New Delhi: Missing authority figures, poor allocation of organs, no data collection and a rampant, underground commercial organ trade -- laws governing organ transplantation in India have failed to eliminate organ trafficking and provide people access to legitimate transplants, says a new report.
Organ Transplant Law: Assessing Compatibility with Right to Health by the Vidhi Centre for Legal Policy, an independent legal advisory group, examined the Transplantation of Human Organs and Tissue Act, 1994, to find serious lapses in how organ donation is carried out in India.
Though the Act has been in place for 23 years, with amendments brought into force in 2014, there remains a critical shortage of organs and lack of access to those legitimately available, because of inefficient or absent infrastructure and high costs. The authors of the report encountered many cases of commercial organ trading, which is a criminal offence. However, only 16 people were on trial in various high courts and the Supreme Court, in 2016, for offences under the Act.
The report, called the first such to examine the law, is damning, when it examines how the Act has been enforced. From RTIs, Vidhi found out that neither states nor the Centre maintain centralised data on the complaints heard and adjudicated by the Appropriate Authorities”. They examined, instead, cases in high courts and the Supreme Court from 1994 to May, 2017. They found “56 percent of cases litigated under the Act are by donors and their families seeking permission for organ transplants. In comparison, only 20 percent of cases litigated under the Act are with respect to the criminal offences under the Act.”
Thus. most cases are brought to court by those trying to get access to organ transplants, and appealing against decisions taken by their state Appropriate Authority.
An Appropriate Authority is a state appointed figure, assisted by Advisory Committees, to regulate service providers -- hospitals and doctors -- and grant, renew, suspend or cancel their registration. No hospital or tissue bank can remove, store or transplant human organ or tissue without this registration. This system, often exists only on paper. The report says, these committees don’t exist in most states, and where they do, they do not act in a uniform manner across states.
Thus, despite much anecdotal evidence of wrongdoing,very few doctors or hospitals or related health professionals get penalised. Replies by the Maharashtra Medical Council and Delhi Medical Council to requests under the RTI Act revealed that neither State Councils have suspended any medical practitioners under this provision so far, said the report.
Data collection, too, is abysmal. The Act says, the National Registry on Organ Transplants must include demographic data about the patient, donor, hospitals, recipient and donor follow up details, transplant waiting. However, registries for organ and tissue donation have only been set up in Tamil Nadu, Kerala and Rajasthan. In most states, data on organ and tissue transplantation is not maintained uniformly. States and union ministries don’t maintain yearly reports on the operations of these registries.
India has one of the worryingly low rates of organ donations. Data from the National Organ and tissue Transplantation Authority (NOTTO) says that 500,000 people in India need organ transplantation annually, with most dying by the end of the year. Of those, 200,000 need a kidney, 100,000 need a liver. Only .01 percent of Indians pledge to donate organs.
The problem is compounded by lack of skilled surgeons and a lack of facilities in rural areas, says the report.
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