make up for this. request for proposals (RFP). The question is
While the MiG-29M is a single-seater varia­ how long the MoD will take before it sets
nt, the M2 is rhe twin-seats trainer version. die ball rolling again. Aircraft manufacturers
Although many aviation experts ex- are aware that India took more than two
pressed surprise at the Indian government’s decades before it finally settled for the Hawk
decision to ask Lockheed Marrin for an as the lAF’s Advanced Jet Trainer. KrishRFI, the company takes a different view. naswamy said: “Yes, we have procurement
Loren E. Timm, deputy, F-16 customer re- procedures, but there is
i: no point in taking
quirements, Lockheed Marrin, said: “You 15 years to buy/order aircraft which have a
can’t buy a more cost effective aircraft than 10-year production cycle. In my estimate,
the F-16 and we support die programme only
onlyififwe
wequickly
quickly procure
procure the 126 aircraft
from cradle to grave. Twenty-four countries and the EGAs roll off die production line
are operating them. It has a 72-to-nothing can we hope to maintain our authorised
record in air kills and is a true multi-role squadron strength.” Even assuming a final­
military aircraft that is capable of day/night, isation of die order for multi-role aircraft in
all-weather, air-to-ground, air-to-air, air-to- the next two to three years, the new fighters
sea, closed air support and reconnaissance are not likely to be part of the lAF’s incapabilities. If the U.S. State Department ventory before 2010. ■

MMHH

off/maintenance wastages. Ironically, the
lAF’s Mirages, which have an exceptional
Hight safety record, suffered four mishaps in
2004. While two were attributed to human
error, one occurred when the aircraft’s main
wheel came off as the pilot pulled in the
undercarriage after takeoff. The fourth one
occurred when an engine blade broke off in
a trainer causing a restriction of power.
Dassault hopes drat the lAF’s familiar­
ity with the Mirage will win it the contract.
But the MiG Corporation too is thinking
on the same lines. Alexey Fedorov, the corFRONTLINE. MARCH 25, 2005

51

I

§ ever, realising that providing free treatment
or dialysis to the needy can at best only help
a few, the Trust decided to concentrate bn
the prevention of kidney diseases. This basi­
< cally meant early detection and treatment
Golden ?*.>'
» of diabetes and hypertension. Says Dr. Ma­
ni: “Every effort was made to keep costs
down, so that the programme would be
affordable by all in India and even in oner
poor countries.”
Says Dr. Manjula Dutta, Head of Hpideomology, Tamil Nadu MGR Medical
University, who looked after the field wprk
for the Trust as unpaid service during her
free time: “Preventive work is actually like
shooting in the foot for Dr. Mani as it
means reduction in his practice. That a crit­
ical care person thought of preventive care
is remarkable. But still he wanted to do it as
he realised that the bulk of renal failure
patients could not afford treatment. I also
decided to join him in his mission.”
As over 70 per cent of Indians livje in
rural areas without any facility for or access
to health care, the Trust decided to choose a
rural area for its out-reach programme. It
chose six villages with a total population of
23,000 in Sriperumpudur taluk’s Maduramangalur Panchayat Union, an area where
trained health workers of the “Tulir Trust”
were involved in providing neonatal pri­
mary care. The Kidney Help Trust trained
where between Rs. 10,000 and Rs. 1,00,000 Tulir’s health workers to do the Sulphosaa year to prevent rejection of the transplant lescetic Acid test to identify albumin in uriand to sustain life.
ne and the Bebedix Solution test to check
The per capita income in India is about the level of glucose (sugar) in the blood.
Rs.21,000. The expenditure on health by The health workers were also taught to
the State and Central governments works check blood pressure accurately and to deout to around Rs.400 per capita a year, tect
t symptoms by asking some simple quesduring
house
visits.
The
Thus, India cannot afford to treat people tions
’ : area was
with chronic renal failure. The only feasible demographics of the entire
option is to prevent the disease, and cost- mapped and each house was given a card
effectively too. For many patients early di­ with details of every family member.
The health workers went to every vil­
agnosis can be the difference between life
lage and invited the people for a check-up
and death.
Prevention is a viable option, partic­ at a designated centre - the school, the
ularly as half the cases of chronic kidney panchayat office or even the shade of a tree,
failure can be avoided just by controlling They went to the homes of those who were
diabetes and hypertension. For instance,, unable to come to ensure as near complete a
just by coimtrolling hypertension (high coverage as possible.
That only 30 per cent of those surveyed
blood pressure) kidney failure can be post­
poned by four years. Constant monitoring were aware that they had a problem under­
and treatment for five years can control lined the importance of screening every
hypertension in over 95 per cent of people member of the community. After di^gnosis, 25
25 per
per cent
cent of
ofthe
the patients
patients preferred to
and diabetes in over 50 per cent, and that is,
too at a cost of Rs. 14.23 per capita. This is take
take treatment
treatment with
with their
their own
own doctdrs. Of
the remainder, 79 per cent cooperated for
the focus of the Kidney Help Trust.
treatment.
Some of the routine steps followed
R. MANI set up the Trust in 1996
mainly with donations given by his were:
Screening of every person once in 18
patients, with five doctors and two persons
who had ren;lal patients in their family. The months with a simple set of questions to
primary aim was to help poor patients meet find out if he or she had swelling of the feet,
rhe expenses of renal transplantation. How- difficulty in breathing, pain on passi
passing
the
ig uriUJ

