Organ commerce rears its ugly head again

This week in health: a quest to catch organ rackets, gender blindspots in health care, Russia’s promise of ‘cancer vaccines’ and unlocking the mysteries of the brain.

Updated - February 21, 2024 09:29 am IST

Published - February 20, 2024 02:32 pm IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: Getty Images

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This nation has an embittered history with reference to illegal organ trade. Media in the 90s were rife with stories about organs being stolen from the poor or literally taken without significant compensation, to be used for those waiting for an organ transplant in hospitals. Localities in the southern capital of Chennai, which also has a flourishing private health care sector, came to be nicked ‘Kidneyvakkam’, because of a rampant trade in kidneys. Investigations revealed how people had been defrauded after being promised a lot of money for a kidney and how quality of life deteriorated rapidly for the poor who had been wrested of their kidneys. The change in the game happened thanks to the Transplantation of Human Organs and Tissues Act, known in short as the TOHA Act, passed in 1994. It criminalised organ trade, buying and selling of organs, and insisted that altruistic donation or relatives alone could attempt to provide an organ in a living donor case. Attempts to strike at the root of the problem, stringent enforcement, and the TOHA Authorisation Committee’s iron hand (in most States) in whetting unrelated donor transplants, resulted in many hospitals losing their licence and an extensive awareness post-the Act intended to head off the gullible from selling their kidney for money. While it is impossible to say with certainty, in a country of this size and diverse quality of governance, that it rooted out the problem in its entirely, it certainly made organ trade less fanciful at a commercial level. It was likely pushed underground, and the violations, ostensibly, few and far between. 

But no one was very surprised when a media investigation of an organ racket involving the people of Myanmar, broke in December last. The London-based The Telegraph alleged that Myanmarese were being brought into Delhi’s Apollo Indraprastha Hospital and being relieved of their kidney, for a consideration. Following this, the government ordered a probe. We did not hear of the results of the probe, but interestingly, last week, in a follow-up, Bindu Shajan Perappadan reported on the Health Ministry’s warning that there are possible commercial dealings in organ/tissue transplantation of foreigners in India. Health Secretary Apurva Chandra, in a written communication, alerted the Ministry of External Affairs of possible violations and asked for support to establish systems for monitoring the process. In an earlier letter he wrote to the Foreign Secretary, Mr. Chandra said: A recent media report has highlighted that in some cases the veracity of the documents to establish relationship between the donor and the recipient, their identity documents, proof of residence etc. cannot be established confidently and the same may not be genuine.

Time is of the essence here, any such organ racket must be nipped in the bud and measures taken to ensure that this incident does not lead to a spurt in other centres across the country. Stamping this out here, and now, using all the tools available to the government is an urgent issue that needs to be addressed. 

On the other spectrum of donations, Afshan Yasmeen reports that the family of a patient with Huntington’s Disease (HD) donated the brain to NIMHANS for research. Huntington’s Disease is a rare inherited disorder that causes progressive neuro-degeneration, and human understanding of the disease is limited to offering treatments for symptoms. Doctors at NIMHANS said this was the first brain donation at NIMHANS of a patient with HD. The patient had expressed her willingness to donate her brain after her demise for research, so doctors could figure out the disease better, and help others in the future, and her family complied. 

In vaccine news, interesting analyses are brewing on the efficacy of COVID-19 vaccinations and their side effects, but more on this, perhaps next week. This week, read on to catch the key points that former WHO chief scientist Soumya Swaminathan said on India’s performance (vis-a-vis) developed countries in vaccination against COVID-19, and Vipin M. Vashishtha asks: Does frequently updating COVID-19 vaccines have any benefits? A new study has found that updated vaccines improved neutralising antibody titres compared to non-updated formulations, but the matching problem persists. Now, what is the matching problem? Researchers update the composition of influenza vaccines every six months to match the strains of the virus that are circulating in the wild, so that the shots may provide protective immunity against the flu. But despite their best efforts, researchers rarely perfectly match the strains loaded in the vaccine with the strains circulating by the time the vaccines reach the market.

