There is an old saying "Where there is a will, there is a way" . Many people in India die every month due to unavailability of compatible donor. In a year about 80,000 persons require heart transplant with equal number of people requiring liver transplant. Doctors at Sir Ganga Ram Hospital have recently come out with a unique solution to the organ donor shortage.

Until 3 months ago, oblivious of each other's existence, eighteen month old Nigerian child Dike Ezeanya and 44 year old Mumbai resident Priya Ahuja were both struggling for their lives due to terminal liver failure. Their families had lost all the hope of life-saving liver transplants as the only available liver donors for each case were of incompatible blood groups.

Little did they realize that their destinies would be so closely intertwined that they would have successful liver transplants by exchanging organs of their donors and become linked forever, emotionally as well as physically. These unique donor- swapping liver transplants were successfully performed recently by the liver transplant team at Delhi 's Sir Ganga Ram Hospital (SGRH) for the first time in the country and perhaps in the world.

Announcing the achievement, Dr BK Rao, Chairman, Board of Management, said, "A team of 35 doctors strove for 16 hours in four operating theatres to complete the two liver transplants. Apart from SGRH, only a handful of other hospitals in the world were geared up to pull off such a logistically challenging case. This swap operation comes as a blessing at the time of organ donor shortage. Hopefully, this will trigger a series of such transplants which would help patients who would otherwise have been denied a transplant due to the lack of a matching donor".

Explaining the concept, Dr. A.S. Soin, the Chief Liver Transplant surgeon, said, "Dike and his mother Chinwe's blood groups were B and A and that of Priya and her husband Harish's were A and B respectively. While both donors' blood groups did not match their own recipients', they were suitable for the other recipient. When we suggested a donor to exchange which is also called 'paired donation', both families jumped at the opportunity.

The biggest challenge in paired donation transplants is that both transplants must take place simultaneously, otherwise the donor for the second transplant (first recipient's relative) may refuse to undergo surgery once his own loved one has been transplanted. While donor swaps are common in kidney transplantation which takes 2 hours, they have not been previously attempted in liver transplantation as conducting two simultaneous living donor liver transplants (4 operations) is a daunting task. This is because they take 10-12 hours each and are technically much more demanding."

But all's well that ends well. Barely 2 months after the landmark operation, both Dike and Priya along with their donors, are well and getting back to enjoying a normal life outside the hospital.

With the renaissance in the advancement of medical science, it became possible to remove organs from living as well as deceased persons, and to transplant such organs to save the precious lives of the ailing, suffering human beings. Like other inventions, this advancement was too inflicted with a social evil, viz. illegal and unethical commercial dealing of human organs, especially the kidneys. Many protests to address the nightmarish situation were made from various political, medical, legal and socially active groups, thereby demanding a comprehensive law in this regard. Otherwise also, in the absence of any law the removal of organs from persons suffering brain-stem death could not have been possible. In view of the above, an Act of Parliament, titled, The Transplantation of Human Organs Act, 1994, was made.

The Act included: the definition of human organ transplant; procedures; safeguards like authority for removal of human organs, regulations of hospitals, appropriate authority, registration of hospitals engaged in removal, storage or transplantation of human organs, punishment for contravention of the provisions of the Act, to ensure that the organs are not misused in any manner, whatsoever.

In the legal definition of the Act, 'organ donation' means that a person pledges during his lifetime that after death, organs from his/ her body can be used for transplantation to help terminally ill patients and giving them a new lease of life.

There are two ways for donating the organs:

a. Living related donor, viz. only immediate blood relations can donate as per the Act, and can donate one kidney, a portion of pancreas or part of the liver.

b. Cadaver Organ donor, viz. all organs can be removed from a person after brain death. Brain death is the irreversible and permanent cessation of all brain functions. Soon after the brain death, healthy organs from the donor to the recipient have to be transplanted.

The main organs and tissues which can be transplanted include:

• Heart and heart valves
• Lungs
• Liver
• Pancreas
• Kidneys
• Skin
• Bone & bone marrow
• Eyes
• Middle ear
• Blood vessels.