LU

I

from either living related or unrelated donors.
There are no accurate figures for the
number of kidney transplants done in In­
dia, as there is no national registry for organ
transplants in place, a practice that is man­
datory in most Western countries where
graft procedures are performed routinely.
Thus estimates of the number of ESRD
’
nts and the actual number of trans­
p. -iS performed are at best guesstimates. It
is estimated, or rather guesstimated, that
fewer than 3,000 transplants are performed
in the country each year; this represents a
fraction of the total number of patients who
require the procedure.
Most parts of India now have hospitals
that have facilities to do dialysis (the puri­
fication of the blood) and kidney trans­
plantation (grafting of a healthy kidney
from a live donor or a cadaver into a pa­
tient), and these procedures are carried out
with very good results. Unfortunately, the
cost is extremely high. Dialysis costs
Rs. 15,000-20,000 a month, and will have
to be continued as long as the patient lives.
Over a million people are on dialysis world­
wide, 90 per cent of them in the developed
world, which accounts for less than 20 per
cent of the world population.
Renal transplantation costs Rs.3-3.5
lakhs and requires medicines worth any­
FRONTLINE, MARCH 25, 2005

53

■n'1

The project area in
Sriperumpudur taluk
Oragadamahdevimangalam

•Ichivakkam

.Chellampattidai

V
Pudupet

.”

’

■ ’VC-.
•
1 (Tirupanriyur

• Kandun

*

—

Kidney Help Trust STulsi Trust
project area
■ Tulsi Trust - mini health centre

Pichivakkam centre limitKancheepuram district
O.M. Mangalam centre limitKancheepuram district
Pudupet centre limitKancheepuram district

Chellampattidai centre limitKancheepuram district
Chennai

Kandur centre limitKancheepuram district
Tirupanriyur centre limitKancheepuram district

ne, blood
I
in the urine, felt the need to pass medicines was adjusted to achieve good
urine frequently (more than twice ini an control.
hour) or get up from sleep at night to pass
Among those who cooperated for the
urine, or felt pain in the back over the kid- treatment, blood pressure was controlled to
nticy area. A sample of urine was examined at ideal levels (less than 140/90) in 96 per
the site for sugar and protein. Diabetics can cent, glycated haemoglobin was brought to
be usually detected by finding the presence the normal level in 52 per cent and it was
of sugar in the urine; protein leaks into the significandy improved in another 25 per
urine in around 80 per cent of patients with cent.
kidney disease. The blood pressure was re­
corded for all individuals over the age of ? I 1 HE efficacy of the project was assessed
five.
JL after eight years by extending it to the
The second step was verification by the adjacent areas with a population of around
doctors of those who answered any of the 21,000 and using it as a control group.
questions in the affirmative. A doctor of the Screeningj was done in both areas last year
Kidney Help Trust examined those with and the findings were compared.
x
high blood pressure (over 140/90) and
A survey was done to find out the nunu­
those who had sugar or protein in the urine, merical
merical value
value for
for the
the kidney
kidney function,
function,
Initial investigation was done at the GFR. The normal value of the GFR in
Apollo Hospitals, which agreed to do some Indians
Indiansisisbetween
between80
80and
and95
95 ml/minute.
ml/minute.
simple tests free. The patients were mon- The
The GFR
GFRwas
was found
found toto be
be below
below 80
80 ml/
ml/
itored regularly by the doctor for blood minute in just 8 per thousand in the project
urea, serum creatinine, blood glucose and area and in 33 per thousand in the new
glycated haemoglobin (a test that gives the area, which did not have the benefit of the
average of the blood sugar over the preced­ project over the last eight years. Thus 25
ing three months). Those with evidence of persons had been prevented from develkidney disease were sent to the Apollo Hos­ oping kidney failure for every 1,000 people,
pitals, where they were investigated and ofwhom 75 per cent would have developed
treated free.
renal failure.
Diabetes and hypertension were treated
Says Dr. Manjula Dutta: “The findings
with effective but low-cost drugs, such as hit us hard, particularly since it showed that
glibenclamide and metformin, and reser­ 70 per cent of those who had kidney disease
pine, hydralazine and hydrochlorothiazide were not even aware that they had it. Berespectively, which the Kidney Help Trust tween 7.5 and 10 per cent of
of the pop
pop-­
provided free. The health workers mon­ ulation either had diabetes or hypertension.
itored blood pressure every week and dia- The gratifying experience: was that 90 per
betes every three months. The dosage of cent wanted to be examined. Now the
54