Naturally, let’s segue into the subject of infectious diseases. Last week we looked at Kyasanur Forest Disease, and sounded the alarm on new and reemerging infections, this week, regarding KFD, Seven more cases were reported on February 14. In Alaska, an elderly man was the first reported person to die of the recently discovered Alaskapox virus. Alaskapox, also known as AKPV, is related to smallpox, cowpox and mpox, health officials said. Symptoms can include a rash, swollen lymph nodes and joint or muscle pain. Only six other cases of the virus have been reported to Alaska health officials since the first one in 2015. All involved people were living in the Fairbanks area, more than 300 miles (483 kilometres) from the Kenai Peninsula, health officials said. All had mild cases and recovered without being hospitalised. It’s unclear how AKPV is transmitted but researchers say it may be zoonotic, meaning it can jump from animals to humans. The bulletin said that tests found evidence of current or previous infection in several species of small mammals in the Fairbanks area, including red-backed voles, and at least one domestic pet.

As we delve into the pharma and research sectors this week, skimming off the top is Russian President Vladimir Putin’s claim that Russia is close to creating cancer vaccines. Mr. Putin said in televised comments that “we have come very close to the creation of so-called cancer vaccines and immunomodulatory drugs of a new generation...I hope that soon they will be effectively used as methods of individual therapy,” he added, speaking at a Moscow forum on future technologies. Mr. Putin did not specify which types of cancer the proposed vaccines would target, nor how. Notably, several experiments are on across the world to find vaccines for cancer, but none of them have crossed the rubicon into effective immunisation. We should wait this one out. 

Meanwhile, there was research-based information on Bengaluru researchers who had developed a paper-based platform for rapid detection of antibiotic-resistant bacteria. Researchers at the Indian Institute of Science (IISc.) and Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR) have developed a paper-based platform which could help quickly detect the presence of antibiotic-resistant, disease-causing bacteria. This would help in treating the patient with the right antibiotic, and not a broad spectrum or expect with a range of inappropriate drugs. This would also have a significant role to play in addressing the issue of antimicrobial resistance.

Jardiance or empagliflozin was recently approved for the treatment of adults with chronic kidney disease in India. The Central Drugs Standard Control Organisation (CDSCO), has approved Jardiance (empagliflozin) 10 mg tablets to reduce the risk of sustained decline in patients with end-stage kidney disease, cardiovascular death, and hospitalisation in adults with chronic kidney disease (CKD) at risk of progression.

The CDSCO also issued sampling guidelines to ensure the quality and efficacy of drugs and cosmetics last week. In the new guidelines, notified last week, it said that interior locations or rural distributions are not covered and thereby the quality of drugs at distant users or last users was not being assessed. “From the past trends it is observed that there is no defined methodology for sample selection and location of sampling etc and was done randomly with the individual knowledge of drug inspectors,” the document stated.

In a very significant development, the NHRC sought a report on the sale of drugs with identical names for different ailments. The consequences of confusion between these medications at the pharmacy can be serious for patients as these drugs are being prescribed by the doctors for treatment of different diseases. You might remember this article, we carried end January. Do check it out for an indepth view. 

If you have asked what makes the brain the most complicated object in the universe, then you’ve come to the right place for answers. Timo Istace, Stephanie Sheir and Nicholas J. Kelley report about how HuthLab’s research is a significant step closer towards accessing people’s actual thoughts. “We’re getting at meaning – something about the idea of what’s happening. And the fact that’s possible is very exciting,” Alexander Huth, the neuroscientist who co-led the research, told the New York Times. Combining AI and brain-scanning technology, the team created a non-invasive brain decoder capable of reconstructing continuous natural language among people otherwise unable to communicate with the outside world. The development of such technology – and the parallel development of brain-controlled motor prosthetics that enable paralysed patients to achieve some renewed mobility – holds tremendous prospects for people suffering from neurological diseases including locked-in syndrome and quadriplegia.

Turning our focus on the gender question, we have had several stories this past week that have placed health care in a gendered context. Saumya Kalia writes about the big diversity blindspot in health policy. A new study found key health policy committees since Independence are overrepresented by men, doctors, bureaucrats and individuals from New Delhi — neglecting diverse perspectives critical for public health systems. I examine if endometriosis will be exempt from the gender pass over. Since policy and treatment focus mostly on women of childbearing age, and on fertility-related mortality, often other conditions go ignored. With new research lined up to examine endometriosis, globally, will this change for women? This is another one we will stay on. 

R. Prasad uses the data to indicate a very precarious situation: Nearly 50% of pregnancies in India are high-risk. A study that analysed the data of nearly 24,000 pregnant women in India has found the prevalence of high-risk pregnancies to be high at 49.4%. ICMR’s National Institute for Research in Reproductive and Child Health (NIRRCH) in Mumbai which conducted the study used the nationally representative cross-sectional household survey data of the National Family Health Survey-5 (2019-2021). The researchers used the unit-level data from the Demographic Health Surveys (DHS) programme. Data from around 28,400 currently pregnant women aged 15-49 years were extracted. 

