‘Transplant surgeons are victims of organ donation abuse’ | Nagpur News

Nagpur: Following FIR against doctors in recent Kidney Transplant malpractice allegations involving husband and wife at Ruby Hall Clinic, Pune, Indian Society of Organ Transplantation (ISOT) reported harassment presumed by saying that such coercive action would block the transplants. Dr. Sanjay Kolte, vice president of ISOT, says such action demoralizes hospitals and doctors. It’s the licensing committee’s job to vet relationship requests, but it’s about dealing with doctors who are at the receiving end when a scam surfaces, the transplant surgeon and urologist said in an exclusive interview with YOU.
Dr. Kolte, who is also the secretary of the Zonal Transplant Coordinating Committee (ZTCC), talks about the progress of transplants in Nagpur.
Excerpts from an interview…
Q. How are transplants governed?
A. The ZTCC has no role in living organ donation. The Human Organ Transplantation Act (HOTA) governs related donations – involving husband-wife, brother-sister, parents, grandparents and grandchildren. The hospital authorization commission is the decision-making body for tied donations. The law does not say “no” to an unrelated organ transplant, but the matter is referred to the state licensing committee. Thus, there are different governing bodies for deceased and living donations. Under HOTA, the umbrella organization for deceased donation is NOTTO (National Organ Transplant and Tissue Organization), five regional organizations (ROTTO), and SOTTO in each state. ZTCC in Maharashtra predates NOTTO so it has not been dissolved and they actually replace SOTTO in the state. All patients on the waiting list receive a NOTTO ID to decide on priority. ZTCC allocates based on ID.
Q. Who is responsible for verifying relationships?
A. Usually doctors are not involved in any kind of malpractice. Doctors are victims of these embezzlements. Certificates of kinship and supporting documents are issued by relatives. The responsibility lies with the relatives. If at first glance there is no doubt, a doctor will not go into details. Nor do doctors have the powers or means to verify identity documents. Their basic and most important job is to ensure a safe and successful transplant. If there’s a mess in the transplant, you can hold a doctor responsible. The doctor is already stressed to ensure the success of the operation. But they are overwhelmed with the verification task. If someone introduces himself saying that he is a relative and that he wants to donate his organ, a doctor explains the process and sends the file to the committee. If the committee approves, they do it.
Q. What leads to malpractice?
A. When a patient is in dire need or the risk of death is high, they fall prey to middlemen, who have a well-oiled system. In the Ruby Hall Clinic case, a similar alleged incident took place. The doctors were absolutely not involved anyway. All of these events disrupt the transplant campaign.
Q. What impact do these incidents have on hospitals?
A. All related living transplants are bound to have an impact if things are not fixed. HOTA does not attribute any responsibility on the proof of the relationship. It is the authorization committee that approves the request and the doctor executes. Absent this, everyone in the system is reserved when malpractice surfaces. Then the doctor, vehicle of the ultimate journey, finds himself trapped. If doctors are unnecessarily reserved or if time is wasted proving their innocence, they will be discouraged from specializing in transplants. Hospitals, too, would think twice before encouraging living related transplants. And patients would continue to linger on the waiting list, search in remote places, or fall prey to such scams.
Q. What is the solution?
A. Patients need to behave more responsibly. More and more people should promise organs. Commitment is not difficult. Hospitals should proactively start identifying brain-dead patients. Intensive care units should play a role in convincing relatives to donate organs. Relatives should also check if the patient is brain dead and how the organs can be used.
Q. How do you sum up this two-decade-old journey of organ transplantation in Nagpur?
A. Progressive but not ideal. Initially we started with one hospital and slowly other hospitals followed. Every year we have seen an increase in the number of transplants. At the transplant institution should have been a reality now. A place that stood out as the first to do a corpse transplant in 2013 and encouraged other cities to take it over has fallen behind in its completion. After 2013, we also started doing liver transplants. We have also partnered to send heart and lungs to remote places like Delhi, Mumbai and Chennai. But we still face problems in transplanting these organs in Nagpur.
Q. Why are heart and lungs still not used here?
A. Relatives of the deceased donor are usually unwilling to wait the extra 10-12 hours required for the transplant team to reach Nagpur and retrieve the organs. They are in a hurry to perform the last rites. The region needs to eliminate this backlog.
Q. Will a dedicated institution help?
A. We started Kidney Transplant at GMCH Nagpur in 2016. After that, the medical school should have acquired a comprehensive organ transplant program. Unfortunately, that never happened after six years. Even the Jawaharlal Nehru Medical College in Sawangi, offering specialty and postgraduate courses in all subjects, should have set up a dedicated center.
Q. What is holding them back?
A. A stable workforce is a problem in rural areas. Doctors come here for a year or two, gain experience and leave. Nagpur has a viability problem. Kidney transplant is the cheapest, liver is more expensive and heart is the most expensive among them. Some dedicated centers are being planned, but hopefully GMCH Nagpur will also offer one.
Q. How many patients are on the waiting list?
A. About 400 are waiting for a kidney transplant, more than 150 liver transplants and as many heart and lung transplants. But since people know that these transplants are not done, they do not enlist. So the number may be higher. After Covid, lung failure became common. Successful lung transplantation also occurs in these patients. Patients have therefore started registering in Nagpur. We are waiting for a hospital to provide this facility here.
Q. Why is the deceased donation rate still low?
A. We have performed 89 transplants from brain-dead patients, but not from circulatory-dead patients. Donation by a patient with circulatory death is increasingly recognized. When the heart stops working and the organs are recovered within a specified time, it is called circulatory death. It is also called donation after cardiac death (DCD). Few centers in India perform DCD. Once the law specifies guidelines, this will become more common and acceptable. The consent of relatives is still a big problem. Generally, people don’t pawn their organs. If a person did it in their lifetime, we don’t need anyone’s permission to harvest their organs after they die. In the absence of a pledge, the donation depends on the family. The success rate is high among family members who are aware of organ donation. But if they are not aware, the donation counseling rate is lower.


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