Tamil Nadu's positive experience with its two-year old cadaver transplant programme has an important message for all States: strong official policy and commitment to transparency can improve the availability of vital organs to save lives. Kidneys, livers, and hearts from brain-dead donors have provided a new life to several patients with organ failure. Remarkably, Tamil Nadu has made the transition from a State with rampant kidney commerce a few years ago to one with a nationally acknowledged deceased-donor transplant programme. Some key factors have helped turn the situation around and set new benchmarks. Chiefly, Tamil Nadu created a network for sharing of cadaver organs, administered by a designated coordinator and an advisory committee. It enlisted government and private hospitals to equitably share the available organs, and opened a patient registry that helps identify recipients. A significant contribution has been made to the process by organisations such as the Multi Organ Harvesting Aid Network (MOHAN) Foundation, which trains grief counsellors and raises awareness, and the National Network for Organ Sharing (NNOS). The overriding principle has been to utilise the organs of brain-dead patients through donation rather than let them be wasted. The efforts have paid off and families of brain-dead people have come forward in altruistic spirit to donate the organs of their kin. Quite remarkably, the donor rate of one per million population a year in the State is ten times the national average.

The case for a sound cadaver organ sharing system cannot be overemphasised. Over 90 per cent of people with end-stage renal failure, for instance, die within months of diagnosis. But for such a transplant programme to inspire confidence among donors, it is vital to treat organs as the property of society, with no possibility of exploitation and commerce. This can be done through a transparent system that makes the rules public and the implementation verifiable. The Tamil Nadu programme is noteworthy for its orientation towards poor patients in public hospitals. The costs of the transplant procedure and medications for a lifetime are fully met by the government in these institutions. Moreover, the active participation of private hospitals, which contribute to the common organ pool, has helped achieve good results. Commendably, during a one-year period from October 2009, Apollo hospitals contributed 34 per cent of the donors. A lot more can be done to improve local use of organs in far-flung areas. Provisioning major hospitals at the district level with the systems necessary to maintain cadavers and the expertise to perform transplants must be made a priority.

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