The Times of India on 4th September 2012 has reported a proposal by the ministry of health to amend rules in the organ transplant act to include 'not so near' relatives.
Suggested modalities to establish the relationship with live donor include
- Old photographs of donor and recipient together
- Staying together and sharing same kitchen for more than 10 years
- Establishment of relationship between donor and recipient by a senior embassy official (for foreign nationals)
Greater caution has been recommended in case of female donors.
To the best of my knowledge, this is anyway a standard practice today and in camera interviews of donor and relatives are the norm in most if not all authorisation committees.
Having had significant experience in this field, what I believe we in India are lacking is the spirit of the law. As an insider, I can safely vouch that the letter of the law is followed to the 't' wherever I have had the occasion to study the system.
What I think needs to be strictly followed and enforced is
Donor to be evaluated and counselled by medical team who is not treating the recipient. This will avoid any potential conflict of interest.
Counselling of the donor privately and offering a medical opt-out in case of his/her refusal to donate. this will avoid pressure from family.
Donor advocacy team consisting of social worker and physician to be present during the authorisation committee meeting.
Until deceased donor organs are available to meet the need, living donation will be the need of the hour. Rather than make it difficult to donate by tightening rules and norms, what should be insisted on is greater transparency, dissipation of information, detailed counselling, donor advocacy and avoidance of coercion or inducement in any form.
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