On January 06, 2022, MOHAN Foundation launched an online course “Legal aspects of organ donation and transplantation”. The course has been designed for doctors/medical practitioners, non-medical/paramedical and administrative staff in hospitals and other interested stakeholders (like NGO’s, law students etc.) who wish to understand the legal aspects in this very niche area. Ms. Pallavi Kumar, Executive Director, MOHAN Foundation-Delhi NCR moderated the event and Ms. Sujatha Suriyamoorthi, Associate Director, Courses, MOHAN Foundation gave a brief introduction of the course and modules of “Legal aspects of organ donation and transplantation”.
As part of the launch, a panel discussion on “Critique of the Act-25 years later” was also organized. Various experts were invited to revisit the Act and critique it to better understand gap areas and future recommendations. Dr. Vikas Mahatme, Member of Rajya Sabha & Founder Medical Director of Mahatme Eye Bank Eye Hospital, Nagpur and Dr. Rajneesh Sahai, Director, National Organ & Tissue Transplant Organization (NOTTO) were invited as the special guests. Dr. Avnish Seth – Principal Director, Gastroenterology, Hepatobiliary Sciences & Transplant Hepatology, Fortis Memorial Research Institute, Gurugram, Dr. Anil Kumar - Additional DDG, Ministry of Health and Family Welfare, Department of Health and Family Welfare, Dr. Noble Gracious – Associate Professor, Nephrology GMCT and the Nodal Officer, KNOS, Dr Rahul Pandit – Director and HOD – Critical Care, Fortis Hospital, Kalyan | Fortis Hospital, Mulund, Dr. Sujata Patwardhan - Prof and HOD, Dept of Urology, GSMC and KEMH, Parel, Mumbai, Dr. Sonal Asthana - Clinical Lead, HPB and Multiorgan transplant Surgery, Aster Integrated Liver Care (ILC) group, Aster group of Hospitals, Dr. Ravi Mohanka -Chief Surgeon and Head of Department of Liver Transplant and Hepato-Biliary Surgery at Global Hospitals, Mumbai and Dr. Veena Roshan Jose - Assistant Professor of Law, National Law University, Nagpur were invited as the panelists.
Main points discussed by Dr. Rajneesh Sahai
- MOHAN Foundation and NOTTO contributed a lot in increasing the rate of organ donation in India. The grief counselors and transplant coordinators trained by these organizations are the real backbone of healthcare units for organ donation.
- The post-graduation diploma on transplant coordination and grief counselling designed by MOHAN Foundation is commendable and has given a necessary boost in the training area.
- NOTTO will support and collaborate with MOHAN Foundation in implementing activities to promote organ donation and deceased donation.
Main points discussed by Dr. Vikas Mahatme
- MOHAN Foundation is doing a wonderful human service by facilitating human organ transplants and giving life to so many people.
- Today, our government is serious about organ donation and wants to facilitate programmes on organ donation.
- There is an urgent need of proper infrastructure for organ donation in each district & state of India. The rules and regulation in the Transplant Law can be modified and amended for the betterment of humankind and for increasing organ donation rate in India.
- There should be a presumed consent system for organ donation in India as followed in some other countries. Opt-out system for organ donation should be practiced in India.
- Advocacy groups can be formed separately in organizations to highlight the challenges faced by them and suggestions to increase deceased donations can be given to the Ministry.
- India needs an opt-out system for organ donation that should be connected to the death certificates.
Main points discussed by Dr. Sunil Shroff
- The Transplant Law of India accepts brain death as form of death to help increase organ donation. We have an excellent and detailed law but sometimes we fall short in implementation of the law.
- Difference between living donation and live transplantation & Deceased donor and transplantation.
- Transplants - Public Hospitals versus Private Hospitals. 90% of transplants are being done in the private hospitals in India.
- Gaps in the Law on death. Brain death is linked to organ donation and it is not accepted as death. Corporate hospitals constantly have problems with the issue of switching off ventilators, if relatives say NO to donation.
- Currently, brain death certificates are not accepted for registration of death. Thus, it cannot be accepted for insurance claim and for any other purpose.
- Donation after circulatory death has increased donations by 33% in many developed countries and the same can be followed in India.
- There is a need of defining “Next of Kin” in case of organ donation and clarification on who is the person legally in possession of the body?
- 76% deceased donors in Tamil Nadu are from medico-legal cases that requires inquest.
- Consent forms for living transplantations.
During the panel discussion, Dr. Shroff also conducted polls for making the discussion more interactive and to receive suggestions from the audience. Poll 1 was “Has the THO Act after 25 years lived up to its expectations? “Majority answered No and Not sure. Poll 2 “What are the major hurdles in implementing the THO Act?” Most of the audience felt that brain death certification and definition of death, consent process from the relatives & medico-legal case and organ donation were the major hurdles. Poll 3 “Do we need inclusion of brain death in the RBDA (Registration of Birth and Death Act)?”. Majority said yes.
Main points discussed by Dr. Avnish Seth:
- We could introduce opt-out system for corneal donations in India to start with. The system could gradually gear up for organ donation.
Main points discussed by Dr. Anil Kumar
- The state governments should regulate all the activities related to organ transplantation, organ retrieval and storage very carefully.
- Brain stem death certification at the hospitals is the biggest challenge.
Main points discussed by Dr. Sujata Patwardhan
- There should be a donor detection unit in public and private hospitals.
- There should be separate intensive care units earmarked only for deceased donations in every government medical college and public hospitals.
- It is very difficult for public hospitals to certify brain stem death due to various organizational & infrastructure challenges.
Main points discussed by Dr. Rahul Pandit
- In cases where we are not able to do the clinical death declaration, selective test- 4 vessels angiography should be done, then the intensivists would not have any problem in declaring death.
- The acceptance of brain death in the RBDA (Registration of Birth and Death Act) will avoid confusion and make brain death universally acceptable.
- Uniform legislation on death has been incorporated in many other countries including USA, UK and Australia, that have faced similar problems in the past.
- The Act can define death as “death of an individual who has sustained either (a) irreversible cessation of circulatory and respiratory functions, or (b) irreversible cessation of all functions of the brain stem”.
- The intensivists should address brain stem death certification related issues very clearly.
Main points discussed by Dr. Noble Gracious
- He explained how and why delinking brain death to organ donation was done in Kerala.
- The government hospitals are losing all potential brain-dead donors due to lack of proper infrastructure for declaring brain death and intensive care units.
Close to 100 people attended the launch event.
Click here to watch the video
Source-Ms. Preeti Goswami