Organ Transplantation
Organ transplant is the moving of an organ from one body to another (or from a donor site on the patient's own body), for the purpose of replacing the recipient's damaged or failing organ with a working one from the donor site. Organ donors can be living or deceased.Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, penis, and intestine. Tissues include bones, tendons, cornea, heart valves, veins, arms, and skin.In most countries there is a shortage of suitable organs for transplantation. Countries often have formal systems in place to manage the allocation and reduce the risk of rejection. Some countries are associated within international organisations like Eurotransplant in order to increase the supply of appropriate donor organs and the organ recipients.Organ Transplantation is a boon to medical industry as it has helped in saving the lives of those who would have died otherwise.
Types of donor:-
Living donors, the donor remains alive and donates a renewable tissue, cell, or fluid (e.g. blood, skin); or donates an organ or part of an organ in which the remaining organ can regenerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, small bowel). Deceased (formerly cadaveric) are donors who have been declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be excised for transplantation. Apart from brain-stem dead donors, who have formed the majority of deceased donors for the last twenty years, there is increasing use of Donation after Cardiac Death - DCD- Donors (formerly non-heart beating donors) to increase the potential pool of donors as demand for transplants continues to grow. These organs have inferior outcomes to organs from a brain-dead donor; however given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered.
Comparitive Cost:-
One of the driving forces for illegal organ trafficking and “transplantation tourism” is the price differences for organs and transplant surgeries in different areas of the world. According to the New England Journal of Medicine, a human kidney can be purchased in Manila for $1000- $2000, but in urban Latin America a kidney may cost more than $10,000. Kidneys in South Africa have sold for as high as $20,000. Price disparities based on donor race are a driving force of attractive organ sales in South Africa, as well as in other parts of the world. In China, a kidney transplant operation runs for around $70,000, liver for $160,000, and heart for $120,000 [21]. Although these prices are still unattainable to the poor, compared to the fees of the United States, where a kidney transplant may demand $100,000, a liver $250,000, and a heart $860,000, Chinese prices have made China a major provider of organs and transplantation surgeries to other countries.
Warehouse for kidneys:India
For years, India has been known as a "warehouse for kidneys" or a "great organ bazaar" and has become one of the largest centers for kidney transplants in the world, offering low costs and almost immediate availability. In a country where one person out of every three lives in poverty, a huge transplant industry arose after drugs were developed in the 1970's to control the body's rejection of foreign objects. Renal transplants became common in India about few years ago when the anti-rejection drug cyclosporine became available locally. The use of powerful immuno-suppressant drugs and new surgical techniques has indirectly boosted the kidney transplant activities.The poor and destitute, victims of poverty, have either willingly sold their kidneys to pay for a daughter's dowry, build a small house or to feed their families or have been duped or conned into giving up their kidneys unknowingly or for very little sums of money.Due to the naiveness and desperation of poor, along with the fact that donating a kidney isn't particularly risky as it does not impair one's health, kidneys have become easily available in India. Combined with low costs and the emergence of an illegal kidney black market which caters to the kidney buyers from around the world, many foreigners and the rich in India have taken advantage of and benefited from the kidney trade.
Organ Transplantation Act 1994:-
An Act to provide for the regulation of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. Organ transplant law does not allow exchange of money between the donor and the recipient. According to the Act, the unrelated donor has to file an affidavit in the court of a magistrate stating that the organ is being donated out of affection. After which the donor has to undergo number of tests before the actual transplant takes place. The Authorization Committee set up for the purpose ensures that all the documents required under the act have been supplied. If it is found that the money has been exchanged in the process then both the recipient as well as the donor is considered as prime offenders under the law.
Loopholes and Solution to Curb the defects:-
Only an affidavit has to submitted to the Authorization Committee for clearance. Sure enough, the committee has been flooded with affidavits prepared by middlemen in connivance with the hospital staff, police and at times, even committee members.
The Act has to been amended. The clause relating to emotional donors should be struck off. In the West, 20,000 transplants take place annually, all from cadaver patients. But in India the figure stands at a dismal 4000-5000 transplants per year. Secondly, the wife should be excluded from the clause. Instead, cousins, nieces, nephews, uncles, aunts should be included. A HLA Tissue typing should be made mandatory to ascertain the relationship of the donor with the patient.
The Hon’ble High Court of Delhi in CWP No. 813/2004 vide its order dated 06.09.2004 had set up a Committee to examine the provisions of Transplantation of Human Organs Act, 1994, and the Transplantation of Human Organs Rules, 1995. The report was submitted on 25.05.2005.
A National Consultation was held on 18.05.2007 and the report was submitted in the second fortnight of August 2007. The recommended changes required amendments in the Transplantation of Human Organs Act, 1994 and the Rules framed there under. These changes are intended to facilitate genuine cases, increase transparency in transplantation procedures and to provide deterrent penalties for violation of the law. In so far as the Act is concerned, the following amendments have been proposed:
1. To empower Union Territories, specially Government of NCT of Delhi to have their own appropriate authority instead of DGHS and / or Additional DG (Hospitals).
2. To make the punishments under the Act harsh and cognizable for the illegal transplantation activities to deter the offenders from committing this crime.
3. To provide for registration of the centers for removal of organs from the cadavers and brain stem dead patients for harvesting of organs instead of registration of centers for transplantations only.
4. To allow swap operations between the related donor and recipients who do not match themselves but match with other similar donors / recipients.
There may be socio-economic disparities in India which encourage illegal trading in organ but the ineffective implementation of the laws is the single major cause of such illegal trading. Recently the boom of medical tourism which is very cheap in India may be another reason for flourishing of such trade. Kidney racket unearthed last year in Gurgoan clearly depicts the loophole in our legal and implementation system, which is required to be addressed as quickly as possible.
About the Author
Manik Grover,New law college,Pune
Comments
