A recent court order sparked the social media buzz over unscrupulous practices in the cadaver transplantation process.
There is a need for more people to will their organs post-death to meet the huge demand. (iStock)
A mass campaign to clear doubts and misperceptions surrounding cadaver organ donation — donating the organs of the deceased — is on the cards in Kerala. This follows a social media buzz over rumours of unscrupulous practices in the cadaver transplantation process.
The campaign, it is said, is being launched also out of fear that the allegations might further dent the cadaver organ donation rate in Kerala — which is already quite low for a literate and socially-aware state.
The campaign will be under the aegis of the Kerala State Organ and Tissue Transplant Organisation (K-SOTTO) — the apex body that regulates the removal, storage, and transplantation of human organs and tissues for therapeutic purposes in the state.
Speculation about shady practices in organ transplantation have been flying thick and fast on social media after a 29 May order by the Judicial First-Class Magistrate-VIII of Ernakulam came into the limelight on 13 June.
The court, while considering a complaint regarding the harvesting of organs in contravention of the Transplantation of Human Organs Act of 1994 in an accidental death case in 2009, found a prima facie case against Lakeshore Hospital and Research Centre in Ernakulam, and eight doctors.
As the court found sufficient grounds for proceeding against the accused, it directed the issuance of summons to all of them.
Dr Noble Gracious SS, executive director-cum-member secretary of K-SOTTO, told South First, “We need not get deterred by the negative campaign that is being carried out with malicious intent.” He added, “We will definitely plan a campaign to counter this.”
However, he remained tight-lipped about the details of the campaign.
Sources in K-SOTTO, however, said a mass-media awareness campaign highlighting accountability and transparency in the state’s organ donation and transplantation system will soon be launched.
Targeted campaigns using transplant procurement managers, who are appointed by hospitals for coordinating all matters relating to the removal or transplantation of human organs or tissues or both, are also being planned.
In both campaigns, it is learnt, emphasis will be laid on clearing the cloud of doubt on declaring a patient brain-stem dead or brain dead.
A person is said to be brain dead when there is an irreversible loss of consciousness, absence of brain stem reflexes, and irreversible loss of the capacity to breathe.
“Upon analysing the negative campaign on social media, it was found that the main allegation is opacity in declaring a patient brain dead. The campaign will try to clear this,” said an official of the state Health Department.
It is learnt the campaign will have a threefold objective: Countering the allegations, making people aware of the importance of cadaver organ donation, and encouraging doctors concerned to classify patients as brain dead.
“Besides the awareness campaign for the general public, the doctors concerned also needed one,” an official of the Health Department told South First, requesting anonymity.
The official added, “Nowadays, doctors are reluctant to certify a patient as brain dead. The main reason behind this is litigation risk. In the wake of the recent incident (the lower court order against a hospital and eight doctors), they have reasons to fear more.”
Confirming as much, another K-SOTTO official told South First that this reluctance was one of the factors that impeded organ transplants from the deceased in the state.
“Some hospitals, as well as doctors, consider brain death declaration and related organ donation a cumbersome process,” said the official.
He added, “They are reluctant as the entire process requires huge manpower and resources. Mostly, live donor transplantation is preferred as it is a scheduled event, whereas cadaver organ donation is an unplanned event, involving risks.”
In January 2020, when the state government organised an international workshop on transplant administration in Thiruvananthapuram, it was observed that myths, misconceptions, and opaqueness were what put the brakes on the organ donation and transplantation processes in the state.
At that event, the then state health minister KK Shailaja commented, “Conservatism persists in society. Due to that some false beliefs like ‘life after death’ is also there. People believe that if they donate their loved one’s organs, it will create difficulties for them in the afterlife,” she noted.
“Such misconceptions could only be addressed through awareness,” she added.
In a state where deceased organ donation and transplantation numbers are abysmally low when compared with the burgeoning demand, health officials apprehend a further slump as an effect of ongoing negative campaigns on social media.
It was in 2012 that the state started “Mrithasanjeevani”, a deceased donor organ transplantation programme. As part of it, an online transplant registry is also maintained.
