New notified Rules of Transplant Act of 2014 may help boost deceased donation in India and ease organ shortage
The Indian Ministry of Health after almost two-and-a-half years has finally got around to notifying the new rules on how to implement the Transplantation of Human Organs (Amendment) Act, 2011. The amended Act after doing the rounds of the Rajya Sabha and Lok Sabha was signed and passed by the President of India in September 2011. However, the Act and rules still need to be passed by the state health assemblies before they can become universally applicable in the country. There are two aspects that the rules have looked at – one is to ensure that the commercial angle to organ donation is curtailed in India and the second is to promote organ donation after brain death.
After reading the document, we have come to the following conclusions –
a. A few sections of the rules are confusing and the clauses are too wordy and unnecessarily lengthy. Some people will need a lawyer to get the right interpretation.
b. A few sections were a bit of a surprise and have gone further than expected to help the organ donation programme move forward. The progressive sections of the rules are given below –
i) Deceased donor maintenance costs have been clearly defined.
ii) During organ retrieval in brain death situation, post-mortem doctor may be requested to be present in operation theatre. This should help hasten the process of donation and avoid delays in handing over the bodies to the relatives.
iii) Appointment of a Transplant coordinator in order for a hospital to be given a license for undertaking transplantation – this aspect will help in counselling of families for taking consent for organ donation where there is a brain dead donor.
iv) More authorisation committees to be formed and the format for this has been laid down – this will avoid delays in getting approval in case of living donations.
v) Certification of brain death possible by Intensive care doctors and anaesthetists – this will ease the pressure on neurologists/ neurosurgeons and improve certification rates and hence improve donor pool.
vi) Required request for donation is a must in case brain death is declared – this will ensure that the relatives are empowered with the knowledge that organ donation is possible if brain death occurs in their loved ones.
vii) Tissue donation will not need a doctor – a trained technician can undertake the procedure – this rule will improve donation rate and ease the pressure on doctors. However, the hospitals will need to ensure that the technicians are well trained before they undertake retrieval of tissues.
c. Some sections of the rules are ambiguous and leave much to be desired. They have not been fully discussed to look at the pros and cons in implementing these rules. Examples are –
i) Value of Donor Registry – even if we have such a registry, permission of relatives will still be required to proceed for donation. If a donor signs Form 7 and makes known his wish to donate after his/her death, but the relatives say no at the time of death, there is no provision for donation to proceed.
ii) The rules have stated that in the organ recipient registry where organs originate from deceased donors, priority should be given to recipients where a living donor refuses to donate. This is absurd and will discourage living donations including swap donations.
iii) There are also too many forms governing the new rules, 21 to be precise. It will be interesting to see how many states take up the new law and rules and the time frame in which the states adopt the new law in the field of organ donation and transplantation
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- Keywords: Transplant Rules 2014, Transplant Amendment Act, deceased organ donation, living donation