He’s got a kidney donor but has to wait - 
The Organ Transplantation Act May Weed Out Touts But Questions Remain 
By Malathy Iyer/TNN     8 May 05

Mumbai: Half full or half empty. The story of Heeralal Jaiswal, a 38-year-old ‘pheriwala’ who urgently needs a kidney, fits this debate to a T. Medical tests have ruled out his brothers and parents as potential donors. His sister-in-law is ready to donate her kidney, but herein lies the most debatable point of the Transplantation of Human Organs Act, says experts. 
Hota, as the act is popularly called, was passed in 1994 to regulate transplants and promote cadaveric transplants. But time and again, there have been voices of dissent and talk of exploitation of loopholes. “The law says that unrelated donors can donate for emotional reasons, and this has been exploited by unscrupulous people to conduct a trade in organs,’’ says Dr Vatsala Trivedi of the Zonal Transplantation Coordination Committee (ZTCC). 
On Heeralal’s case, the opinion is likely to be divided. While one school of thought would like to hold up his example as a case for change, another would point out to the potential of subverting the law here. “According to Hota, his sister-in-law cannot be classified as a related donor,’’ points out Dr M Bahadur of Jaslok Hospital who is attending on Heeralal. Hota defines parents, siblings, children and spouse as family. 
Moreover, the law of the state demands that Heeralal should spend six months on ZTCC’s waiting list before undergoing an unrelated transplant. 
Hailing from a farming family from a village near Gorakhpur, Heeralal came to Mumbai to try his luck but ended up as a ‘pheriwala’ in Kurla earning between Rs 25 and 55 a day. When his legs starting swelling up, tests revealed renal failure. 
His brothers sold a portion of their ancestral land and rushed to Mumbai in March. “We have around Rs 90,000 for his treatment, but day-to-day living expenses and treatment are eating into the amount,’’ says his elder brother Gialal Jaiswal. A transplant operation could cost between Rs 1.5 lakh and 2 lakh in the city. 
Doctors who are members of the ZTCC—which uses a computerbased programme to coordinate cadaveric transplants in the city, thereby avoiding outside influences—are sceptical. While Dr Vatsala Trivedi refused to answer any hypothetical questions on Heeralal, another doctor who doesn’t want to be identified says, “How is it possible that none of the blood relatives are compatible donors, while a sister-in-law who has no blood relation is?’’ 
Moreover, transplant patients need life-long medicines that are expensive. “If the family doesn’t have resources, how are they going to sustain him after the kidney transplant,’’ asks the doctor. 
According to sources in the state government, there is a move to increase the scope of the “related donor’’ clause to include the extended family like uncles, aunts and cousins. “This would ease the problem of poor patients like Heeralal who seem to be at the receiving end of a few unscrupulous elements who abuse the law,’’ says Dr Bahadur. 
But ZTCC members are not convinced. “One will suddenly see a rash of relatives rushing to donate kidneys. We will not be able to prove that they are related or not,’’ says a ZTCC member. 
Worse, the cadaveric programme—that barely sees double-digit donations every year—will further suffer. “As it is, we find that hospitals and doctors don’t support cadaveric programmes for reasons best know to them,’’ says Directorate General of Health Services Dr Subhash Salunkhe. 
Asked about the resistance to the six-month-wait on ZTCC, Dr Salunkhe said, “Let doctors and patients come up with a better alternative to stem organ trade and we will listen to them.’’ 
For the moment, he plans to call a meeting of various hospital heads and urologists to discuss their reservation to Hota. “People seem to have several issues vis-a-vis Hota, we want to listen to them before forwarding suggestion to the central government for any amendment,’’ he added. 

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