Date : June 6, 2013
MUMBAI: Instead of simplifying the process for organ donation, the Centre seems to be imposing more bureaucratic hurdles and adding to the trauma of donors' family members.
A draft of fresh national guidelines for organ transplant says forensic departments of government hospitals will play a pivotal role in organ donation. The problem, say experts, is that grieving relatives may have to wait longer—first, for busy, overworked forensic experts from understaffed departments to turn up for the donor operation at the transplant centre and, second, for the donor's post-mortem to be completed at a different centre.
The guidelines are part of the Centre's plan to introduce an all-India transplant programme along the lines of the American one. The draft for the Transplantation of Human Organs Act, put up on the website of the Union ministry of health and family welfare for feedback, says forensic doctors need to be present during organ retrieval operations to check whether organs are suitable for retrieval. Next, the body will be taken to a government-designated centre for post-mortem.
"There is a perennial shortage of forensic experts. How can they leave their work at post-mortem centres and rush to be present at a retrieval operation?" said Dr Vatsala Trivedi, who conducted the country's first cadaveric kidney transplant in Sion Hospital in 1997.
She feels the step will not only add to the woes of grieving relatives, but also the retrieval team and the hospital. "It would be desirable to have rules that are donor-friendly rather than adding unnecessary bureaucratic hurdles."
Chennai-based C E Karunakaran of NNOS (National Network of Organ Sharing) said, "Forensic doctors have no incentive or motivation to rush for organ transplant. Worse, what if the retrieval is scheduled for the middle of the night?"
Given the workload on forensic doctors, experts feel they may not be able to reach hospitals (where retrieval operations are scheduled) in time before a brain-dead person's heart stops beating. Solid organs like heart, liver, kidneys, lungs, etc, can only be retrieved when the patient is in the irreversible state of brain death.
In Tamil Nadu, private hospitals can take a no-objection certificate from the government and perform post-mortem with the help of a specially appointed doctor, says a former forensic expert. "But why is a post-mortem needed at all if it is a clear case of road accident?" said Karunakaran. He feels the US system should be followed in which forensic doctors rely on the transplant surgeon's assessment for post-mortem.
In Mumbai, where a zonal transplant coordination centre (ZTCC) oversees the distribution of organs and post-mortems on donors, there have been instances where donor families have suffered due to delays in getting police permission for post-mortem. "With India planning a national organ sharing mechanism so that organs from one city can be sent to another, a uniform mechanism for declaration of brain death and post-mortem is important," said Dr Gustad Daver, who heads ZTCC-Mumbai. He underlined that the point was not to trouble families who are in grief.
Dr Sunil Shroff of Chennai's Mohan Foundation said, "This requirement will prolong the post-mortem unless it is done on the same premises and this will mean delays in handing over the body to relatives."