Dealing with a Celebrity 4


 DR A.G. Phadke

Today kidney transplantation is a well-established operation the world over. It is performed on those patients in whom both the kidneys do not function due to damage caused by diseases like glomerulonephritis, diabetes etc.

The Problems faced by the Indian transplant surgeon are complex and riddled with legal, moral, ethical and socioeconomic as also religious issues existing in our country. To discuss them here would probably be out context with the subject matter of this book though I feel that they should be discussed separately to expand the awareness of the lay public. I have some such dilemmas in some of the cases I have performed and the human aspects of these dilemmas are what I wish to dilate upon. There are today two alternatives to treat such patients. One is dialysis and the other is to transplant a viable kidney from a donor. It is in obtaining a suitable donor kidney that the Indian transplant surgeon faces the greatest difficulty.

In the West, kidneys were initially obtained from identical twins if one was available, or from close relatives. Subsequently, with the availability of immunosuppressive drugs and tissue typing, cadaveric kidneys were used. However, since these cadaveric kidneys were harvested after cessation of circulation, they would undergo some deterioration due to lack of oxygen and were consequently not very effective. This brought about the concept of organ donation from otherwise healthy victims of vehicular or other accidents, who had no chance of survival due to irreversible brain injury (confirmed by a flat EEG tracing), but whose heart had still not ceased beating.

In the West, since kidney from close relatives was not forthcoming, this seemed the only logical alternative. Widespread public education and appropriate legislation permitted doctors in the West to use these kidneys for transplantation after the accident victim was declared by competent medical personnel as "brain-dead”.

In India this last source viz., kidneys from victims of accidents are as yet unavailable to us due to the intricate social and legal problems extant in our nation. Leave aside such kidneys, even cadaveric kidney, albeit not ideal, was not very easily available due to the sanctity attached to a dead body by most Indians.

So most donor kidneys used in kidney transplants in India are from live donors. These are usually close relatives like siblings or parents, but here I must add a painful fact that in my practice of 10 years in the field of transplant surgery, I have seen properties exchange hands between 2 brothers after a transplant surgery! Other times, due to domestic constraints, a sibling is not willing to offer his kidney to a suffering brother or sister. It is usually the mother who without any reservations is willing to offer her kidney to save her precious child's life.

The other source in India is from unrelated poor persons who are lured into donating a kidney for a sizable monetary consideration. This "sale" of donor kidneys has raised several ethical and moral questions and given such donations a bad name, to the detriment of an effective national policy on kidney transplantation. There is a very pathetic situation in our country wherein a young man is dying of kidney failure but has the money to offer to a potential kidney donor, and on the other hand, there is another young man who has two functioning kidneys but is dying of poverty and therefore willing to donate one of the kidneys. Neither the Government nor the society has any provisions, unlike in the West, support a young jobless man who has no prospects of getting one. In India for millions of unemployed people, there is no hope but to continue to live and die in abject poverty. What then is wrong, especially when the Government and society have failed them, for these two helpless people to help each other.

To many medical men, this idea of mutual help is totally unacceptable. They think this is "trade in human organs.'' But let me inform the readers that this concept has its origin in the West, where donating" kidney for monetary consideration is illegal. In fact in the West, there is a law which prohibits such transactions because the affluent society can also afford to dialyse patients with kidney failure till such time as when a suitable donor is available. Most of our Indian patients can ill afford to indulge in such a prohibitively expensive treatment.

I personally and strongly feel that whether we like it or not, till such time as kidneys from unrelated dying donors become freely available, we will have no choice, but to make a compromise with our conservative morality and accept donation of a kidney by a needy person for a monetary consideration, especially since such a donation will still permit the donor to lead a normal life. In fact, it may surprise some readers to learn that some people are born with one kidney, and yet lead as normal a life as people born with two kidneys!

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar