Organ Transplantation In India

Key Takeaways

• Organ transplantation is a gift to the medical sector since it has saved the lives of people who might otherwise have died.
• Establishing an Authorization Committee (AC) and Appropriate Authority (AA) in each state or union territory to regulate transplant activity. Each one has a distinct function.
• Transplantation is a time-consuming and costly procedure for which there is no state funding.
• The Transplantation of Human Organs Act, 1994 allows the medical practitioner the authority to remove organs for donation if the body is not claimed by relatives within 48 hours of death.

Introduction

Human organ transplantation is a significant success story in medical science and technology. In medical words, a 'transplant' is a procedure in which a portion/part of the body or a whole organ is removed from its original location and transplanted to a new location in a different person.

However, because the number of patients in desperate need of a transplant far outnumbers the number of donors available, legislation is required to prevent the illegal commercialization of organ transplantation.

History

In comparison to the world's most industrialized countries, India has a far shorter history of organ transplantation. In the 1970s, India was the first country to undertake a kidney transplant. In the 1980s and early 1990s, transplantation activity increased, but it was mostly limited to live donor kidney transplants in a few major regions. Kidney transplantation activities gradually increased as additional facilities opened and the number of trained personnel increased. However, this resulted in the well-known kidney trafficking in India in the 1980s, which received widespread media attention. Patients from all over the world began flocking to India for transplants from a paid donor.

In response to the growing kidney scam in India, the Indian government formed a committee in 1991 to produce a report that would serve as the foundation for regulations governing organ transplantation throughout the country. It was also done in order to provide a clearer explanation of the term "brain death."

The Transplantation of Human Organs Act, 1994 (THOA) was passed by the Indian government in 1994. Furthermore, in 1995, the Transplantation of Human Organs Rules were changed, expanding the scope of donation and adding tissues for transplantation. The Act made organ marketing illegal and formalized the idea of brain death in India, allowing for deceased organ donation from brain stem dead people.

Regulatory Bodies

Advisory Committee

• For a period of two years, it was to be chaired by an administrative specialist who was not below the level of Secretary to the State Government.
• Two medical professionals with a medical postgraduate degree and at least 5 years of work experience in the field of organ or tissue transplantation should accompany him/her.
• The goal of the committee is to assist and advise the appropriate authority (AA).

Authorization Committee

• The goal of this committee is to accept or reject applications from donors (other than family) to ensure that they are not being exploited by making a donation for monetary gain.
• The AC examines the donor's and recipient's combined application and performs an interview to confirm that both parties have genuine intentions and that the donor is aware of the surgery's potential hazards.

Appropriate Authority

The goal of the Appropriate Authority is to govern human organs:

• Removal
• Storage
• Transplantation

These duties can only be performed if the hospitals have been granted a license by the authorities. The procedure of removing the eyes of a deceased donor, on the other hand, is not required, is not regulated, and does not require licensing procedures.

The AA's functions include

1. Hospitals for transplant surgery are inspected and registered.
2. The hospital's required standards are enforced.
3. Conduct regular inspections of the hospital to assess the quality of transplantation and follow-up medical care for both the donor and the recipient, as well as an inquiry into any potential violations of the Act.

Punishment under the Act

• According to Section 18 of this Act, anyone who is responsible for the removal of a human organ or tissue with the right to do so can be sentenced to ten years in prison and a fine of up to Rs. 20 lakhs. If that person is a medical professional, the AA will submit his name to the State Medical Council, which will take necessary measures, such as deleting his name from the council's register for three years for the first crime and permanently removing it if he/she commits another infraction.
• If a person engages in the commercial trading of human organs, he or she can be sentenced to a term of imprisonment of not less than 5 years, but not more than 10 years, as well as a fine of not less than Rs. 20 lakhs, but not more than Rs. 1 crore, according to Section 19.
• In accordance with Section 20, Any individual who breaches any other provision of this Act can be sentenced to up to 5 years in prison or fined up to Rs. 20 lakhs.

Current scenario

• An ICU is needed to diagnose a brain-dead donor because it has the facilities to keep the patient's remaining organ systems alive. However, there is a shortage of such ICUs, which are mostly concentrated in major cities. These are already overworked, understaffed, and operated without a centralized command structure. So, on one hand, there is a dying patient, and on the other, there is a patient who is already dead but requires special attention in order to successfully retrieve body organs. As a result of this condition, medical practitioners instinctively place a lower emphasis on the brain-dead patient.
• Obtaining consent (informed consent) from family can be a difficult process. The doctor in charge of the treatment may not be sufficiently motivated to obtain such approval from the families. In other circumstances, the patients may be without relatives or may not be present when the brain death diagnosis is made. Although the Act grants the medical practitioner the ability to remove organs for donation if the body is not claimed by its relatives within 48 hours of death. If the person's family is found after the time period has passed and protest to the act, it could be a major issue. Furthermore, organ donation is not a decision made by a single relative, and the entire family may require persuasion, resulting in the loss of critical time.
• Transplantation is a time-consuming and costly procedure for which there is no government financing. The majority of deceased donation occurs in the private sector, according to reports. Furthermore, many donors and recipients come from private facilities. This creates an imbalance in terms of accessibility, regardless of their ability to pay, because the bulk of organs are currently going to the wealthy, while the poor do not have the same opportunity.

Conclusion

One of the most significant advances in medical science and technology is organ transplantation. However, not everyone will be able to reap the benefits of this achievement. In its current form, a cadaveric donation in India mostly favours the wealthy and supports only a small fraction of patients who seek it. It has also resulted in underprivileged people being exploited.As a result, while we should strive to increase contribution rates, we must not lose sight of the overall picture. Many of the concepts and methods used in modern deceased donor transplantation come from the developed West, where social values and health systems differ from those in India. We need to create an egalitarian, open, and non-oppressive framework in India. This will be a long and difficult process, one that may be linked to the larger fight for a more advanced and accessible healthcare system for all.