This is the second part of a series on organ donation. Click to read the first part)
The government-run Mrithasanjeevani is the only hope for the people suffering from organ failure. The organ-donation coordination platform was known for its life-saving work. Is it still the case?
B Abhijit is something like a loner when the other plus-one students live an active life. The 17-year-old yearns to play with his friends but he is suffering from a kidney ailment diagnosed more than a year ago. He is the oldest of the two sons of Anitha Kumari and Binu Karott in Neyyattinkara in Thiruvananthapuram district.
Abhijit is required dialysis every four hours, something which puts a disproportionate burden on his daily-wage earning parents. They have to raise Rs 50,000 per month for the dialysis sessions. Doctors had advised for immediate surgical intervention but the parents could not afford that. They have registered in Mrithasanjeevani. They have been waiting for more than a year for a kidney that can be transplanted to Abhijit.
Kerala launched Mrithasanjeevani in 2012. The project lets patients register and receive organs harvested from people declared brain-dead after accidents. About 2,400 registered patients are waiting for organs through the official project that runs under the state health ministry. About 50,000 people may be awaiting organs across the state, according to unofficial reports. About 700 perished in the past three years.
Organ donation is transparent when done through the Mrithasanjeevani project. The project is deliberately put under a shadow by unscrupulous people who benefit from illegal organ trade involving healthy people. Most of the fraud happens when patients rely on middlemen to receive organs from living people. This key difference is lost on some people who object to donate their dear one’s organs after death.
Mrithasanjeevani suffered greatly from movies that suggest that hospitals harvest organs without the knowledge of patients as well as fake campaigns on social media. The project was running efficiently until 2016. Organ donation under Mrithasanjeevani fell from 72 in 2016 to 18 in 2020 so far.
Organ donation is held in two ways in Kerala. Organs are harvested from a brain-dead patient through the Mrithasanjeevani project or from live donors. The latter method is not connected to the Mrithasanjeevani project.
Organ harvesting through the Mrithasanjeevani project is done only after taking the permission of the relatives.
Patients suffering from organ failure can accept organs from strangers only if they do not have any relatives to donate organs to them. The donor and a relative of the recipient have to appear before a committee formed by the government.
Brain death is confirmed as per guidelines issued by the health department. The process to declare someone brain-dead can be initiated only after examinations have confirmed that the central nervous system has been damaged. At least four expert doctors should form a team to check the patient. Two of them should be from a list put up by the government. Two doctors will conduct the examinations while the other two will oversee the tests and analyse the results.
In the first stage, the team of doctors has to ensure through a brain scan that the patient stands no chance of recovering from the severe blow to the brain. They also have to ensure that the patient’s blood has no traces of alcohol or drugs. Body temperature should be above 32 degree Celsius. Electric pulses are administered for nerve stimulation tests. The doctors will also check for any fluctuation in hormones and minerals in the body.
The second stage consists of two sets of examinations every six hours. If the patient is aged below 18 years, the examinations are held every 12 hours. These tests are so rigorous to look for any movement in the organs or any sign of breathing.
Only after the confirmation that the brain is totally unresponsive, an apnoea test is done. The examination is to see if the patient can breathe without the aid of the ventilator. Only after a satisfactory conclusion, brain death can be pronounced. All four doctors have to sign the report which has to be handed over to the relatives of the patient.
Humane experiences
Leena, aged 52, is resting in her house at Bhoothathankettu in Ernakulam district. She has a new heart, one that once belonged to Lali, a teacher at Chembazhanthi in Thiruvananthapuram.
“I had no hope when I registered at Mrithasanjeevani for a heart. But I received a heart within two months. Mrithasanjeevani gave me a second life,” Leena said.
Leena owes her fresh lease of life to the big heart shown by the relatives of Lali, who was declared brain-dead in May. The heart was transplanted in a hospital in Kochi on May 9. The state government offered to transport the heart from Thiruvananthapuram to Kochi in a helicopter free of charge.
Before leaving the hospital after the transplant, her children, Shiyona and Basil, signed consent papers to donate all their organs after death.
Yet the successive governments have handled the key projects without the priority it deserves, a few replies obtained under the Right to Information Act reveals.
When asked whether the government has officially named the project to coordinate posthumous organ donation, the department said that the project – Kerala Network for Organ Sharing (Mrithasanjeevani) – has not been officially named so.
Who is the top authority for the project at the state level? The government has not yet issued an order to name a state chief for the project.
Any orders related to the structural issues of the programme? None so far.
(Reporting by Jayan Menon, Santhosh John Thooval, A S Ullas, S V Rajesh, Vinod Gopi; Compiled by Jaison Parakkatt)
