Thoughts on Cadaver Organ Donations in India

Organ donation in India is still in its infancy. Everyone from the Union Health Minister Ghulam Nabi Azad to doctors working in both private and public sector hospitals concur on the need for more donations and advocate the creation of Organ Banks, greater public awareness about the noble cause of organ donations as well as on the urgent need of passing laws and developing transparent, hassle-free mechanisms, which allow swift organ retrieval, banking and transplantation.

I believe that the entire Transplant Program suffers from at least three severe malaise. These are lack of governmental regulation, poor infrastructure for quick retrieval and transplantation and total public apathy.

Apparently a comprehensive  ‘Transplantation of Human Organs Act’ is being considered by the Indian Parliament. The act once cleared by the parliament will hopefully lead to a far better utilization of the donated organs and create a network of Organ Banks, which would be able to freely exchange information about the availability of an organ, its swift retrieval, its likely recipient and the hospital, where the procedure might be done. While one can hardly fault the government on its intent, the execution of the program will determine its success.

The government must establish clear guidelines on brain death, when can organs be harvested, which hospitals (both privately owned as well government hospitals) are notified for organ harvesting as well as transplants, who all can donate an organ and what would be the process for locating the recipient once brain death has been established.

I would recommend that the government should establish an autonomous body, comprising of eminent doctors, organ transplant surgeons, lawyers of repute and other medical professionals who can come together to formulate guidelines on organ donations and transplants, establish mechanisms for quick retrieval and harvesting of organs from a brain dead donor and most importantly locate a recipient awaiting a transplant.

A national registry of all those who are in need of organ transplant should be established forthwith. It should list all individuals who need a transplant and should have their detailed medical records available on the touch of a button.  The registry should also list organ banks and the hospitals who have the infrastructure and the capability to carry out transplants. These hospitals must have nodal officers/doctors, who can act quickly once a brain death has been established. These officials should access the medical records of those listed as needing an organ on the national registry, check out if they are suitable candidates for receiving an organ, establish the logistics of getting the organ and the recipient together at a hospital where a transplant can be carried out and than start the process of getting the patient and the organ to the hospital.

While, this may sound simplistic, this would require immense coordination and effort. This calls for a dedicated body, state of the art IT infrastructure, logistical support in safely transporting the organ, getting the recipient to the hospital at a moment’s notice and gearing up the hospital for a fairly complicated surgery at a very short notice. The government must take the lead in setting up this mechanism and ensure that it is fast, efficient and incorruptible. Most importantly the workings of this body, should be completely transparent. I fully understand that often this body will have to take decisions regarding who gets an organ and perhaps a new lease of life and who doesn’t. These will always be hard decisions, involving questions of life and death and must be taken with utmost care, without any prejudice and in a completely transparent manner. Thus, we must have people with a track record of great efficiency and  of unimpeachable integrity running this institution.

Last but not the least, it is imperative that the government create awareness about organ donations. Cadaver donations in our country are minuscule. The trauma of the untimely and unexpected death of a loved one itself usually numbs the minds of those, who have take decisions related to donations. To make matters worse, many people still believe in reincarnations and can never imagine donating organs lest it impacts life in the other realm. The government must fight these obstacles resolutely, it should educate people about the benefits of organ donations and maybe reward folks who decide in favour of donations.

Donating organs of a loved one  so that people, mostly strangers, get a new life is undoubtedly the most noble of gestures. It requires courage, conviction and immense generosity. The government must ensure that once someone takes a decision like this, the organ reaches the right recipients and many lives are saved. This should happen all the time, seamlessly and without fail.




The Rural Doctors

In a bid to provide primary healthcare services in rural India,the Ministry of Health of the Government of India has proposed a 3.5 years abridged medical course. The idea is to churn out doctors  willing to work in rural communities faster. The proposal mooted by the health minister Ghulam Nabi Azad has drawn mixed reactions from various quarters. Many have argued that by introducing an abridged diploma course the government will be playing with the lives of the rural folks. The essential argument is that even the basics of medicine can not be taught in such a short period of time. Others have taken a contrary view, pointing out that replacing today’s rural quacks with doctors having a basic formal medical education will be a huge plus.

In rural India, where more than 60% of India lives access to good quality healthcare is minimal. The government has spent millions of rupees in trying to provide primary healthcare in these areas and has met with little success. The twin problems of medical infrastructure and trained people has stymied government effort for long. Of these, it can be argued that the infrastructure problem is rather easily taken care of, the government just has to find the will power and the money to build primary health centres. The bigger problem is of finding qualified and trained doctors to work in rural areas.

Forcing newly minted doctors from government-run medical colleges, which offer subsidised education is a sub-optimal solution. These doctors hailing from large urban centres have no desire to work in rural, underdeveloped areas, where they can not possibly have the lifestyle that they are used to. The divide between Bharat and India has ensured that the chasm is too big to bridge and these doctors and their patients have almost nothing in common.

In rural India today, primary healthcare services are largely provided by a class of quacks, masquerading as doctors. Illiterate rural folks have no idea of the knowledge or formal qualifications of these ‘doctors’. They do not have the courage or the wherewithal to find out the antecedents or the past experience of these physicians and the entire system works on blind faith. Usually, these quacks have some knowledge of medicine largely acquired by having worked as assistants to doctors in big cities. Thus, they are able to continue the charade by prescribing commonly used OTC medicines and some wide spectrum antibiotics, for almost all ailments. Many people recover from common ailments, those who do not or grow steadily worse are referred to real doctors in nearby towns and cities.In remote and far-flung areas, things are even worse. Faith healers and babas of various hues treat people using ‘jhaad-phoonk’, which are nothing but ancient pagan rituals.  This is the terrifying reality of the 21st century rural India.

In this context, it makes eminent sense to have a cadre of rural doctors with some formal medical education. They would be able to provide far superior care than what is presently available in rural India. That the government proposes to hire rural youths in this program will ensure that these doctors continue to live and serve in their own communities. Unlike, their urban counterparts, these doctors do not run the risk of being fish out of water in this environment.

The government should now swiftly move forward towards evolving a mechanism for setting up rural medical colleges and lay down guidelines for enrolling rural youths in these courses. It should set up a few rural medical institutes and a regulatory body to regulate the proposed system. The government must also apprentice these rural doctors in government hospitals for at least 6 months so that they learn the practice of medicine from senior and more qualified doctors.

This solution I know is far from ideal. It also smacks of a certain class bias (more qualified doctors for slick city dwellers, under-qualified and not as well-trained doctors for poor rural folks), but such is the reality of the urban and rural life in India that even an idea like this has its distinct merits.  



The Future of Medical Education in India – The Way to Go

rural medical collegesThe Union Health Minister Ghulam Nabi Azad appears to be busy shooting the breeze by announcing vague policy changes involving setting up of Medical Colleges through private capital and in collaboration with government run district hospitals. The minister who is well known for putting his foot in the mouth, recently announced at a FICCI conference that the government is considering relaxing the norms for setting up medical colleges by the private sector. He also announced that these colleges can be affiliated with the government owned district hospitals, thus doing away with the requirement of a teaching hospital to be attached with the medical college.

The minister is seeking private equity participation in rural, backward and far-flung areas of the country. He believes that the private players can be attracted to set up medical colleges in these parts of the country by offering concessions such as access to district hospitals.

Doesn’t this sound completely hare brained?   Continue reading