The Organ Trade Debate on IBNLive

Dear VV,

It is a good step forward as it increases the chances of finding a matching donor. Being a swapping program, success in terms of curbing organ trade will probably depend on the profile of organ-seekers from foreign countries (I understand that this racket catered primarily to them). Did they come to India because it is cheaper as newspapers are suggesting or because they cannot find donors (presuming their countries do not have a national/statewide organ donation program) or because the long waiting list for organs in their own countries and/or the failure to find a match made them look for other avenues? I suspect it is the last one. Many of these countries, as was mentioned in the debate, depend largely on cadaver transplants though there may not be a bar on living people also from donating (see for example the US program http://www.organdonor.gov). If these folks are able to get their near relatives to donate but there is no match, only in such cases are they likely to find the Indian system useful. I do not know how far that is the case; that ought to be a concern because in countries with national programs, given that there is no absolute need for near-relatives to donate in order for a person to receive an organ, it is possible that such a practice is not widely prevalent which raises the question: are these people who look to India going to be able to find a relative willing to donate? If the answer is no and such people are looking to solve their problems only through money, the program may not prove very effective after all.

Dear Tarunabh,

Thanks for the comment and links. It is a good idea though a trifle premature in the Indian context. As has been pointed out by many, the idea of organ donation upon death is still to gain acceptability at large, a situation quite different from the one in the UK as stated in that BMA article.

As I understand it, a ‘soft’ consent would involve the relatives not being asked for consent but merely being informed about the dying man/woman not opting out of donation though an exception is made out when ‘it is apparent that to proceed with the donation would cause major distress to the individual’s relatives’. That exception essentially allows the family to veto the idea and the question in that case is whether it would be any more effective than informed consent.

One concern is that implementing such a measure may raise law and order problems. When someone dies, it is a sensitive moment for the physician and the hospital as well because emotions can run high and the institution and the doctor not only get a bad rep but are sometimes blamed for the death. Besides, it is not just the immediate family but the patient’s entire parivar who end up staying on or near the hospital premises commiserating one other. At such a time, it would be quite ill-advised to do something as intimate as harvesting organs against the family’s wishes (in theory, family decisions are supposed to be exercised on the basis of what the patient him/herself would have wished under those circumstances but particularly in the absence of any written testament, I do not believe that these distinctions are sufficiently developed or recognized in the Indian context)and may lead to confrontation and even a riot (if the cops are called to defuse the situation, they sometimes end up brokering compromises based on the exigency that may actually be in violation of any such law). So in practice, it is questionable whether presumed consent will turn out to be superior.

Dear Tarunabh,

You are right about the paternalistic notions of our political leaders. It is a pity that there are no libertarians across the political spectrum.

Coming to this issue, you are right that presumed consent may still help particularly, I think, if doctors are encouraged to get actively involved in the effort. For example, with respect to family planning promotion, it is often seen that the main source of aggressive promotion/forceful exhortation of tubectomies when someone has delivered a third child comes from the delivering obstetrician. This can border on coercion – if they are hesitant, they are repeatedly told to get it done and even rebuked should they decline the advice. This is of course at variance with what we understand about how physician-patient interaction should be conducted but it is quite probable that their efforts do play some role in the couples’ eventual choice. Likewise, a campaign to enlist doctors in such an effort may yield some dividends as they may use their position to advocate for this cause.