Dr. Sumanth Raman and Dr. George Paul’s articles (Open Page, June 17) merit a response to set the record straight. To pay or not to pay is the fundamental question in this whole debate on organ donation. The answer lies very simply in the fulfilment of the four basic principles of medical ethics: Autonomy, Beneficence, Non-malfeasance and Justice. Does the deceased organ donation programme fulfil these criteria?

A person can choose to make a decision about donating his organs after death. Since this involves no element of coercion, which could exist in a living donation, this is true autonomy. Through deceased organ donation, there is benefit to not just one but many patients (beneficence). There is also no harm to the donor (non-malfeasance). Finally, there is an equitable distribution of organs (justice).

So YES, deceased organ donation is simply the RIGHT way of doing things.

The advocates of the paid living organ donor programme are missing the wood for the trees. One could “logically” stretch the theory about autonomy over one’s body from selling an organ to more unsavoury ideas such as child or bonded labour. Dr. Francis L Delmonico, President-Elect, The Transplantation Society, in an editorial in The New England Journal of Medicine, says: “The fundamental truths of our society, of life and liberty, are values that should not have a monetary price. These values are degraded when a poor person feels compelled to risk death for the sole purpose of obtaining monetary payment for a body part. Physicians, whose primary responsibility is to provide care, should not support this practice. Furthermore, our society places limits on individual autonomy when it comes to protection from harm. We do not endorse as public policy the sale of the human body through prostitution, despite the purported benefits of such a sale for both the buyer and the seller.”

For argument’s sake, let us look at a government regulated paid organ donation programme — does Dr. Raman seriously believe that there could be no manipulation here and that an organ might not be sold to the highest bidder? The time and effort that the government spends on regulating and monitoring this could be channelled into screening and early intervention for diseases like diabetes and hypertension which cause over 50% of kidney failure in our country.

MOHAN Foundation, having worked in the field of deceased organ donation for the past 15 years, is in a good position to comment on the change in the people’s attitude to organ donation. We mentioned Spain’s presumed consent in the context that it has come up with something that works for the country. The suggestion was that we evolve an Indian model. Dr. Raman’s suggestion that doctors would declare people who are alive dead to snatch their organs belongs more in the realm of a novel by Robin Cook and should stay there!

Deceased organ donation is not just the right way of doing things. It is actually an achievable goal and not merely a utopian suggestion. There are 2,10,000 patients in India who require a kidney. In 2010, there were 1,35,000 road accident fatalities (NCRB data). About 69% of these victims would have had fatal brain injuries (Ind J Neurotrauma, 2008).

In this pool alone, there are over 90,000 brain-dead patients who could be organ donors provided their relatives say “yes.”

A small percentage of this pool would be sufficient to meet the requirement for organs in our country. Develop a strong and transparent programme — it is the right direction to take.

(Dr. Sumana Navin is Course Director, MOHAN Foundation (Multi Organ Harvesting Aid Network), and Dr. Sunil Shroff is Professor and Head, Department of Urology and Renal Transplantation, Sri Ramachandra Medical College and Research Institute, Porur, Chennai. Email: Email: mohanfound @ gmail. com)

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