Tamil Nadu has a reason to celebrate, and it’s for nothing less than a matter of life and death. For the second consecutive year, the state has been recognised as the leading state for organ transplantation. Specifically, Tamil Nadu’s cadaver transplant programme has been judged the best in the country, and the state has also performed the maximum number of organ transplantations in India.
The Transplant Authority of Tamil Nadu (TRANSTAN) says that, in the last 8 years, 4,938 organs have been transplanted in Tamil Nadu. According to a performance report from October 2008 to October 31, 2016 by TRANSTAN, there have been a total of 887 donors from Tamil Nadu. In these eight years, 257 hearts, 130 lungs, 836 liver transplants, 1615 kidneys, 11 pancreas, two small bowels, 300 heart valves, 1339 corneas, 46 skin grafts and two blood vessels have been transplanted in the state.
If the sheer numbers are not impressive enough, add to them the fact that this dramatic shift has taken place in a state that was once known as India’s capital of the “transplant tourism” industry.
So what made this turnaround possible?
Facing a massive kidney scam in 2007, the Tamil Nadu government decided to proactively promote the growth of deceased donor organ transplants in the state, as a substitute for paid organ donations. In line with the decision, the state conducted a series of workshops in the state to build awareness among the medical fraternity on deceased donation and the procedural requirements for transplants, and received feedback on streamlining the process of allocating organs for patients.
On the legal and administrative front, the government issued several orders aimed at making the transplantation process more transparent and efficient. It made it mandatory for hospitals conducting transplants to register with the state, run counselling services, regularly submit records on all transplants conducted, employ a transplant coordinator to manage the process and publicly announce all charges for transplant procedures.
It also designated hospitals with a minimum sufficient bed strength and minimum operating and intensive care facilities as potential sources of cadaver organs. Most importantly, the government made it mandatory that cases of brain death be properly certified. Additionally, in case of road accidents, it made organ removal permissible before the completion of post-mortem exam where necessary. And it created a centralised waiting list system to ensure proper coordination in the allocation of donor organs.
The government also took major steps to build coordination between itself and non-profit organisation and public and private hospitals. Key to these efforts have been entities like the Multi Organ Harvesting Network (MOHAN) Foundation and the National Network of Organ Sharing (NNOS), which help hospitals strengthen the secondary and tertiary activities around organ transplantation, and are involved in such activities as training transplant coordinators, grief counselling for donors’ families, educational programmes for hospital staff and so on.
What all these efforts have done is make it more likely that consent can be obtained from relatives of brain dead patients for organ donation, that donor bodies and organs are well cared for and hence suitable for transplantation, and that the matching of donors to recipients is carried out as smoothly as possible, so that no valuable organs are wasted.
It is the well-coordinated, efficient process instituted under the Tamil Nadu Cadaver Transplant Program, started on September 16, 2008, that has contributed significantly to the state’s dramatic turnaround in organ transplantation. In the period from 2008 to 2013, the central registry created under the programme recorded over 2,000 transplants, with the numbers of donors rising steadily from 43 in 2009 to 129 in 2013. By 2014, the state’s organ donation rate shot up to a very heartening 1.9 per million population as against the countrywide average of 0.34 per million population.
A major impetus for organ transplantation also came from a few high-profile donation cases in the state. In particular, the case of Hithendran, whose doctor parents donated all his organs after he suffered brain death in a motorcycle accident, received widespread attention in the state, and built popular support for deceased organ donation.
Receiving the 2016 award from Union Health Minister J P Nadda at a ceremony in Delhi on November 30, State Health Minister Dr C Vijaya Baskar also pointed out that the Tamil Nadu government had made significant financial investments for promoting organ transplantation.
While transplantations are done free of cost in government hospitals, patients who undergo transplants in private hospitals are covered under the Chief Minister’s Comprehensive Health Insurance Scheme. Under this scheme, patients are provided with financial support of up to Rs 30 lakh, the highest in any state in the country, said Vijaya Baskar at the event.
Tamil Nadu’s programmes still have areas to improve upon, particularly in surgical management and in laboratory facilities for cross matching donors and recipients. But what the state has managed so far testifies to the potential good that can come from clear-headed policies and proper coordination and training.