Promoting cadavers

Every year, over 16,000 patients across Andhra Pradesh and Telangana state reach end-stage kidney failure. They are then added to the pool of dialysis patients. Dialysis could mean long periods of sustained pain. But there’s also a solution — which is simple, cost-effective and yes, sensible. Because from that massive number of kidney patients just about an estimated 1,000 patients get transplants done either from cadaver or from a live donor. With about two lakh patients and only 5,000 transplants presently in a year, the demand-supply gap is huge. The reason for this is lack of donors. Source of kidneys for transplantation is either cadaver donor or live, related donor. But, most patients on the cadaver list die waiting for a kidney.

Amitava Sinha Roy clearly remembers his days of dialysis — even if it was seven years ago. The procedure meant 10 months of treatment, three to four-hour sessions per week and endless pain. “I never looked forward to dialysis treatments. They were extremely painful. Two needles were inserted into my arm and my blood was pumped out by a machine, purified and then sent back into me. There was tremendous pain. I was lucky that my wife’s kidney matched and that there was a transplant. Many patients wait for years for a donor and many just die without finding one.”

Post-procedure is not a great time either. “To keep the transplanted kidney in place, immuno-suppressant medicines are given. But these depress your body’s immune system and hence a transplant patient is far more perceptible to infections, specially chest and urinary tract. Apart from personal hygiene and avoiding dirty spaces, public bathrooms, personal contact etc., I have to monitor my diet, avoid street food. Food should be cooked in approved oils, like olive oil and sunflower oil, and raw fruit and vegetables should ideally be avoided.” And who better than Amitava when it comes to the importance of kidney transplants from cadavers. “A cadaver can provide organs for 33 patients. This also stops kidney patients from undergoing painful dialysis.” Kidney connections According to a 2007 report by the World Health Organisation, around 2,000 Indians sell a kidney every year. With rising numbers of end-stage kidney failure patients, the demand for kidneys is very high. Dr Pradeep Deshpande, professor of Nephrology at Gandhi Hospital, says: “The touts are able to exploit extremely sick patients who urgently need money for medical expenses or who require money to support family after their death. In this case, they carry out check-ups, prepare false documents and get their kidneys donated to those who are in need.”

In AP and TS, it has been found that 16,000 patients reach end-stage kidney failure every year and are added to the pool of dialysis patients. Dr Alla Gopala Krishna Gokhale, Cardiac Surgeon, Apollo Hospitals, also one of the first doctors in Andhra Pradesh to perform a successful human-to-human heart transplant and first successful lung transplant, says, “The only way to stop organ trafficking is to promote cadaver donation. To run the transplant programme smoothly in any other state there is a need to develop proper cadaver donation programme. So many accidents happen in the country. Several people have brain injuries. If we are able to encourage cadaver donations we may be able to meet requirements. The government should also provide some incentives in case of poor donors.” LOOPHOLES The Organ Transplant Act is comprehensive. At the same time illegal organ trafficking is thriving so why not make it legal and put a curb to it Argues Dr Gokhle, “People from small places call us and say, they want to donate organ because they need money. When we don’t encourage them they approach touts, who make money out of it why not make it legal That way, the donor can directly approach the recipient who in turn can take care of the donor. There will always the supply and demand. In India, it’s illegal so people go to Sri Lanka and get the transplant done.”

The supply-demand gap for donor organs paves the way for illegal transplants and trade of human organs. “As with any other Act, 100 per cent fool-proof implementation is not possible. For instance, the Act strictly prohibits any financial transactions between donor and the recipient family. Another grey area is establishing the relatedness between the donor and recipient in a live transplant. Prescribed documents and medical tests to establish relationships are required in such cases,” says Dr R. Chandrasekhar, Executive Vice President, Yashoda Hospitals.