Red tape trips patients: Transplant body in ‘denial’, 3 hearts wasted
Pushpa.Narayan@timesgroup.com
22.03.2018
Chennai: Red tape in the state’s transplant procedure threatens to turn into tripwires for patients desperately in need of vital organs. Tamil Nadu has wasted three hearts since March 5 — just around a fortnight — after three families donated the organs of brain-dead relatives.
In all the cases, doctors said they could not use the hearts because Transplant Authority of Tamil Nadu (Transtan) officials insisted they had to “follow rules” that give priority to Indians on the waiting list and “not deny” them the organs.
The overemphasis on regulations made a 24-year-old woman with chronic lung failure wait more than four hours on Sunday in a city hospital, with her chest open, waiting for an organ. She finally received the lungs of a 17-year-old boy, declared brain dead by doctors at Rajaji Medical College and Hospital, Madurai, but doctors could not use the donor’s heart to save a life.
Transtan convener Dr P Balaji, however, blamed Gleneagles Global Health City, Chennai, for the loss of the heart, saying the heart had been “cross-clamped” before the transplant authority could allocate it to a suitable recipient.
“I have sought an explanation from the hospital for starting the retrieval process before our consent,” he told TOI on Wednesday.
Transtan sent out messages to hospitals as soon as the boy’s family agreed to donate his organs. It allotted Rajaji Hospital one kidney and Government Tirunelveli Medical College and Hospital the other. The liver was given to Apollo Hospitals, Madurai, and the heart and lungs were allocated to Global Hospitals.
“At 3.14pm that day, when the brain death declaration was confirmed, we gave hospitals the nod to harvest the organs. Minutes later Global Hospital said that the heart recipient had a fever and it would take just the lungs. We had too little time to reallocate the heart,” said Dr Balaji.
But doctors confirmed that though there were four Indian patients in state group with the donor’s blood group (AB+ve) and all the hospitals declined as the recipients were not ready, Fortis Malar had by this time come up with the names of potential foreign recipients.
Transtan was still looking for possible Indian recipients. It then approached the National Organ and Tissue Transplant Authority. Meanwhile, by 4.30pm, the donor was taken into the theatre so transplant surgeons could open the patient and assess the organs.
At 5pm when the team from Global confirmed that the lungs were fit for retrieval, it asked its Chennai team to wheel the recipient into the theatre. “We prepared the patient for the transplant and opened the chest,” said a senior transplant surgeon. “But we did not remove the lungs.”
‘Surgeon had volunteered to remove the heart’
By then, the national authority had told Transtan it could give the heart to a foreigner after it ensured there is no Indian recipient across the country.
“This takes time. Before we could reallocate the heart to Fortis, at 6.55pm, doctors from Global Hospitals retrieved the lungs,” Dr Balaji said. “They could have preserved the heart in a special solution. But they did not and the heart could not be used,” he said.
However, the transplant surgeon said he had volunteered to remove the heart, but did not have recipient confirmation from Transtan. “We had to reschedule our travel and book seats on the last flight of the night, at 8.30pm. We told the transplant coordinator of the hospital that any delay could be dangerous for our patient. He told us to go ahead. We spoke to doctors at Fortis who had a foreign patient and volunteered to retrieve the heart but finally did not because we were told there was no recipient,” the surgeon said. He and his team have met state health secretary J Radhakrishnan, he said. “We will submit our reply with evidence.”
In another instance, Transtan said the hospital had on March 5 turned down a heart from Tirunelveli Medical College and Hospital at the last minute. “The heart could not be used,” Dr Balaji said.
Doctors on Sunday also could not use a heart from Andhra Pradesh, because coordinators wanted to ensure no Indian was denied the organ. The state has retrieved organs from more than 1,000 people in the past 10 years, including 378 hearts and 237 lungs; it has given 137 hearts and lungs to foreign nationals in the past three years.
“There have been allegations that hospitals are overlooking Indian nationals to favour foreigners. Hospitals are now asked to give an undertaking that Indians are not overlooked or denied organs before they are allotted them to foreigners,” Dr Balaji said. “Our organ utilisation has been exemplary, but we must not waste time on confirmations. The brain death message should be sent at the same time across the country,” said Fortis Hospital heart transplant surgeon K R Balakrishnan.
