Malpractices in Organ Transplantation

Context: A plea in the High Court seeks a CBI investigation into alleged malpractices in organ transplantation.

Common Malpractices

• Commercialization of Organs: Involves the illegal buying and selling of organs, exemplified by clandestine organ trade networks.
• Falsification of Donor-Recipient Relationships: Used to bypass legal restrictions. For instance, in 2018, a family in Chennai was accused of fabricating a relationship with a recipient.
• Improper Brain Death Determination: Involves hasty or incorrect declarations of brain death to expedite organ retrieval. In 2016, a family in Mumbai claimed their relative was prematurely declared brain-dead to facilitate organ harvesting.
  • In India, brainstem death is legally recognized as a form of death, permitting organ donation.
• Exploitation of the Poor and Vulnerable: Involves inducements or coercion to obtain organs from impoverished individuals. In 2013, individuals from West Bengal were reportedly enticed to foreign countries under false promises and coerced into donating organs.
• Violation of Ethical Guidelines: Involves non-compliance with medical and ethical standards during transplantation procedures. For example, in 2015, a recipient in Delhi died after a kidney transplant due to complications arising from substandard medical care.

Causes of Malpractices

• Organ Shortage: The severe lack of available organs creates a black market, leading to illegal activities.
• Poverty and Exploitation: Economic hardships make individuals vulnerable to organ trafficking.
• Weak Regulatory Framework: Deficiencies in legal frameworks and their implementation create loopholes.
• Lack of Awareness: Contributes to misconceptions and illegal activities in organ transplantation.
• Commercialization of Healthcare: Prioritizes profit-driven decisions over ethical considerations.
• Corruption: Within the healthcare system, it facilitates illegal organ trade and transplantation.

Concerns and Challenges

• Organ Shortage: Results in long wait times and high mortality rates for patients awaiting transplants.
• Awareness and Education: Impact donor registration rates, with cultural and religious beliefs also influencing decisions.
• Legal and Ethical Issues: Despite legal measures, problems with organ trafficking and illegal trade persist, raising ethical concerns.
• Infrastructure and Logistics: Inadequate cold storage and inefficient transport can delay or complicate organ delivery.
• Cost and Accessibility: High costs can be prohibitive for many in lower-income areas, affecting access to essential treatments.
• Post-Transplant Care and Compliance: Challenges in adhering to immunosuppressive medication and regular check-ups due to high costs and logistical issues can impact patient health.

Way Forward

• Comprehensive Legislation: Implement stricter laws to curb organ trafficking and ensure ethical practices.
• Dedicated Organ Transport Corridors: Establish specialized routes for efficient organ transportation. Several states in India have initiated the development of green corridors for this purpose.
• Enhancing Public Awareness: Conduct awareness programs and campaigns through mass media.
• Real-Time Tracking: Implement a centralized system to track organs from retrieval to transplantation.
• Ethical and Legal Framework: Impose stringent penalties for violations of organ transplantation laws and develop clear ethical guidelines for all stakeholders involved.

Steps in Organ Transplantation

• Donor Identification: Identifying a suitable donor, either deceased or living.
• Organ Retrieval: Carefully extracting the organ from the donor.
• Organ Preservation: Maintaining the organ in optimal condition for transplantation.
• Recipient Evaluation: Assessing a patient’s suitability for transplantation.
• Matching Donor and Recipient: Finding a compatible donor for the recipient.
• Surgical Procedure: Transplanting the organ into the recipient’s body.
• Post-Operative Care: Monitoring and managing the patient’s recovery.
• Immunosuppression: Administering medication to prevent organ rejection.

Living and Deceased Donors

1. Living Donors: Individuals aged 18 and above are eligible to donate certain organs, including:
   • One of their kidneys
   • A portion of the pancreas
   • Part of the liver
2. Deceased Donors: Can donate six vital organs: kidneys, liver, heart, lungs, pancreas, and intestine.
   • In cases of brainstem death, approximately 37 different organs and tissues can be donated, including the six life-saving organs mentioned.
   • After natural cardiac death, only a few organs/tissues can be donated, such as the cornea, bone, skin, and blood vessels.