De-Lurking on the Net

August 16, 2012

Organ Shortages Around the World And Unresponsive Governments

While the Syria Crisis is on and there are unavoidable deaths taking place not just in Syria, Afghanistan, Pakistan and other places, does the mind not wander if these deaths can bring someone else to life? Definitely it does. Most govts. around the world however considers that organ donations should only come from altruism or someone’s own will. What if some one never had a time to reflect and convey the will to donate when the death came. Such a time could be when a suicide bomber brings the death to innocents. When I think, that Ajmal Kasab, the only captured terrorist of Mumbai mayhem in Nov 2008, has got no right to live, would it not be nice if after his death, his organs could be used to give life to others. After all he killed so many. But would anyone accept his organs? I personally would not mind to have his. World Medical Association thinks no prisoner can give a real consent for organ donation so it is unethical to use any prisoner’s organs. But when a condemned prisoner has died following a death sentence, why those organs of that person be wasted and not be used for someone needing them?

(Illustration courtesy: Deccan Chronicle newspaper of southern India)

An article appeared few days back in Guardian paper from UK body worth more than alive“. The article author wanted to sell all her organs and everything else but no body was interested even though she got the prospective prices for body parts as selling or trading of organs is outlawed. Perhaps, she was just testing the waters for writing an article. If, she had discovered some underground organ trade in UK, there would have been alarm in media and it would have become a big news.

In China, few days ago, a nationwide trafficking ring of organ traders was busted that included doctors . On Pakistan TV (PTV) recently, I saw a reporter doing a live sting operation and talking to a doctor(specialist in transplants) pretending to need a liver and kidney. The doctor readily agreed to arrange it for certain amount of money and was willing to meet the reporter next day. In India, last week a prominent politician died needing liver because the family of dead donor suddenly reversed the decision to donate. There was a big illegal organ trading in India in the past and it is quite likely that it must be even now. People were getting kidnapped from roadside and when waking up they were discovering they had lost their kidney. This illegal organ trade in India, China was bringing medical tourists until recently, perhaps it still does.

There is an acute shortage of organs world wide. When new treatments are evolving all the time, it seems incredible that countries are not moving fast enough to make more organs available. Every year, 1,50,000 Indians need either transplantation or dialysis Just 3,500-4 ,000 kidney transplants are performed annually in India. In UK, about 1,000 people die each year because they do not get a transplant, according to NHSBT, its nationwide transplant donor organisation. To reform the organ donation system, NHS is running a survey. After the survey, it will try to emulate Israel where they give priority to those who are already on the donors list themselves. They will also try to introduce opt out system (presumed consent) of organ donation like 17 other European countries in particular Belgium and France. US and UK currently practice opt-in system like India does. But at least there is a nationwide donor database in US and UK unlike in both India and China.

                                                                                                                                                                                 In India, Transplantation of Human Organs Act was passed in 1994 and rules were made in 1995. These rules have been recently amended in 2008. The main purpose of the act was to regulate transplants and promote deceased (cadaver) donor organ transplant. Still the bureaucratic nightmare one has to face is very frustrating. Even those who want to donate can not do so easily.    Of
course, if the donors are next of kin and from the same state then perhaps donation can be accepted without too much paper work but otherwise get NOC from respective state authorities. In accidental deaths, police has to give no-objection certificate after autopsy and dead bodies have to be sent to transplant registered hospitals. The doctors are not allowed to visit for organ harvesting . Often it is too late when the organs are collected. Organ donation does not need big funds to operate. There is a good trend setter NGO, MOHAN based in southern Indian state, Tamil Nadu, which is becoming a model for other states to follow. But it can not be a state issue. The govt. of India need to make national donor register and transplant co-ordination body and remove all bureaucratic hurdles. I wonder if it is general apathy or inaction present in all Indian policy making . It is regrettable when we know one person ‘s donation can benefit 25 others.

There is a time window for organ collection.

Hearts/Lungs

4-6 Hours

Liver/Pancreas/intestines

12-18 Hours

Kidney

36+ Hours

During all this time, if the donor and recipients have to run from pillar to post than death is the only outcome even if one is rich or powerful person.

In US, the Organ Procurement and Transplantation Network Network (OPTN) was created by the Organ Transplant Act of 1984 by United Network of Organ Sharing (UNOS). Even though, it has best records for cadaver collection for opt-in countries. The rules state that all hospitals should report any death to local organ procurement organisation (OPO) which then discusses the issue of donation with the prospective donor’s family. However, the availability is uneven across all of US. In Spain, which has got even better record than US, there are dedicated referral units attached to every hospital.

In China in 2007, its Chinese Deputy Minister of Health Huang Jiefu admitted that there were 95% organs used for transplant came from executed prisoners. After a media and worldwide scrutiny, they agreed to restrict this from donors to their immediate relatives. The world Medical Association thinks it is unethical to take organs from prisoners because they can not consent organ donation of their own free will. It is said that selling violate human dignity,  eliminates the measure of true charity for making such a donation and promotes a market system which helps those who can pay. A French pharmaceutical company buys placentas from Canadian hospitals to manufacture vaccines and other blood products . In US, sometime back a family resorted to conceive and abort pregnancy in order to get tissue for their suffering child. This may be the state of things to come but should such a family be condemned or helped? Why should such universal organ shortages be there?

Not all people are born equal. Some  minds only comes once in centuries. It may be anathema for socialists and liberals to accept it, but I believe, there is a need when the human race may want to save its best people. Suppose, Einstein needed an organ tomorrow and he is the last person on the waiting list and dies. Will it not be our incompetence then not to be able to save him? I suppose not only there should be national organ banks like countries have blood banks but also these all organ banks should be linked across the world. There should be an international body like Red Cross for collecting and donating both blood and organs. Like Red Cross, it should be allowed to work even in war torn areas and exempted from attack from all sides. There simply can not remain only two sources for organ transplant– live donors and deceased ones who have already given consent. No dead bodies should be wasted – let that be of a prisoner, attack, accident victim or one due to natural death. So, opt-out or presumed consent for all countries is a must.

No religion condemns organ donation. There is nothing better than after the death of a person if part of him or her can still live. For a burial or cremation, there is no use to save an organ. So, why would anybody mind to donate is beyond me. I have several friends who all have got diabetes which is one of the main disease that may cause organ failure. So, I dread about them. In 1995, my father died. I did not know at the time, being a doctor, he had desired to donate all his organs. Because there was no national donor register in India, so no body brought this up. It was my brother, who only knew about his desire but forgot in the grief of his sudden death. We all regretted it greatly afterwards for not being able to carry out his wish.

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