This is something anyone who ever has to get into a hospital will certainly be concerned about. Will your medical insurance be accepted there, will the process be cashless throughout? Read our story: Cashless Everywhere initiative welcomed by patients but hindered by slow implementation in hospitals. On paper, the Cashless Everywhere scheme launched by the General Insurance Council in January means that any medical insurance policyholder can now access cashless facilities for treatment in any hospital, even if that institution is not in the network of their insurance company. On the ground, however, the scheme’s uptake has been slow, marred by low consumer awareness about cashless hospital facilities, no standardisation of rates for treatment and medical procedures in hospitals across India, and the inability of medical institutes to quickly implement the new initiative. When hospitals and insurers fail to agree on treatment costs, cashless services cannot be offered.

In our tail piece for this week, Sridhar Sivasubbu and Vinod Scaria once again dig into DNA to provide fresh insights on what DNA helps us figure out the past and present, and the future. In what our ancestors’ genomes can tell us about modern health, the authors say ancient DNA (aDNA) studies powered by cutting-edge genomic techniques have opened a window into the past, providing unprecedented insights into the genetic makeup of our ancestors. And by extracting and analysing DNA from ancient skeletal remains, scientists can reconstruct the genetic profiles of these people. Studies of such ancestral DNA have provided glimpses into the genetic diversity and population dynamics of ancient communities, their migration patterns, interactions, and adaptations to local environments, and even into the diseases these people confronted and how the afflictions shaped human evolution.

From the Health page

If you have a few moments, do also read the following stories:

PM Modi lays foundation stone of AIIMS-Rewari in Haryana.

Smoking leaves a lasting adverse impact on immune responses.

Explained: Can rheumatoid arthritis be prevented?

Health Ministry data confirms what rare disease activists have been saying: Centres of Excellence is grossly under-utilising funds for rare diseases.

5 patients die as oxygen runs out in Gaza hospital seized by Israeli forces, health officials say.

India sends assistance to cholera-hit Zambia.

NIMHANS study identifies novel risk genes associated with brain disease affecting walking and balance in Indian population.

For this week’s regional content from a swathe of bureaus in the country, click the following links:

Andhra Pradesh

Sambasiva Rao M. reports that an ex gratia of ₹5 lakh was granted for a family of diarrhoea victim in Guntur.

NTR hospital staff in Anakapalli demanding bribes for post-mortems, allege ZPTC members at Zilla Parishad meeting in Visakhapatnam.

NGO provides free HPV vaccination to 50 girls in Visakhapatnam.

Karnataka

Snakebite cases and deaths now notifiable in Karnataka.

Karnataka’s Health Department launches neonatal ambulance services.

Hubballi doctors perform advanced heart surgery to give a 64-year-old woman a new lease of life.

NIMHANS to host second edition of Mental Health Santhe in Bengaluru.

Karnataka Budget on Health: Focus on upgrading infrastructure.

Kerala

C. Maya writes about Kerala’s Karunya Arogya Suraksha Padhathi, a scheme that is bleeding hospitals dry.

Kerala minister to launch ‘Ormathoni’ for Alzhemeir’s patients on February 15.

Kerala gets award for TB elimination activities.

Discussions on to explore if those with medical graduate degrees from abroad can be allowed to have clinical training in self-financing medical colleges in Kerala.

C. P. Sajit interviews Rajmohan Unnithan about addressing healthcare challenges, and setting up of AIIMS in Kasaragod.

Kerala issues heat-related health advisory.

Annual health screening for all above 30 years in Kerala.

Odisha

Satyasundar Barik reports state honour at the last rites of persons donating organs in Odisha.

Tamil Nadu

3,544 cases of H1N1 in 2023 was the highest in 14 years in Tamil Nadu.

Health department to look at leveraging PCR to pick up TB antigen.

C. Jaisankar writes: Medical tourism shows signs of improvement in Tiruchi.

Woman dies during sterilisation surgery at Nainarkoil PHC, relatives allege medical negligence and stage road roko on Madurai-Rameswaram NH.

Telangana

Lavpreet Kaur reports that over ₹1.2 lakh worth of fake medicines were seized in Hyderabad.

Siddharth Kumar Singh reports: Telangana trails in health spending, reveals CAG report.

Tripura

Syed Sajjad Ali writes about the Tripura Government launching its health insurance scheme.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here

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