Tamil Nadu’s deceased donor organ retrieval programme is a good example of a transparent, State-led initiative that can demonstrably curb trade in human organs. It is not by accident that the programme has achieved a donation rate for kidneys, livers, hearts and lungs that is many times higher than the national average; last year, nearly half of all donations from dead donors in India were in Tamil Nadu. A combination of socially-minded medical professionals, supportive governments and high levels of openness has encouraged several families to altruistically give away the organs of their kin who suffer brain stem death, mostly in road traffic accidents. The Tamil Nadu model, recently featured by BMJ (the British Medical Journal) as a replicable framework for other States, has many aspects that merit close attention. What stands out in its design is the requirement that all hospitals doing transplant surgeries register with a State authority, offer counselling to the kin of potential donors, submit records of transplants and declare their charges. The online publication of waiting lists, the hospitals involved and guidelines for allocation of organs has strengthened public confidence in the system. Notably, many recipients are poor.

It is no secret that the evolution of such a forward-looking measure in Tamil Nadu is the response to an unedifying past — one that made the State notorious for trade in kidneys procured by middlemen from living donors, mostly the poor. Commerce in organs continues in many other parts of the country, exploiting a provision in the Transplantation of Human Organs Act that allows living unrelated people to give, for reasons of attachment to or affection for the recipient. This must be countered forcefully by promoting the cadaver donation model. Even Tamil Nadu can do a lot more, by devoting attention to trauma units in district hospitals, where cadavers can be maintained for organ donation, and doctors trained to identify brain stem death and perform transplants. Commendably, the expertise acquired thus far by the State is being widely shared with health systems across the country, and there can be no excuse for others not to institute similar programmes. It is, of course, vital to remember that the major supply of cadaveric organs comes from the shocking number of road accidents that kill over 134,000 people a year. On the other hand, organ demand is also inexorably rising due to weak preventive measures and treatment access for diabetes and hypertension. Free public provision of dialysis, which is currently unaffordable in the private sector to most patients, can help many with end-stage kidney disease. Curbing organ commerce needs a national initiative.

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