Mumbai: Private hospitals have contributed to 95% of cadaver donations in the city this year, and only two of the 40 cadaver donations came from the the State-run JJ Hospital. There were no contributions from KEM, Sion and Nair hospitals, the city’s busiest civic-run tertiary healthcare facilities.
The cadaver donations have facilitated the transplants of 50 kidneys, 37 livers, 28s heart and one lung in the city.
Most of these surgeries were done in private hospitals, which have taken a lead in identifying potential donors and convincing families to participate in organ donation. Topping the list of private hospitals are Fortis, Kokilaben, Jupiter, PD Hinduja, Saifee and Wockhardt.
This year, the 172-year-old JJ Hospital facilitated two back-to-back transplants for the first time since it opened its doors to patients. The initiative saw hospital dean Dr. T.P. Lahane, senior bureaucrats and State Medical Education Minister Girish Mahajan getting involved in convincing families.
Dr. Lahane said getting families on board is the biggest challenge for public hospitals. “There is a big difference in patients visiting private and public hospitals, which plays a defining role in organ donation. Our patients are often illiterate and from the lower socio-economic strata of society. The concept of brain death is novel to them; they feel there’s a chance their family member will recover as long as she or he is on the ventilator.”
Question of trust
Dr. Avinash Supe, dean, KEM Hospital, said education and awareness play key roles. “We approach patients regularly, but most don’t agree readily. This year, for instance, relatives of more than five brain dead patients were approached but none consented to donate organs. They feel the patient is not getting proper treatment and the doctors are after the organs.”
The hospital has a successful kidney transplant programme under which surgeries are done at half the price that private hospitals charge. However, most kidneys come from living donors. Dr. Supe said the scenario will change sooner than later. “We have appointed five counsellors under the Nation Organ and Tissue Transplant Organisation (NOTTO) to be posted at KEM, Sion, Nair and JJ hospitals. One counsellor has also been appointed for an Aurangabad Hospital.”
Patient distrust is not a problem faced only by public hospitals; private ones face it more. The solution, says Dr. Ram Narain, executive director, Kokilaben Dhirubhai Ambani Hospital, lies in dispelling myths surrounding organ donation and investing in manpower to communicate with grieving families. “The backbone of our programme has been rigorous training of transplant coordinators, counsellors, psychologists and intensivists.”
A solution could be found by following simple protocols. Nilesh Mandlewala of Donate Life, a non-profit in Surat, said the basic effort of identifying brain dead patients has worked wonders at Surat Civil Hospital. “For the past 12 years, the hospital didn’t get a single cadaver, but everything changed after June this year when they started identifying brain dead patients. Since then, we have got 10 families to donate organs.”
Mr. Mandlewala begins with an empathetic conversation with the family before informing them about organ donation. “Every family needs to be handled differently. If they give consent, we stay with the family at every step till the last rites are performed, so they don’t feel abandoned after donating their dear one’s organs.” He says public hospitals have tremendous scope of improving the organ donation programme, given the huge inflow of patients. In the past two years, Surat has sent 15 cadaver hearts to Mumbai, contributing majorly to the success of the city’s heart transplant programme.
According to Dr. S.K. Mathur of the Zonal Transplant Coordination Centre (ZTCC), public hospitals can give the programme the real impetus it needs. “Tamil Nadu has the highest number of cadaver donations, including a significant contribution from public hospitals. In Mumbai, cadaver donation was first started in public hospitals. In March 1997, Sion hospital was the first to perform a cadaver kidney transplant.”
There are more than 3,500 people waiting for a transplant and the list is growing. A senior doctor, who declined to be named, said, “While Mumbai’s public hospitals hide behind a low brain dead conversion rate, it’s undeniable that they don’t take much effort to even identify and report brain deaths.”
