Dr. Sanjeev Puri
The concept of organ transplantation as a therapy for replacement of non-functioning organs originated in the twelfth century B.C. in India when Sushruta, a physician who taught medicine in a school in Kashi (Varanasi) started transplantation surgery. Rhinoplasty or nose reconstruction was at that time practiced in India on women accused of adultery and on criminals who were punished by nose amputation. This has been described in Sushruta Samhita, an ancient Sanskrit text on medicine and surgery. This was known to the Khmer king Ya?ovarman of Cambodia as well as in Tibetan literature. It was also translated to Arabic as Kitab Shah Shun al-Hindi’ or Kitab i-Susurud, in Baghdad during the early 8th century which reached Europe and there it was practiced.
The first successful Live Donor renal transplant in India was performed at the CMC Hospital, Vellore in January 1971 by Drs. Johny and Mohan Rao, almost 17 years after the first kidney transplant in America .Since then several thousand transplants, including other organs as pancreas, liver, heart and lungs, have been done in our country. Excellent technical and medical expertise was available in the country. This led to the business of human organs’ trafficking with a well established network of rich needy patients, poor socio-economic donors, middlemen, agents and some clinicians too. Transplants in India needed a suitable legislation to not only make organs available, but also protect the medical profession.
This led to the enactment of “Transplantation of Human Organs Act (THOA) 1994 to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. THOA was now adopted by all States except Andhra and J&K, who had their own similar laws. Under THOA, source of the organ may be the near relative donor (mother, father, son, daughter, brother, sister, spouse). Other than near relative donor could donate only out of affection and attachment or for any other special reason that too with the approval of the authorisation committee. This act also defined the Deceased donor, especially after Brain stem death where a person cannot breathe on his own but can be maintained through ventilator, oxygen, fluids etc. to keep the heart and other organs working and functional. Other type of deceased donor could be after cardiac death. Brain Stem death was recognized as a legal death in India under this act, like many other countries, which has revolutionized the concept of organ donation after death. Despite a facilitatory law, organ donation from deceased persons continued to be very poor leading to commercialization due to poor availability of organs.
Government of India amended THOA 1994 and the amended act was now called Transplantation of Human Organs & Tissues Act (THOTA), 1994 with inclusion of tissues and tissue banks and retrieval centres. ‘Near relative’ definition expanded to include grandchildren and grandparents, higher penalties for trading in organs, National Human Organs and Tissues Removal and Storage Network and National Registry for Transplant, and prohibition of organ donation from mentally challenged persons etc.
The first successful cornea (Eye) transplant in the world was performed in 1905 by Dr Eduard Zirm in Czech Republic. In India, Dr RES Muthiah started the very first eye bank in 1945 at Regional Institute of Ophthalmology Chennai where he performed the first corneal transplantation in 1948. Later Eye Bank Association of India (EBAI) started a movement for donation of eyes in India which is still running successfully.
Transplantation in Jammu and Kashmir: Corneal transplantation started in Government Medical College Jammu in early 1980s with eyes procured from outside the state. In fact there were few eye donations as well with transplantation to the time till act came into being in J&K.
THOA 1994 was passed in J&K Assembly as The Jammu & Kashmir Transplantation of Human Organs Act (J&K THOA) 1997. It was amended in 2018 as per THOTA, 1994 and named as J&K Transplantation of Human Organs and Tissues Act, (J&K THOTA), 1997.The Directors of Health Services Jammu as well as Srinagar headed the Registering Body in the respective division. Kidney transplantation started around 1999 in Sher-e-Kashmir Institute of Medical Sciences (SKIMS) Srinagar and thereafter, corneal transplantation in Government Medical College Srinagar in July 2017 and GMC Jammu in Dec 2019.
With the reorganization of the state of Jammu & Kashmir as Union Territory on October 31, 2019, the J&K THOTA, 1997 was replaced by the THOTA, 1994 with the Director General Health Services (DGHS), New Delhi as the Registering Authority. This authority has registered GMC Jammu and GMC Srinagar both for Kidney and Cornea Transplantation and Eye Bank; ECRC and Perfect Vision Srinagar (private facilities) for Corneal Transplantation; and Command Hospital (Military/Northern) Udhampur for Organ Retrieval and Corneal Transplantation and Eye Bank.
In the year 2022 in J&K, GMC Jammu has to its credit 4 eye donations with 4 corneal transplantations; GMC Srinagar did 9 corneal transplantations and ECRC Srinagar did 8 corneal transplantations. And this year, 2023 till July, 2 eyes donations along with 2 corneal transplantations in GMC Jammu; 4 eye donations with 4 corneal transplantations in Command Hospital Udhampur and 4 corneal transplantations in GMC Srinagar. There has been no corneal donation in Kashmir division so far and eyes were procured from eye banks outside the UT.
All the kidney transplantations conducted so far in J&K were from live donors. Last year, SKIMS did 39, GMC Jammu 12 and GMC Srinagar 2 kidney transplantations. This year till July, SKIMS performed 20, GMC Jammu 5 and GMC Srinagar 7 kidney transplantations. The cadaveric organ donation has not yet started in J&K.
