MOHAN Foundation has sent the below mentioned suggestions and recommendations to Standing committee on Health of Rajya Sabha on 7th of March 2010. If you agree with some or all of these please send in your recommendations too to the members so that the current THO act can help provide momentum to the deceased donation programme in India.View Health Committee Members
Reason for recommendation – Brain death can happen in any hospital in the country -authorized by Appropriate authority or non-authorized hospital. Restricting organ donation only in registered hospital restricts the scope of the donation process. This de-inking of hospitals would help with the following –
At present Tamil Nadu government has made such a provision vide GO no. G.O.(Ms.) No. 289 Dated: 5.9.2008 (Health and Family Welfare Department - Non-Transplant centers - Criteria for non-transplant centers to retrieve organs from brain dead persons).
The current amendments includes a Mandatory clause - where in event of brain death in the ICU -it is mandatory for doctors to ask for organs – in such an event in a non- licensed centre where a doctors makes such request, it is important that in such a hospital surgery for retrieval of organs should be possible.
The THO Act recognizes a person in ‘lawful possession of the body’ as the authority to give consent for organ donation of the deceased. The term “lawful possession” is ambiguous as the Act fails to explain the term and also the people who can be considered as the ones who are in lawful possession of the body. Therefore it becomes important to incorporate a list of qualified relatives as mentioned in the transplant act from USA & UK (UAGA and HT Act), who are the persons who have the authority to give the consent. This list should be in the prioritizing order of family members, where, if the member who is on the top of the list is not present, the decision can be taken by the member next to him in the list. This will save time when dealing with the unstable deceased donor. It would also give legal authority to a relative who may not be father or mother at the time when consent is requested.
Definition of next to kin also is ambiguous in certain situation and can be similarly defined
In our experience with over 400 donations over the last 10 years the current provision makes organ retrieval surgery on the discretion of the police officials and forensic doctor. In most situations they do not understand the complexity of the situation and organ preservation. Moreover the cause of brain death in our country are maximum from fatal road traffic accidents that number 140,000 per year. Of these 67% have brain death as per a study from AIIMS.
At present brain death declaration is being only made for organ donation purposes. In many instances when a request is made for organ donation and when relatives refuse for donation they usually do not want the ventilator to be switched off and wish the continuation of the vegetative state.
Reason for recommendation –This puts strain on ICU resources especially in Govt. Hospitals as other needy patients are refused life saving treatment. The doctors also are on the defensive once they ask for organ donation, as the relatives feel that it is because the doctors have vested interest they have kept the ventilators going but because they have refused the request they want to get rid of the body by switching off the ventilators. .
Current Status – “CHAPTER II AUTHORITY FOR THE REMOVAL OF HUMAN ORGANS -Authority for removal of human organs in case of unclaimed bodies in hospital or prison
Reason for recommendation –
1. This whole clause has no meaning for organ donation unless such body that is left unclaimed in a hospital or a body from the prison is on a ventilator. In ordinary circumstances in 48 hrs the body would be decomposed and no organs can be utilized. In such situations presumed consent for eyes, heart valves, bones and cartilages should be passed.
Reason for recommendation –sharing between public and private hospitals. Most donations take place at present in Private hospitals. Sharing of organs can take place only if hospitals are allowed to share costs of maintaining brain death, costs of Intensive care and cost of operative procedures. This should be clearly spelled out in the procedures without any ambiguity.
Objectives of Advisory committee should be able to assist the Appropriate authority and include -
The Advisory committee shall in turn nominate four sub-committees to assist in its functioning for