Trust covers 50,000 people in 48 villages.”
Funding for the Trust came from a
number of individual and corporate donors. The total cost of the project, including the salaries of the workers and the
doctors, the transport of doctors from
Chennai to the project area, chemicals for
the urine tests, and all the medicines used,
worked out to just Rs. 14.23 per capita a^^ .
year. This does not take into account the
tests done at the Apollo Hospitals, which
were free (but this could add up to another
couple of rupees per person).
Says Dr. Mani: “We believe we have
established and validated a simple and ef­
fective protocol for the prevention ofa large
proportion of kidney failure at a very low
cost. We have not measured the impact of
the incidence of stroke and heart disease,
which would probably be even greater*1'''n
the benefits to the kidneys.”
This programme can be replicated eas­
ily for small groups and even taken up by
members of the community with a little
help from doctors and laboratories.lt can
also be incorporated easily intoj^^mment
health programmes using the
Dr. Jan J. Weening, presid^M^^B^
tional Society of Nephrology (1SN^|H|^^ ,
Dr. John Dirks, chairman, ISN’s Commis-^S^M
sion for the Global Advancement of Nephrology and Professor Emeritus of Medicine
W
at Toronto University, visited the project
site and were convinced that the model
should be replicated. Dr. Weening said the
protocol would serve as a paradigm for the
rest of the world. Dr. Dirks said it was
particularly important as, according to projections, there would be 350 million diabetics in another two decades. And, of them,
50 million will be in India. “These are silent
diseases that creep up on one and have
astating effects.”
Talking about why it was important to
screen large populations, Dr. Weening said
it was not possible to detect a small vessel
disease in one’s brain or heart. “The first
time you notice it is when the patient develops a stroke.... If you want to pick up those
patients early, you cannot pick them up by
looking at the brain or the heart, but you
can pick them up by looking at the urine,
You will find small traces of protein there....
If it is found at an early stage, then the
patients can be treated.”
Dr. Weening said the programme had
drawn considerable international attention
from the research papers that Dr. Mani had
published in international journals. The
study would have a tremendous impact in
bringing down cases of stroke and heart
failure and not just chronic kidney disease.
It is a model worth replicating throughout
the world. ■
FRONTLINE, MARCH 25, 2005

^P-16-

♦ KidneyRacket

■

■

'

i T

IGNOBLE PROFESSION: (Clockwise from above) A patient at Kakkar hospital
awaiting kidney transplant; Sareen being arrested; Sareen's residence

MERCENARY
SCALPEL
The organ trade of Amritsar thrived
on deceit and secrecy
By VIJAYA PUSHKARNA

uridal Singh’s problem was
simple. He had been
promised Rs 5 lakh for his
kidney, but was paid only Rs 45,000.
He had complained to the police, but
to no avail. Singh finally landed up at
the portals of the Punjab Human
Rights Organisation (PHRO). Little
did he know that he was about to hand
over the key to a major scam.
Retired judge A.S. Bains, chairman
of PHRO, decided to follow it up. The
probe unearthed a huge kidney
transplant racket, involving medical
malpractice, organ trade, political
56

