Discussion on Ethics of Kidney /Organ Transplantation
Source: Karmayog Yahoo Groups
1) Responses of Kisan Mehta
Taking out kidney from a living person is illegal in addition to the fact that that would bring about enormous consequences to the donor. It is ethically immoral. The Act however has a provision for taking a kidney out from a living genetically related relation as the chances of rejection of a kidney transplanted from a relation are lower. Genetically related persons include the patient’s offsprings as well. The husband is not related yet offers a kidney out of pure affection and permission is sometimes given. No money transfer is involved in such cases.
Asking for donation through email network does not help as close relations and the spouse do not offer because such appeals were published in a network. Such appeals through press or media can be construed to inviting purchase and sale of kidney and would expose you and the publishing in legal trouble.
If close relations and/or spouse are not ready to oblige, only chances are what medical profession suggests to be backed by drastic change in lifestyle in entire family.
Response 2 : We are all aware that trading in live kidney involving taking out of a kidney from a living person is prohibited under the Indian Penal Code as well as under a law specially enacted. Request therefore for a kidney from anybody in India is illegal and all those involved are punishable under law.
The chances of the donor suffering bad health and the donee rejecting a kidney are high. Let us not think of live kidney harvesting in any case.
It is observed that kidneys taken from a genetically related person that is father, mother, brother, sister, son, daughter(but not husband or wife ) have a greater chance of being
accepted by the donee. Tests such as HLA typing etcof the likely genetically related donor and donee should be carried out. Such transplantations are prmitted under law.
Urologists and Nephrologists carrying out kidney operation are conversant wih the procedure.
Cadaver transplantation is allowed however this necessitates elaborate prior preparations. We in India have not created the elaborate machinery for cadaver transplantation.
Response 3 :Donating one’s body after one’s death helps in improving the quality of life for the living.
*Donating one’s body after death can give to the donor a feeling of immense satisfaction of having done her/his last duty of serving the community that provided care and love during one’s life time.
*Donation avoids burning of wood, a finite natural resource where cremation is practised and encroachment on limited space for all the time where burial is followed.
*A number of organs retrieved from the dead body in time can gift to an ailing human a fresh opporunity to live a normal life. Cases of many humans having restarted normal kife after receiving organs from one donated body exist in good number. Unique is the case of nine humans restarting normal life after receiving different organs from one young healthy body lost in a fatal accident.
*Any body can be used for imparting education on anatomy of a body in medical colleges. At present many colleges do not receive adequate number of bodies for the purpose.
*A dead body can be used for carrying out studies of afflictions more specific to a particular group of humans in comparisuon to others.
We can now go to body donation that provides a possibility of retrieving those organs, the transplantation of which on an ailing person can give a fresh chance to live longer with reduced suffering and pain.A living person can donate her/his body after death. The Anatomy Act enables donation of the body after death. The Act says that if a person has, during her/his last sickness, indicated his wish to donate the body after death before two persons and he has not rescinded her/his offer subsequently, the body shall be donated.
A person can donate her/hos body by declaring in writing during her/his lifetime, her/his wish to donate the body on death. It is important to keep the near kins of his decision so that they can donate immediately on death. Delay in handing over would defeat the object of donating the body for use by others afterwards.
All this is possible because she/he is accepted to be the owner of one’s body during her/his lifetime. After death, the nearest kin comes in possession of the body. In that case, the kin’s decision shall prevail. The kin may or may not donate the body for a public purpose. To provide for increasing possibility of death occuring suddenly and away from relations, it woud be wise for the person to keep, in his pocket, a letter declaring her/his desire to donate the body as well as authorising the finder of the body to straightaway donate the body to the nearest medical college-cum-hospital having teaching facility and authorising hte recipient hospital to receive the body and dealing with the body for a public purpose.
In case of death outside the purview of the family doctor, the qiuestion of death certificate will arise. The recieving hospital can issue the certificate after post mortm check. To make the last wish operative after death, the person should keep the next of kin informed of the desire to donate the body and of having kept such a letter on her/his body to avoid complications and delay.
Time is of critical essence to ensure reutilisation of body organs hence every person coming across the body shall have to complete her/his part on a high priority basis. Taking out the HLA typing tests before death would help expeditious reutilisation of usable body organs. The HLA data will have to match with the
likely receiver of organs.
With the advance of science, many organs are reutilisable. Information on usable organs should be made available on a continual basis by the authorities based on advancement of medical science. Organs retrieved from a person having sudden death like in accidents have a lesser chance of being rejected by the receiving body as organs are still in reutilisable condition.