Pushpa.Narayan@timesgroup.com
22.03.2018
Chennai: Red tape in the state’s transplant procedure threatens to turn into tripwires for patients desperately in need of vital organs. Tamil Nadu has wasted three hearts since March 5 — just around a fortnight — after three families donated the organs of brain-dead relatives.
In all the cases, doctors said they could not use the hearts because Transplant Authority of Tamil Nadu (Transtan) officials insisted they had to “follow rules” that give priority to Indians on the waiting list and “not deny” them the organs.
The overemphasis on regulations made a 24-year-old woman with chronic lung failure wait more than four hours on Sunday in a city hospital, with her chest open, waiting for an organ. She finally received the lungs of a 17-year-old boy, declared brain dead by doctors at Rajaji Medical College and Hospital, Madurai, but doctors could not use the donor’s heart to save a life.
Transtan convener Dr P Balaji, however, blamed Gleneagles Global Health City, Chennai, for the loss of the heart, saying the heart had been “cross-clamped” before the transplant authority could allocate it to a suitable recipient.
“I have sought an explanation from the hospital for starting the retrieval process before our consent,” he told TOI on Wednesday.
Transtan sent out messages to hospitals as soon as the boy’s family agreed to donate his organs. It allotted Rajaji Hospital one kidney and Government Tirunelveli Medical College and Hospital the other. The liver was given to Apollo Hospitals, Madurai, and the heart and lungs were allocated to Global Hospitals.
“At 3.14pm that day, when the brain death declaration was confirmed, we gave hospitals the nod to harvest the organs. Minutes later Global Hospital said that the heart recipient had a fever and it would take just the lungs. We had too little time to reallocate the heart,” said Dr Balaji.
But doctors confirmed that though there were four Indian patients in state group with the donor’s blood group (AB+ve) and all the hospitals declined as the recipients were not ready, Fortis Malar had by this time come up with the names of potential foreign recipients.
Transtan was still looking for possible Indian recipients. It then approached the National Organ and Tissue Transplant Authority. Meanwhile, by 4.30pm, the donor was taken into the theatre so transplant surgeons could open the patient and assess the organs.
At 5pm when the team from Global confirmed that the lungs were fit for retrieval, it asked its Chennai team to wheel the recipient into the theatre. “We prepared the patient for the transplant and opened the chest,” said a senior transplant surgeon. “But we did not remove the lungs.”
‘Surgeon had volunteered to remove the heart’
By then, the national authority had told Transtan it could give the heart to a foreigner after it ensured there is no Indian recipient across the country.
“This takes time. Before we could reallocate the heart to Fortis, at 6.55pm, doctors from Global Hospitals retrieved the lungs,” Dr Balaji said. “They could have preserved the heart in a special solution. But they did not and the heart could not be used,” he said.
However, the transplant surgeon said he had volunteered to remove the heart, but did not have recipient confirmation from Transtan. “We had to reschedule our travel and book seats on the last flight of the night, at 8.30pm. We told the transplant coordinator of the hospital that any delay could be dangerous for our patient. He told us to go ahead. We spoke to doctors at Fortis who had a foreign patient and volunteered to retrieve the heart but finally did not because we were told there was no recipient,” the surgeon said. He and his team have met state health secretary J Radhakrishnan, he said. “We will submit our reply with evidence.”
In another instance, Transtan said the hospital had on March 5 turned down a heart from Tirunelveli Medical College and Hospital at the last minute. “The heart could not be used,” Dr Balaji said.
Doctors on Sunday also could not use a heart from Andhra Pradesh, because coordinators wanted to ensure no Indian was denied the organ. The state has retrieved organs from more than 1,000 people in the past 10 years, including 378 hearts and 237 lungs; it has given 137 hearts and lungs to foreign nationals in the past three years.
“There have been allegations that hospitals are overlooking Indian nationals to favour foreigners. Hospitals are now asked to give an undertaking that Indians are not overlooked or denied organs before they are allotted them to foreigners,” Dr Balaji said. “Our organ utilisation has been exemplary, but we must not waste time on confirmations. The brain death message should be sent at the same time across the country,” said Fortis Hospital heart transplant surgeon K R Balakrishnan.
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