Feb 2, 2003

0

nexus, death and disappearance, and
cheating.
The seam’s epicentre was the holy
city of Amritsar, where surgeon
Praveen Kumar Sareen ‘ripped off’
kidneys of illiterate poor, mainly
migrants from Uttar Pradesh and
Bihar, and transplanted them on rich
patients. Dr O.P. Mahajan, principal of
the Government Medical College,
Amritsar, cleared the cases, and a
clutch of other doctors aided and
abetted the crime inside Kakkar
Hospital. Middlemen of the trade
spread far and wide and trapped
unsuspecting people into parting with
a kidney. Often, the promised sum was

not paid.
A special investigation team under
senior police officer A.A. Siddiqui is
probing the murky affair. Says he: “It
was organised crime. Kidneys were
removed and sold and money passed
hands. All the clauses of the transplant
act were violated.”
The affidavits signed by donors and
recipients were full of false
information regarding addresses and
the relationship between the donor
and the recipient. If the affidavits are
to be believed, most ofthe donors were
servants of the recipients, and it was
“love and affection” for the employer
that made them part with their

kidney. The doctors amassed wealth,
battle between doctors and the police,
with Sareen having done two
with the local branch of the Indian
transplants every three days in the last
Medical Association deciding to
two years; the rich got a kidney and a
boycott patients from the police
department.
chance to live.
Sareen has been trying to justify
Some non-resident Punjabi
doctors also allegedly sent patients
what he has been doing. In an article
he wrote in a medical journal, he says
from the UK and the US for kidney
transplants. The greater the need for
that it may be more ethical to perform
a paid renal transplantation from a
the kidney, the more they paid the
doctors, who in turn persuaded the
voluntary unrelated renal donor than
from a related donor or a spouse,
poor donors to part with the organ for
under family pressure.
a song.
Medically, however, preference is
The issue is now becoming
given to a related donor, the world
political. Punjab Chief Minister
over. It could be that of a sibling or a
Captain Amarinder Singh appears to
parent or a child. When kidneys of
have got the second scam (the Punjab
relatives are not available, mOst
PSC scam was the first) in which he
institutes prefer to wait for a cadaver
alleges the connivance of his
predecessor Parkash Singh Badal.
kidney, rather than deprive a healthy
The chief minister said about 300
person of a kidney. “We cannot be sure
labourers had lost their kidneys.
Though the investigators are yet
'j j
to come up with a final figure,
The issue has become a
the chief minister said that 20battle between doctors and
25 people might have lost their IM
cops,
with the doctors
lives. It has been alleged that
deciding to boycott patients
Sareen paid Rs 50 lakh to Badal
for the Majitha byelection in
from the police department.
2001.

st-gar -

kidneys.
The ‘servants’ were put up in
shabby shacks, virtually in captivity, till
the surgery, and thereafter sent out on
to the streets. That is, if they did not
die on the surgeon’s table. When a few
died, the bodies were allegedly
cremated as unclaimed. As was
expected, the special investigation
team found none of these ‘servants’ at
the houses of the recipients, their
alleged ‘masters’.
Gurvinder Singh, a donor, told
investigators that he was kidnapped
and held in captivity for two months.
He lost consciousness one day and
when he regained it, he was without a

Not a single recipient has
been arrested so far. The special
investigation team figures that Sareen
ensured VIP recommendations for
every recipient so that his illegal
enterprise was secure, politically.
Many donors, on the other hand, are
behind bars for selling their kidneys.
According to Justice Bains,
Sareen’s name figures in most of the
cases registered by the police, along
with those of the donors. The names
of recipients, who paid hefty fees, are
nowhere mentioned.
Bains also has evidence that
certain hospitals and some doctors
from around the country had referred
kidney patients to Kakkar Hospital,
telling them that a transplant would
cost Rs 5 lakh.
Countless innocent migrants from
Uttar Pradesh and Bihar, who came to
Punjab with the hope of having a
better life, have been cheated in the
scam.
Sareen and Mahajan have been
arrested. They are, however, getting
support from the medical fraternity.
The issue is slowly turning out to be a