According to the Act, sale/ purchase of human organs and tissues is a punishable offence. Even if the deceased had pledged in his lifetime and had been issued with a signed donor card, the doctor will still ask for the permission of the family members before removing the organs. Except the eyes, no organ can be removed at home. It can only be removed at the authorised hospital after the brain death of a person who has to be put immediately on a ventilator and other life support system.

Organ Retrieval Banking Organisation, set up at the All India Institute of Medical Sciences ( AIIMS ), New Delhi , is the nodal centre of the country, with the purpose of encouraging and creating awareness about organ donations, fair and equitable distribution and optimum utilisation of human organs.

There is a great shortage of donors. At times, there are donors available within the family, but are not medically compatible for the recipient. Then there are illegal organ trade rackets operating clandestinely. To address all such problems, the Health Ministry has recently proposed amendments in The Transplantation of Human Organs Act, 1994.

According to the sources in the Health Ministry, including R. Ravi, Deputy Secretary (Medical Services), the draft Bill has been sent to the Law Ministry for vetting and forwarding the same to the Union Cabinet, which is expected to be tabled in the next session of the Parliament.

At present, transplantation of organs is legally permitted only between blood relations like father, mother, son, daughter or the relations emotionally close to the recipient. However, in the proposed Bill, some of the amendments include:

• Grand-parents/ grand- children are also being included in the list of relatives.
• No organ removal from the living minor.
• Swapping is allowed in cases, where the donor is medically incompatible for his own relative but is compatible for another. Hence, the two families unknown to each other can exchange the organs.
• Foreigners are not allowed to get organs from Indians.
• Penalty provisions have been enhanced drastically. The recommended fine is Rs. 50,000 to five lakh and the proposed imprisonment is from the present three years to seven years.
• Unscrupulous organ trade will be a cognizable offence.
• The amendment also suggests concessions to the living donor like train ticket concessions, customised life insurance policy of two lakh rupees; lifelong free medical check-up and treatment in the hospital where the organ donation was made.
• The proposed amendment also suggests registration of all hospitals and clinics going for organ transplantation, followed by a regulatory authority in each state, to monitor their activities and investigate the complaints of foul play.

The government shall also carry out education and awareness programmes to motivate more and more people for donating their organs.

Reacting to the proposed amendment in The Transplantation of Human Organs Act, 1994, noted Senior Advocate Ram Jethmalani said, "It is good that the amendment is being made in this law but you should cut the restraint of organ donation on sale. What is the harm if two consensual adults are in agreement to act as donor and the recipient on an agreed financial term? What is the harm if one is getting a new lease of life and the other is getting the financial assistance for which he might have been in desperate need? However, the point to check is that no racketeering takes place."

Welcoming the latest move of the Union Cabinet to bring in amendments to Transplantation of Human Organs Act (THOA) 1994, a young advocate and freelancer on legal contemporary issues, Hemant Kumar asserts that these were long overdue and the need for the same was even felt by judiciary when five years back (September 2004) the Delhi High Court in Re: Balbir Singh v. Authorization Committee ordered constitution of a Review Committee to examine various provisions of the Act and the rules made thereunder. The amendments being brought are a result of national consultation held on report of aforesaid committee.

Owing to certain complicated and long drawn provisions for organ transplantation, the genuine cases have been thwarted in recent years, hence the amended law may bring in some succor to desiring and intending persons. He, however, cautions that constant monitoring as well as stringent action must be taken to tame the menace of donor-broker-doctor nexus prevailing in our country owing to certain lacunae in the legislation. Hemant recalls the sordid episode of a notorious doctor, Amit Kumar ( aka Kidney Kumar) surfaced some time back in which he performed over 3000 kidney transplant operations hoodwinking the legal requirements and bypassing the process of authorization committees in active connivance of law enforcement agencies. The need of the hour is to stem this rot. The Authorization Committees empowered to grant approval must endeavour to separate wheat from the chaff. Also, urgent steps must be taken to immediately pass Clinical Establishments Bill currently pending before Parliament for effective regulation of the THOA.

Gautam Buddha once said, "Thousands of candles can be lighted from a single candle, and the life of the candle will not be shortened."