Several doctors are not sure of the reasons for fall

The drastic reduction of the number of cadavers at government hospitals, and the organs available for transplant at these public health centres has raised concerns in Tamil Nadu.

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Between June 2011 and December 2011, Stanley Government Hospital had one in-house kidney donor and five organs received from outside the hospital. During the same period, the hospital had one in-house liver donor and four livers that came from the common pool. Similarly, at the Government General Hospital, the largest public set up that uses a large number of organs (kidneys) for transplantation, the numbers have been similarly abysmal. Since June, the GH has had four ‘local' or in-house donors, and three kidneys from outside the hospital. Kilpauk Government Hospital has done only a single kidney transplant since October 2008.

Sources at the Government General Hospital and Government Stanley Hospital agree that the number of organs have indeed dropped substantially, but are not clear about the reasons for the fall, not only in the number of cadaveric organs available in-house, but also in the number of transplants being done over the last six months. A top official at GH said, “It is true that the total number of transplants have come down at what was once a busy centre for organ transplantation in the State, and Chennai. However, we are yet to identify the reasons.”

“There is definitely some problem somewhere. It took us 15 years to organise the liver (cadaver) transplant programme at Stanley. It takes very little to close it down,” said R.Surendran, Director, Institute of Surgical Gastroenterology and Liver Transplant, Government Stanley Hospital. He also set up the cadaver maintenance programme in Stanley Hospital to facilitate cadaver transplants. On Monday, he resigned his post in protest against “bureaucratic delays and hurdles” that hampered implementation of the department's various projects.

“There is no doubt that the problem of non-availability of cadavers/organs has to be addressed immediately, and seriously. The government hospitals are the only way poor people who cannot afford the costs of getting a transplant at a private health care set up can get a second chance at life. If we are unable to provide them organs here, they really have no hope,” Dr. Surendran stressed.

A senior official added that a couple of meetings have already been convened under the chairmanship of the dean of the hospital to analyse the reasons, and take positive steps to rectify the situation. In terms of number of accident admissions, and number of brain deaths, the figure has remained rather constant. Veena, the grief counselor at GH for the organ transplant programme suggests a couple of possible reasons that the hospitals are not able to convert the number of brain dead patients into organ donors. “Brain dead patients become unstable even after declaration of brain death; and their relatives are unwilling to donate or it would take time to harvest the organs after consent is received,” she says.

However, doctors point out that these circumstances are not exclusive to the last six months of 2011. “These are factors that have been at play for as long as we have had the programme going. While there can be fluctuations in availability of organs from brain dead donors from time to time, a six-month drought cannot be explained away with these reasons alone,” the senior official involved in the cadaver transplant programme said.

The cadaver donation programme of the Tamil Nadu government was started in October 2008, and the flow of organs was rather slow in the beginning. However, it picked up in 2009, and the first half of 2010 rather rapidly, leading to the rest of the nation sitting up to take notice of the programme being implemented in Tamil Nadu. Apollo Hospitals and the Government General Hospital were the two main sources of cadaveric organs. Now with the source drying out at the GH, it is but natural that the number of transplantations has also dropped noticeably, officials added.