that it will help the patient,” says a
senior nephrologist.
Interestingly, the Chandigarh­
based Post Graduate Institute of
Medical Education and Research, a
premier hospital, has done very few
kidney transplants in the last fefy
years.
Many years ago, the institute
organised a sports meet of renal
transplant patients to demonstrate
that donors and recipients could lead
a normal life. The participants were
mainly people who had given kidney?
to their sons, brothers and other
relatives. The annual event was soon
given up and the hospital virtually
stopped transplant surgeries and
started campaigning for cadaver
kidney transplant. The reason,
according to a senior doctor, was the
death of a donor on the operating
table.
But in Amritsar’s Kakkar Hospital,
the death of several donors appears not
to have mattered, possibly because
they were nobodies.
■
Feb 2. 2003

37

Crime

Paying the piper
D-Company suffers yet another jolt
as Sharad Shetty is killed in Dubai,
By DNYANESH JATHAR & QUAIED NAJMI

engeance is mine’. Chhota
Rajan may not have said it in
so many words but the
Mumbai don is out to make rival
Dawood Ibrahim and company pay for
their mistake of mounting an
unsuccessful attempt on his life in
Bangkok, three years ago. On January
19, Rajan cut off Dawood’s right hand
when his button men gunned down
Dubai-based Sharad Shetty, who had
kept his boss posted about Rajan’s
movements prior to the Bangkok
operation.
Shetty, head of the Rami Group
which owns the Regent Palace and
Regal hotels in Dubai, was gunned
down at the lounge of the India Club,
a popular hangout of Indian
businessmen. As he walked in around
9 p.m. (10.30 p.m. 1ST) to attend a
dinner, he was confronted by two
nattily dressed youth in their mid-30s.
Before Shetty, 45, could react, they
pumped bullets into his chest and head
from point-blank range.
The police were immediately called
in but the assailants had by then
melted into the darkness outside. Two
hours later, Shetty s wife Shashikala,
who witnessed the shooting, was
escorted home. Shetty’s children—
daughters Swayam and Shraddha and
son Sandeep—were told about the
incident only later.
The shootout bore the stamp ofthe
underworld and shocked the
expatriate Indian community,
especially the businessmen among
whom Shetty was popular. It also
angered the Dubai Police. The hugely
popular Dubai Shopping Festival was
underway and the bloodletting could
not have come at a worse time. “We
will act tough with those who could be
a source of trouble,” said MajorGeneral Dhahi Khalfan Tamim, chief
58

Feb 2, 2003

of Dubai Police.
“The murder should be an eyeopener and it should encourage
us to review our visa and
investment policies. We should not
allow people with a criminal
background to stay amid us.”
His concern is not without reason.
Dubai desperately wants to avoid the
tag of being a playground of criminals
from the subcontinent, specially in
view of Uncle Sam’s war on terror.

The revenge trail
Munna Jhingada: Led the team of
sharpshooters in Bangkok. Now
in Karachi.
Vinod Shetty: Mumbai hotelier
who spied on Rajan. Killed in
Mumbai in 2001.
O.P. Singh: Maintained contacts
with Sharad Shetty. Killed last
year in Mumbai.

Sunil Soans alias Sunil Florist:
Helped Vinod Shetty. Killed last
year in Mumbai.
Guru Satam: Helped Vinod track
Rajan. Now possibly in Malaysia.
Sharad Shetty: Coordinated
intelligence against Rajan. Killed
in Dubai on January 19.

Meanwhile,

known as India Sports
Club, has been accused of
accepting members without
checking their antecedents. When
asked whether the club would review
its membership policy, its secretary
refused to respond.
T t will take a while for Dawood to
_L recover from the loss of Shetty, w1
hailed from Dakshina Kanna
district in Karnataka. Their friendship
goes back a long way. Senior Inspector
Pradeep Shinde of the Mumbai Police
crime branch said the two met in the
late 1970s when Dawood was still
making his mark in the underworld.
Shetty was then running a modest
jewellery shop in Jogeshwari, a
communally sensitive pocket of north­
western Mumbai. In those days,
Dawood was mainly dealing in
smuggled gold, and the friendship was
mutually beneficial.
“Gold consignments used to be
dumped in airport dustbins, to be
picked up later by sweepers on
Dawood’s payroll,” said Shinde. “It
would then be routed to Shetty.” In
1983, the duo was arrested by the
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