New Delhi: The Centre has come out with draft guidelines that aim to determine criteria for receiving a kidney from a cadaver donor, in order to bring in greater transparency and tackle illegal kidney trade while prioritising patients in urgent need of renal transplant.
As per the proposed norms, patients requiring a kidney transplant will be registered centrally by hospitals through an online process. The registration will be approved by a kidney advisory committee after evaluating the need for transplant. Once approved, patients will be put on the “active” or “priority” list, based on specific guidelines.
At present, kidney donation is a legal maze, with the big demand-supply gap driving a black market. Estimates by Organ Retrieval Banking Organisation (ORBO), which functions under
‘end stage renal disease’, maintenance dialysis is an acceptable and reasonably good alternate therapy; so for majority of such patients, transplant is not considered an emergency procedure AIIMS, say 1-1.5 lakh patients require kidney transplants in India, whereas only 3,5004,000 receive it. However, experts say these estimates are much lower than the real demand because a lot of cases are either not diagnosed or not registered on time.
The National Organ and Tissue Transplant Organisation (NOTTO), under the aegis of the health ministry, will maintain the registry of patients in need of transplants.
The draft guidelines, made public by the health ministry on Friday seeking public comments within a fortnight, also stated that patients on a given city’s waiting list will get the first priority. “If no recipient (is) eligible in city waiting list, then allocation will be done to state and then to other states in the ROTTO (Regional Organ and Tissue Transplant Organisation), and then to other ROTTO nationally,” the draft said.
Though some states like Tamil Nadu have already constituted such committees, kidney donation from cadavers is largely unregulated across the country. So far, there were no central guidelines to monitor such donations.
“This initiative reflects our commitment to promote organ donation in the country. We will finalise these gui- delines after we receive various suggestions and comments on these draft guidelines. Once finalised, these guidelines will go a long way in promoting organ donation in the country,” health minister J P Nadda said. He added that an agreement with state governments and healthcare institutions will be signed in due course to ensure implementation of the guidelines.
The draft guidelines also suggest that recipients be aged below 65 years. It also recommends that patients go for maintenance dialysis wherever possible and be on it for more than three months on a regular basis before being considered for transplant.
It has been suggested that patients who no longer have dialysis access be urgently listed. Besides, patients with end stage renal disease who are unlikely to get a donor with a negative cross-match will also be given priority. For the full report, log on to www.timesofindia.com
Just as doctors have a duty of care and respect to their patients, so the rest of us have an obligation to doctors. It is a basic tenet of civilised societies that medics should be allowed to care for the sick and wounded in wartime as well as in peace. The concept of medical neutrality was enshrined in the first Geneva convention more than a century and a half ago, and over those years it has offered countless doctors, nurses and their patients a degree of protection in the cruellest times. Attacking medical facilities, transport and personnel intentionally is outlawed.
No one should need to be reminded of that; yet it appears that we must be – repeatedly. In May, the security council adopted a resolution to strengthen protection for healthcare workers, the sick and wounded, and hospitals and clinics in war zones. The measure was prompted by increasing assaults on such facilities; according to the International Committee of the Red Cross, 959 people were killed in 600 such attacks in 2014 and 2015 alone. It has proved fruitless. The strikes are now so frequent they are in danger of being normalised. On Wednesday the United Nations secretary general was forced, for the second time in four months, to spell out international law’s protection of medical services and its demand that the wounded and sick, whether civilians or fighters, be spared: “Deliberate attacks on hospitals are war crimes. Denying people access to essential healthcare violates international humanitarian law.”
Ban Ki-moon spoke hours after the two largest hospitals left in rebel-held areas of Aleppo were bombed out of service. Physicians for Human Rights says there were 382 attacks on 259 health facilities in the country between March 2011 and June this year, killing 757 medical personnel. There can be no doubt that many of those have been targeted. The bald numbers fail to capture the true impact: murdering a dozen doctors may cause the deaths of hundreds or even thousands of civilians, who are either too frightened to access healthcare or are simply left without services at all. Those who attack facilities intentionally know that they are destroying the morale of the communities they serve. Such assaults are intended to exacerbate suffering and drive people from contested territory.
Syria is far from an isolated case. In South Sudan, the Central African Republic, the Democratic Republic of Congo, Libya and many more places, healthcare workers are suffering. Médecins Sans Frontières has been forced to withdraw from the north of Yemen following the fourth attack against its facilities by the Saudi-led coalition in less than a year, killing 32 and injuring 51. The US and UK are not only failing to rein in Saudi Arabia, but continue to sell it arms.
And though Monday will mark the first anniversary of the US bombing which killed 42 at an MSF hospital at Kunduz in Afghanistan – including patients who burned in their beds and medics attacked as they fled the building – the organisation still awaits an independent investigation. In that case, as in Yemen’s, the facility was targeted despite the fact that MSF had repeatedly given its location; and the strike continued despite MSF alerting US forces that they were hitting a medical facility. As the organisation’s president observed earlier this year, four of the five permanent members of the security council have, to varying degrees, been associated with coalitions responsible for attacks on health structures.
It is important to acknowledge profound differences between cases. In Syria, attacks are routine and clearly intentional; there is little doubt that the Assad regime and its allies are calculatedly hitting the healthcare system. Reckless as well as deliberate actions can be war crimes. But it is significant that MSF continues to share the coordinates of its facilities in Afghanistan and Yemen, to protect them. In Syria, it keeps them secret.
In all instances, however, medics not only deserve to work safely; they have a right to do so. States must adopt clear policies for their militaries and train personnel accordingly. Attacks upon health workers and their workplaces should be investigated and documented thoroughly. Where countries fail to hold fighters to account for human rights violations, they should be pursued internationally. A dedicated UN high representative, as suggested by MSF, would help to keep the issue on the agenda. We must refuse to accept strikes on facilities and staff as aberrations or – worse – as a new rule of war, if doctors and the patients they so courageously serve are to be protected.