THIRUVANANTHAPURAM: Organ donation is in news again, but for the wrong reasons. It’s feared that the controversy raging over organ donation at Lakeshore Hospital in Kochi will further debilitate the deceased donor transplantation programme of the state government. The number of life-saving donations from the deceased has registered a dip in the past few years after a Malayalam film portrayed the operations of an organ trade mafia, triggering fear and suspicion among the public.
In 2015, as many as 218 transplant surgeries were performed following cadaveric organ donations, but the number plummeted to just 37 in 2022. The number of annual transplantations over last two years comes in at 50. This at a time when more than 3,000 patients await liver and kidney transplants in the state. According to advocates of organ donation, the latest controversy has created more sceptics, besides reinforcing the doubts regarding organ trade.
“People have concluded that the doctors have already been punished by the court. This controversy has caused immense damage to the deceased donor programme,” said Mathew Philip, chairman of the Liver Foundation of Kerala (LIFOK), a charitable organisation supporting liver transplant surgeries. He himself had received a donor liver eight years ago.
“People have publicly announced that they will no longer donate organs. Ironically, this will aid the organ mafia involved in exploiting impoverished patients to sell their organs. When the deceased donor programme is affected, patients will turn to live donors,” Mathew added.
One of the key objectives of the cadaver organ donation project is to safeguard the vulnerable poor from organ trafficking. The state government initiated the ‘Mrithasanjeevani’ (KNOS) programme to coordinate cadaveric organ donation in 2012 — three years after the controversial transplantation happened in Lakeshore Hospital. Transparency has since improved and KNOS transformed into the Kerala State Organ and Tissue Transplantation Organisation (K-SOTTO).
“Clear-cut guidelines have been formulated to avoid confusion and improve transparency. While the Transplantation of Human Organs Act (THOA) 1994 laid the foundation, the amendment in 2014 gave more clarity on the procedures related to brain death declaration in various states. Despite these changes, the deceased donor programme has suffered due to the allegations,” said Dr Noble Gracious, executive director of K-SOTTO. He clarified that no hospital had tried to harvest organs from unidentified bodies.
Under the current protocol, hospitals are required to form a committee of four doctors to certify brain death.
Tw of the doctors must be from the empanelled list of the Directorate of Medical Education. The doctors must provide certification twice, with a six-hour gap, confirming brain death. Normally, the doctors certifying brain stem death inform the patient’s relatives about the same.
The recent controversy revolves around the death of Abin VJ, a 21-year-old who suffered a severe head injury in a bike accident in November 2009. He was declared brain dead, and his liver was donated to a Malaysian recipient with the consent of the donor’s mother. On May 29, a court in Ernakulam issued summons to the hospital’s doctors based on a private complaint alleging procedural lapses in treatment, death declaration, and organ donation.
The hospital issued a statement clarifying that the court order aimed to verify the truth of the complaint and emphasised that all medical procedures, organ donation laws, and human rights laws were strictly followed during the incident.
Procedures to declare brain death
The hospital forms a four-member committee
Committee comprises medical superintendent and treating doctor, and two doctors empanelled by DME
Four doctors to examine the patient twice with a six-hour gap
Inform patient’s relatives about brain death
Get consent of relatives for organ donation in presence of two witnesses
Family can ask for stopping of treatment or sign the consent
If there is a consent for organ donation, hospital informs K-SOTTO
K-SOTTO solely responsible for the allocation of organs to hospitals
If there is no consent, the body is handed over to relatives, or for postmortem for medico-legal cases
Who can donate
Near relatives
Any person other than near relatives can donate for the reason of affection