Organ transplantation

I wish to react to the letter from Manu L. Kothari and Lopa A. Mehta on this subject. ‘The authors have objected to organ transplantation on two counts.’

1. Possibility of malpractice in the form of murder to obtain organs once cadaveric transplant program is started in our country. This fear is based on fiction (by Dr. Robin Cook) and therefore appears to be fictitious. Whilst I share the authors’ anxiety on the possible misuse this is, in reality, unlikely. Experience in western countries, where cadaveric organs have been used for transplantation for over two decades, has shown that there has been no misuse as depicted in Coma. Every law can be exploited by the unscrupulous. To prevent such abuse one needs an honest, conscientious person in authority. If those in charge turn a blind eye – as was done recently in Bombay and Bangalore, misuse is inevitable.
2. Futility of organ transplantations due to poor bio-availability, post-transplant physical ill health and fiscal consequences. There is always the possibility of a transplant failing but the risk of such an event is 10% with kidneys and 15% with livers. Aren’t such failures seen with other therapeutic modalities as well? Will the authors disallow any treatment that cannot guarantee 100% success? If 85 of 100 patients with irreversibly damaged livers can return to work (2) isn’t this to be preferred to all of them dying or remaining bedridden, economic and psychological burdens to their families? Failure is nothing but success turned inside out.

Transplantation is expensive in the West. A liver transplant there would cost Rs. 40,00,000 to Rs. 70,00,000. By my estimate, and that of others, the cost in a public hospital in this country would be Rs. 1,50,000 to Rs. 2,00,000. (3)

Bio-availability may improve and postimmuno-suppressant infection reduced with the development of gene therapy a dream that will come true one day.

Let us accept that organ transplantation is the only hope for thousands with end-stage organ failure whose life is otherwise endangered. This procedure has come to stay despite reservations on the part of some. In order to curb unethical trade in organs from live persons it is essential for us to develop our program for using organs from cadavers as envisaged in the Human Organ Transplantation Act (1994). It is the duty of all socially conscious persons – especially those with the benefit of training in medical science – to support it.