Kerala's dangerous new fad: an obsession with organ donation
- Since 2008, an organ donation revolution has been going on in Kerala
- Recently, a Christian bishop donated a kidney to a Hindu, making the national news
- Priests and nuns are a target, being pressured into organ donation through a sense of Christian guilt
- The poor are another target, and are often treated as commercial cadavers
- The sad case of three-year-old Anjana, the youngest \'donor\' in the state
- Government norms on donation, and how they are being violated
On Sunday, 29 May, a bishop from Pala in Kottayam district, Kerala, made the front pages of national dailies. In a country that sees headlines of pettiness and revenge every other day, Bishop Jacob Murickan did a most Christian thing, deciding to donate his kidney to a Hindu.
It was depicted as a selfless act of sacrifice, with all the Christian undertones of guilt and redemption. On top of that, there was a larger secular message, with the recipient being a Hindu.
But the bishop was just logging into the latest medical craze in Kerala - something that has become commonplace over the last five years: organ donation and transplants.
This social revolution has been celebrated in long articles like this one in the Caravan.
Organ donation, no doubt, is important in India. According to a Kerala government document, the organ donation rate in the country is only 0.08 per million population.
Now with an entire system in place, mostly in Kerala and Tamil Nadu, organ transplants are happening in a jiffy. All systems are in place, including the instant creation of 'green corridors', through which organs can be transported at high speed.
But one needs to ponder about the inherent dangers of patients being declared dead prematurely, procedures not being followed, and commercial considerations overriding humane concerns.
A 'Christian' act
The social movement encouraging people to donate organs was started by Father Davis Chiramel in 2008, when he donated his kidney. In fact, when Bishop Murickan announced his decision to donate his kidney on 28 May, Father Chiramel was present by his side.
Since 2008, priests and nuns have been under tremendous pressure to donate their organs, out of a sense of Christian guilt. No wonder, then, that 15 priests and six nuns have donated their organs in Kerala alone, according to The Indian Express.
The movement took off after it got corporate backing from the maker of V-Guard electronic stabilisers, Joseph Chittilapilly. He has brought into corporate governance some elements of Christian religious thought, notions of purity, straightforwardness, no excessive profit and so forth.
Chittilapilly also gives out awards for organ donation and runs an active campaign.
Pressure on the poor
There is also immense pressure put on the poor to donate organs as soon as their relative is pronounced brain dead. These people are looked at in an utterly commercial way.
For example, last year, an organ was transported from Thiruvananthapuram to Kochi in two hours (the normal time by road is four hours). It was helped on its way by the police along the entire 'green corridor', which was created in a matter of minutes.
It was hailed as an achievement, an example of government efficiency. But no one talked about the person who had died - whose organ was being transported. He was, after all, a commercial cadaver, stripped of all humanity; his family just made to sign on a form.
A study of some of the patients declared brain dead shows that all of them were from poor families.
In the case of three-year-old Anjana, who died in Thiruvananthapuram in August last year and was declared the youngest donor in the state, a report said: "Her parents, much to the dismay of relatives, accepted the request to donate."
In this case, like in many others, there was a sense of triumphalism, not one of tragedy that had taken away a young life. Nowhere was the agony of the family considered important.
"Anjana, who was admitted to SAT Hospital since Thursday, was declared brain dead on Saturday night, donated her liver, two kidneys and corneas [sic]," a newspaper report said.
There was not a single line on how she died, or where she lived, or who gave the permission to donate. Didn't anyone say that Anjana should be kept under observation for a few more days, just in case? Didn't someone want to look at the injuries she sustained or the symptoms she showed and figure out if better treatment could have been provided to save her?
One day, Anjana was brain dead; on the second, she had been declared a donor, and on the third, her organs had been transplanted into someone else.
In another case near Coimbatore, "a poor washerman family's magnanimity in its time of grief saved the lives of eight people," according to The Hindu.
Poor accident death victims are seen as commercial cadavers, while the rich insist on more tests, more time and life support systems. Needless to say, the onus of magnanimity always lies on the poor.
Norms that no one follows
The Transplantation of Human Organs Act, 1994, has in place many of the procedures to be followed to declare a person 'brain dead'. But, alarmed at the rise of the 'donation movement' after 2008, the Kerala government rightly put in place a series of strict norms, by which a person could be declared 'brain dead' for organ transplant.
"Considering the fact that the deceased donor organ donations are done with an altruistic motive and in a generous and charitable manner as a willing contribution to society, it is necessary that this organ donation be governed by transparency on all fronts to ensure that the sentiments of the donors relatives are adequately respected," says the 2011 government notification, signed by principal secretary Rajeev Sadanandan.
The strict procedure consists of two examinations by two different teams of doctors . The examination has to be conducted six hours apart.
The constitution of the team of doctors is an elaborate procedure in itself, which would take one day at least.
No doctor associated with the transplant is allowed in any of the two teams.
Of two resident medical practitioners who have to be in one team, one has to be from an outside government hospital, and selected by a panel.
Neuro-surgeons who are part of the team have to be from an outside hospital.
Also, recipients have to be decided by various prescribed norms. Foreign nationals can be given organs only if none of the entire registry of Indians fit in for various reasons.
If all procedures are followed, it would take at least 24 hours for a victim to be formally declared 'brain dead'. But at present, it is done in four or five hours. Organs are harvested immediately, in clear violation of the norms, and transportation and transplant is completed in the next 24-48 hours.
In addition, foreigners are frequently transplanted with Indians' organs, violating all norms.
But one of the senior-most neurosurgeons in Thiruvananthapuram admits that the doctors themselves are not aware of any such government norms.
The procedure now followed in Kerala is that the attending doctor proclaims a patient brain dead, and soon after, another neurosurgeon at the same hospital confirms it.
None of the procedures mentioned above are followed.
Does brain dead equal dead?
In most cases, yes. But careful examination through MRI and EEG by experts can detect blood flow in some parts of the brain, which would mean that the patient is in coma and not 'brain dead', and hence holds a chance of revival.
The hurry to declare a patient brain dead, visible in some case in Kerala and Tamil Nadu, is highly dangerous. Especially if two prescribed committees of doctors do not sit and evaluate the case.
According to a highly-qualified doctor (FRCS) based in Australia, who spoke to this reporter, the following criteria are required to declare a patient brain dead: "Pupil dilation, unresponsive to light, absent pulse or heart beat, flat line on ECG."
This procedure is mostly followed, but no time is given for a rare revival to take place. This is a grey area, where some experts feel more time has to be given, due to the huge advances in technology:
"To ensure that the loss of brain function is irreversible, physicians must determine the cause of the coma, exclude conditions that might mimic it, and observe patients for a period of time to ensure that recovery isn't possible," according to Mayoclinic.org. This crucial 'period of time' is never given.
Even in the case of patients who have expressed the desire to donate, confirmation signatures have to be obtained, and can even be declined by relatives, according to the norms. None of this is followed. Poor families are almost forced to agree to donate without being given the chance for outside opinion.
Edited by Shreyas Sharma
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