National Organ Transplant Programme (NOTP) was implemented in 2011 in India. Under this programme a National Organ & Tissue Transplant Organization (NOTTO) with its office at Safdarjung Hospital New Delhi along with 5 Regional Organ & Tissue Transplant Organizations, (ROTTOs) were established. ROTTO North East in Guwahati for Assam, Meghalaya, Manipur, Nagaland, Mizoram and Tripura; ROTTO East in Kolkata for West Bengal, Jharkhand, Bihar, Sikkim and Orissa; ROTTO North in Chandigarh for J&K, Punjab, Haryana, Himachal, Chandigarh, Uttarakhand, UP and Rajasthan; ROTTO West in Mumbai for Maharashtra, Gujarat, Goa, MP, Chhattisgarh and Goa, Daman and Diu; ROTTO South in Chennai for TN, Kerala, Telangana, Andhra, Karnataka, Pondicherry, Andaman-Nicobar and Lakshadweep. Also 20 State/UT level ie State Organ & Tissue Transplant Organization (SOTTO) bodies were constituted to run this programme under THOTA, 1994.
Organ Donation is crucial to save lives of millions of people around the globe. An organ/tissue is donated by a human donor, living or dead, which is transplanted in the body of human recipient. Millions of people all over the world suffer from end stage organ failure, so there is huge demand for human organs.
In India, 1.80 Lakh patients suffer every year from renal failure and only 9000 kidney transplants are done. Liver transplant is needed in 25-30 thousand every year and only 3000 transplants are done. 50 thousand patients suffer from Heart failure every year with only 150 transplants performed. Cornea (Eye) requirement is 1Lakh against which only 25000 transplants done every year.
This is due to a wide gap between demand and supply of organs/tissues. Demand for organs annually is around 5 lakh with only around 40 thousand organs available leading to a gap between demand and supply. Organ donation rate in India is 0.64 per million population and this ratio is highest in Spain with 48 per million. 17 patients die each day waiting for organ donation in our country. Live donations are not enough, cadaveric donations are required. 1.5 lakh persons die due to Road Traffic Accidents; they could be potential organ donors.
There are two types of organ/tissue donors: 1. Living Donor ie an adult capable of giving legally valid consent may donate either one Kidney or a portion of Liver as one kidney is enough in life and liver has capability to regenerate. Such donor may be a near relative or other by way of affection. 2. Deceased or Cadaveric Donor of any age and sex. Such donors could be of two types: i. Brain Stem Dead Donor ie. a patient in ICU with complete irreversible cessation of all brain functions, but vital organs are kept alive by artificial support like ventilator, oxygen, iv fluids, drugs etc. Brain Stem Death is recognized as legal death in India under the THOTA. After Brain Stem Death, almost 37 different organs and tissues can be donated including kidneys, heart, liver and lungs, tissues like corneas, tissues, bones, blood vessels, skin. ii. Natural/ Cardiac Dead Donor where only few tissues like eyes, tissues, bones, blood vessels, skin and sometimes heart can be donated. It is also pertinent to mention that I/V drug abuser/tattooing in last 6 months; or a person with HIV, HBV, HCV, HTLV, COVID, Syphilis, Sepsis, Malignancy, Collagen Vascular Diseases etc. cannot be donor.
It is important to remember that after a person is certified legally as brain dead and becomes an organ donor, it is the family, which is the legal heir of the dead person that authorizes the hospital for retrieval of organ/tissue, even though the dead person may have pledged organs/tissues during lifetime. Once donated, organs/tissues can be transported by creating green corridor to the recipient hospital anywhere in India, without wasting precious time required for organs to survive. The crucial time between retrieval ie. removal of organ till its transplantation is: Heart and lungs: 4-6 hours, Liver: 12-20 hours, Pancreas:12-24 hours and Kidneys:48-72 hours.
J&K SOTTO: Jammu and Kashmir State Organ and Tissue Transplant Organization is a state level organization, was established in September 2019 in Jammu. Among many functions of SOTTO, important functions are facilitating multi organ retrieval from a Brain Stem Dead Donor, thereby allocating Human Organs to the hospitals in and out of the UT/State as well as conducting Awareness Programmes and IEC Activities. This organization is credited with 2200 organ donation pledges, 175 awareness activities, 15 trainings for doctors and paramedics, mock drill for organ transport, roadside wall painting under Jammu Smart City Project, Radio advertisements, TV interviews, Newsletter etc. among many achievements.
Ministry of Health & Family Welfare, Govt. of India has recently directed Director NOTTO to get THOTA, 1994 implemented in whole of India ie. to do away with domicile certificate for transplantation, no fees to be charged for registration as recipient and to finalize uniform organ/tissue specific allocation criteria’s in consultation with all stake holders. This is being done under “ONE NATION ONE POLICY”.
This year the central ministry has decided to run an organ donation awareness campaign by the name of “Angdaan Mahotsav in line with Azaadi Ka Amrit Mahotsav. Every year, Indian Organ Donation Day is observed on August 3 to mark the first successful heart transplant in India from a deceased donation done in AIIMS New Delhi on this day in 1994. This day’s celebration is to augment awareness about organ donation, dispel myths and misconceptions associated with organ donation and motivate and encourage the citizens of the country to donate organs and tissues after death as well as to imbibe the value of organ donation in their lives, along with felicitation of the families of organ donors. Moreover whole July month is observed as the month of Organ Donation to commemorate THOA enactment on 8th July 1994.
One can become an Organ Donor simply by pledging. This pledge can be done online by visiting the NOTTO website or offline by filling a form available with all the transplant centres and J&K SOTTO office at Super Specialty Hospital, GMC Jammu (contact phone no. 7889749233).
The author is Eye Specialist, presently the Joint
Director, Jammu & Kashmir State Organ & Tissue
Transplant Organization (J&K SOTTO)
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