By – Dr. (SMT.) Vatsala Trivedi, Mumbai

The Government of India passed the Transplantation of Human Organs Act (TOHA 1994) in 1994 July and it was enforced in State of Maharashtra in Feb,1995. As per the Act the government of Maharashtra promptly formed State Appropriate Authority, State Authorization Committee, visited various institutions, recognized the local brain death committee & gave recognition to carry out transplant activities. In March 1997 first Cadaver Renal Transplant was carried out by L. T. M. G. Hospital. Following this sporadic cadaver transplants were done at various recognized institutions in Mumbai & Pune. But all these were as a result of effort made by individual hospitals, as there was not definite networking amongst the hospitals. Many like-minded NGO’s got together & formed NODC (National Organ Donation Campaign) so as to consolidate the effort in promoting organ donation, net working & fair distribution but hardly had any impact.

In September 1998, the Government of Maharashtra requested L. T. M. G. Hospital, Sion to put up the draft proposal for setting up a ZTCC (Zonal Transplant Co-ordination Center) in the city of Mumbai. After studying the details about other international groups like UNOS, European Transplant Foundation, and UKTSSA etc., the following proposals were put up, which should suit the Indian Scenario.

Purpose of Z.T.C.C.

To improve organ donations, Procurement & Transplantation system in Mumbai initially, & then adopt the same module all over Maharashtra. This would also increase the availability & access of donor Organs for patients with end organ failure. It could also establish tolerance in the patient to other tissues, such as a heart or pancreatic islets made in the laboratory from the same line of embryonic cells. This experiment was described in September 11, 2001 issue of proceedings of the National Academy of Sciences.

AIMS & OBJECTIVES

1. Effective cadaver organ procurement.
2. Increase patient access to state-of-art transplant technology.
3. To improve system of sharing renal & extra-renal organs.

This is done by:-

a. Donor & recipient matching by specific criteria established for each organ.

b. Improve transplant outcome.

c. Provide a system by which immunologically sensitized patients are offered best possible opportunities.

d. Decrease the Wastage of Organs.

     4. Assure quality control by collection analysis & publication of data on organ donation & transplants.

     5.Maintain & improve professional skills of those involved in organ procurement & transplantation.

     6. To have immunosuppressive drug bank.

     7. To increase public awareness.

To achieve these aims ZTCC maintains

1. Waiting list of recipients.

2. List of donors & recipients of organs.

3. Donor & Recipient matching / his to compatibility.

4. Data on organ allocation.

The data should be used for learning about the impact of the cadaver transplant, donor factors, waiting period, transplant rate, grafts Universal social, regional factors, etc.

Composition of ZTCC

Cadaver transplant activity is a hospital-based activity with participation of all strata of society. The core group, which makes the donor organ functional in recipient in case of kidneys, is the transplant surgeons & the nephrologists. They in turn are dependent on entire hospital i.e. on intensives, neurosurgeons, neurologists, administrators, anesthesiologists, also on service branches like pathology, microbiology, imaging services, Paramedical staff like nursing staff, physiotherapists, medical social workers, dieticians, class IV employees ... etc .. No cadaver transplant programme can be successful unless there is a time bound co-ordination between intra hospitals, inter hospital & the society at large. This co-ordination will be effective only by co-operation of each member & the co-operation is always possible by deep involvement of each member. Keeping this in mind the ZTCC as an organization was composed. Every recognized transplant institution of Mumbai is a member of this organization. This includes 13 recognized hospitals including 3 municipal medical colleges, 1 government medical college, 1 central government hospital, (INS Ashwini) & 8 private corporate hospitals.

The actual members of the ZTCC are of the following categories

1. Chief administrative officer of each recognized hospital that is empowered with implementation of decision taken by ZTCC in his/her hospital. This is to achieve intra hospital co-ordination.
2. One or two transplant experts to have scientific inputs.
3. Miscellaneous: - This group is society at large which includes representatives of NGO, business community, lawyers, journalists, IPS Officers, representatives from State Appropriate Authority, and any other socially eminent personalities.

With these aims, objectives & composition the first meeting of ZTCC in Mumbai was held on 18th Dec., 2000, with following office bearers:

Mr. Julio Ribeiro (Rtd.) IPS was the President, 2 Vice Presidents (1 from private hospital & 1 from L.T.M.G. Hospital, as ZTCC is located at LTMG Hospital.), and one Gen. Secretary from LTMG Hospital. One Joint Secretary from private hospital  one Joint Secretary from Asst. Director of Health Services representing State Appropriate Authority and one treasurer who was from miscellaneous group. The center was registered with Charity Commissioner & a bank account was opened in the name of the center.

The initial response looks extremely encouraging as from March 1997 to December 2000; the city of Mumbai had only 21-22 cadaver renal transplants as against 20 cadaver renal transplants in the year 2001 & by April 2002, 6 more were done, a total of 26 cadaver transplants in 15 months. The major contribution for initial transplants in the period 1997-2000 was from a public hospital i.e. L.T.M.G. Hospital & 1 private hospital i.e. P.D. Hinduja Hospital. After the formation of ZTCC many other hospitals too got activated & successful transplants were carried on.

Monetary Sources

The office space with electrical fixtures, water etc. was provided by Bombay Municipal Corporation in the department of Urology, L.T.M.G. Hospital & Medical College.

 1. Initial contribution of Rs.25, 000/- from each member from a private hospital was collected.

2. Furniture donation from the private hospital was expected.

3. Proposals for contribution of State Government & Bombay Municipal Corporation are in process.

4. Service charges from member hospitals were proposed.

The procedure adopted for waiting list is that every recipient gets registered amongst the recognized hospitals. The member hospital through their Chief Administrative Officer sends the details of the recipients in the format provided by ZTCC.

The Final Goal of ZTCC are enlisted as follows : 

1. To have data on all transplant programmes.
2. To provide database for periodic analysis, reporting on efficiency of transplant programme of city, for basic & clinical research.
3. The data should be utilized for: -

                a. Impact of HLA matching & transplant outcome.

                b. Various organ preservation methods & outcome.

                c. Various donor characteristics (age, medical history .. , etc.)

                d. Waiting period of recipients & transplant rate.

With these aims, objectives & composition, ZTCC started in December 2000, which is indeed a humble beginning, but aims to make cadaver organ transplantation, a reality in our country.