The deceased donor transplant data maintained as part of the programme showed a significant decline in the number of donations in recent years.
It was in 2015 and 2016 that the state recorded its highest number of deceased donors, 76 and 72, respectively. In 2017, it came down to 17 and then nosedived to just eight in 2018.
From 2019 to 2021, a slight revival can be witnessed — 19 (2019), 21 (2020), and 17 (2021). However, in 2022, it again plummeted to just nine.
In 2023, till May, nine deceased donors were identified.
While the total number of donors registered with Mrithasanjeevani from 2012 to May 2023 is 354, those registered to receive solid organs — kidney, liver, heart, lungs, pancreas, and small intestine — and corneas, heart valves, and others during the period were 5,042.
The state is also collecting a fee from expectant recipients who are registering with Mrithasanjeevani.
If it is for a kidney, it is ₹2,000. For the liver, heart, pancreas, larynx, small intestine, hand, and others, it is ₹5,000.
The government has so far collected an amount of ₹1.28 crore as registration fees.
A section of public health experts feels that the main beneficiaries if cadaver organ donation is shown in a bad light will be those behind the living organ transplant racket in the state.
According to them, the clandestine dealings — including the sale of organs will — rear their ugly head once cadaver organ donation takes a hit.
In 2020, the Crime Branch stumbled upon an organ transplant racket that centred its operation in Thrissur.
The sleuths then found that the racket supplied kidneys and livers from living donors to affluent patients for serious money.
The then Crime Branch IG S Sreejith found that middlemen working for hospitals lured persons from needy families to donate organs to patients with deep pockets and requiring a transplant.
While the donor was paid a meagre sum, the middlemen as well as the hospitals pocketed large amounts.
The law forbids the sale of organs.
In the case of cadaver organ donation, some unethical practices persist. This was highlighted by none other than the former head of the Forensic Medicine Department, Government Medical College, Thiruvananthapuram, Dr Sasikala K.
According to her, some private hospitals allot organs on their own despite strict guidelines regarding organ donation and transplantation. It was in the international workshop on transplant administration that she raised this allegation.
“Some private hospitals donate one organ towards the government pool and the other they allot as per their wish. They then eschew themselves from providing any explanation on why they had allotted a particular organ to a particular person,” commented Sasikala then.
She added, “These actions will only help put the entire organ donation process under suspicion. Also, incomplete documentation of the process related to organ donation, including brain death certification, is another major concern.”
The significance of her comments lies in the fact that it is in private hospitals that organ transplant surgeries happens the most.
As per data, in the case of deceased organ donation and transplantation between 2012 and 2023 (March), there were 350 donors and 1,007 recipients in the state.
Of the total recipients, 774 patients relied on private hospitals and 233 on government hospitals.
Since the commencement of cadaver organ transplantation in 2012, the state has been divided into three zones — south, central, and north.
This is for sharing of organs to facilitate transportation, ease organ distribution, and minimise the ischaemia (restriction in blood supply to any tissue) time of the organs.
In the state, a total of 51 hospitals are involved in organ transplants. Leading the list is the central zone with 24 hospitals, followed by the south zone (17) and north zone (10).
The number of empanelled doctors authorised to certify brain death is 225 in the state, 138 in the central zone, 50 in the north zone, and 37 in the south zone.
It was in 2017 that the state first brought its major change in the brain death certification process. This happened as questions were raised about the genuineness of the process being followed.
As per the change, the certification would have to be carried out by a team of four doctors, of whom at least two must be from outside the hospital.
Real-time videography of the brain stem death certification and apnoea test — an important clinical test performed usually at the end of the brain death diagnosis procedure — were also made mandatory.
Then, in January 2020, Kerala became the first state in the country to come out with guidelines for brain stem death certification.
As per the guidelines, a medical practitioner could discontinue all treatment including cardiorespiratory support without the consent of the patient’s family upon the certification of the brain stem death of a patient.
In May 2023, an expert working group and 10 organ-specific subcommittees with a panel of experts were constituted to develop protocols, policies, and standard operating procedures for organ donation and transplantation in the state, with special reference to the deceased organ transplantation.
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