KOCHI: Was the state government aware of a possible violation of norms relating to organ harvesting by the hospitals? The tightening of rules over the last 11 years — the first set of guidelines, announced in 2012, was tightened in 2017 — suggests that the government had a needle of suspicion on the sensitive issue.
Organ harvesting made news again after the recent order of a judicial magistrate (first class) here, which summoned seven doctors of Kochi’s Lakeshore hospital following a complaint that an accident victim’s organs were harvested in 2009, flouting rules. The case relates to transferring a kidney of 21-year-old Abin, a native of Thodupuzha, to a Malaysian citizen after the former was declared brain dead following a bike accident.
Suspicions about the possible malpractice in declaring the patient brain dead and growing concerns among the public about illegal organ harvesting had forced the government to revise the guidelines to issue brain death certificates.
The number of deceased organ donors in Kerala, which stood at nine in 2012, rose to 58 in 2014 and 76 in 2015, as per the Kerala Network for Organ Sharing (KNOS) data. In 2016, too, the figure was as high as 72.
In the first set of rules issued by the Kerala government in April 2012, the government said four doctors, including one resident medical practitioner and one independent resident medical practitioner nominated by an appropriate authority, should certify that the patient is brain dead. A neurologist approved by an appropriate authority and the doctor treating the patient comprised the remaining two members of the board.
As the number of deceased organ donors spiked, a Public Interest Litigation alleging malpractice in declaring a patient to be brain dead when he/she is not actually so was filed by Dr S Ganapathy, a Kollam-based retired medical practitioner, in May 2017. Meanwhile, the government came out with another order, dated February 2017, which further tightened the rules on the brain death certification process. Under the new rule, the real-time videography of the brain death certification must be produced for both the apnoea (examination for determining brain deaths) tests.
The new changes, which made the process tighter, also required that the panel of doctors should include one doctor from the government service. “Recently, some concerns were expressed that the current guidelines had loopholes which could raise concerns about the genuineness of the brain death certification process,” states the order dated February 1, 2017.
However, a top government official, who was then with the health department, told TNIE that the new order was issued to convince Dr Ganapathy and also the public. “Dr Ganapathy’s case led to a decline in the number of brain deaths, and the second order was issued by the government to convince him and the public,” said the officer with the department of health services, on condition of anonymity. In 2017, the number of deceased organ donors declined to 18, and the figure for 2022 is in the single digit at nine.
Speaking to TNIE, Dr Ganapathy said: “When I was admitted to a hospital for heart surgery, I planned to donate my organs if something happened to me. However, my daughter alerted me that there is a mafia behind organ donation.” He said he filed the complaint after seeing a sharp increase in organ donation in Kerala in the 2014-2016 period. He also said he believes that the system is not transparent as there were no strict rules.
When contacted, Rajeev Sadanandan, Kerala health secretary in 2017, admitted that the new rules on deceased organ donation were tightened following concerns regarding loopholes among the public. “The after-effect of the controversy is that the relatives of brain-dead patients may deny organ donations, affecting those waiting for donors at KMOS,” he said.
Following the court order, Lakeshore Hospital, in a detailed statement last week, clarified that all tests were performed after obtaining written consent from the mother of the deceased to conform to Transplantation of Human Organs laws in the presence of two witnesses. “Allegations of serious dereliction of duty against the doctors regarding the brain death of Abinand that the brain death certificate was wrongly issued, were factually incorrect,” it said.
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