Cases of young persons giving away one out of the two kidneys for realising quick money are on rise. Taking out an organ from a living person is a criminal offence however this happens on an increasing scale. Some medical centres sustain only on such immoral and illegal harvesting of kindney from living persons for making cash money. While the law prohibits taking out live organ from a living person, it did not provide for appropriate donation of body and/or organs after death. Even the provisions of the Anatomy Act were not being implemented properly.
The `Dehdaan’ (donation of body after death) movement got a filip in Maharashtra in 1986. Some of us observed the irregularities in operations going on under the Anatomy Act. The procedure for donating was simplofied and rationalised in next few months.
Different States had different provisions and followed different procedures creating confusion in the minds of the living. Efforts were made to standardise the procedue. During working in the area, we came across rampant trafficing in live kidney retrieval from young poor for transplanting into the obdy of the rich ailing from kidney failure at an advanced age when chances of prolonging life through this practice are very low.
Some of us felt this trafficking to be heinous and against nature from all angles. Nature has provided that the life shall be implanted by senior humans to the new one wanting to take birth on this planet. Hence the need for having an uniform law for the country that enables any person to donate organs after her/his own death. We moved at Delhi and have got an appropriate machinery that bans immoral practices.
Body donation and subsequent reutilisation are grey areas anywhere in the world because a human possibly places highest value, above all, for prolonging one’s own living and is ready to pay any money for the excuse to continue in this world, whether or not beneficial to the world. Wise governments have therefore entrusted the administration of body and organ to public organisations having high credibility for this noble object of donating life to the succeeding generaitons and for the benefit of the common humans. The governments extend all help to these public organisations to support these operations. Stakeholders, that is donor, recipient, medical profession are all involved but not given the authority to decide and operate the working.
Concerned citizens were anxious to work for a faultless and foolproof working of the Act for the benefit of the humanity. This was not going to happen. During the passing of the draft bill (drafted by vcitizens) into the law and afterwards, citizens who brought the matter to the fore have tried to work for hte efficacious operations of the Act. All efforts have failed and operations have remained in hte bureaucratic hands resulting in uncontrolled increase in rampant trafficking especiaklly in kidney. Are earnest citizens wanting to work for this noble cause of ordaining life to younger generation by the senior generation?
Response 4 :We are really disappointed to see messages in the Karmayog asking for kidney donation. The casual way they are published gives a feeling that Karmayog is very deep in the live kidney retrieval and implantation trafficking going under the fashionable name of donation. As explained earlier, taking out kidney from a living person or helping a person to get kidney in that manner for fixing into a person who has managed to get a pliable medical professional
To recommend kidney transplantation is a criminal offence. Every person or institution directly or indirectly involved is subject to be arrested and punished.Yet in this country, this trade is going on with the medical profession making the most. The Government of India passed the Act making live kidney retrieval and implantation (transplantation) a criminal offence about a decade ago after some of us worked for a long time.Taking out a kidney, an essential organ of a human is ethically immoral as well as morally improper. We create new life by giving birth. To expect the new life to give away an essential organ for earning some money for an old human who has wherewithal to buy a kidney endangering the survival of the young life is inhuman.
No human having any conscience shall ever become a party to this heinous practice at any stage. How can Karmayog continue to remain in this sinful activity? It appears that kidney transplantation has become a status symbol to show off one’s material wealth.
There are many options for not creating a situation for kidney to fail, managing liveable life with kidney ailment. The powerful do not want to follow nature’s ways and rush for kidney trafficking. In fact rejection of transplanted kidney are frequent. There is higher survival in case where kidney is taken out of a close blood relation.
Cadaver transplantation has become quite popular in the advanced countries. It is possible to develop elaborate programme for cadaver transplantation in the same lines like eye donation. In fact cadaver transplantation is frequently undertaken for multiple organ implantation. Why not some of our younger Karma yogis take up cadaver transplantation as a programme to help the humanity? In the meantime, will you like to announce in unequivocal terms and as frequently as required to Karmayog shall not entertain any request for immoral and illegal practice.
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Kisan Mehta , Priya Salvi
Prakruti and Save Bombay Committee
102, MAUSAM, Plot No.285, Sector-28,
Vashi, Navi Mumbai-400705.
Mobile: 9223448857 (Kisan Mehta)
Mobile: 9324027494 (Priya Salvi)
Email: kisansbc@mtnl.net.in
http://www.savebombaycommittee.org
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2) Vinay Somani
It is equally disappointing to see such a view being expressed that it appears that Karmayog is very deep in the live kidney transplantation racket, etc.As readers of the Karmayog e-group may be aware, the messages that are circulated are sent by the readers themselves and do not necessarily reflect the interests and views of those managing the group.
There is an attempt to regulate / edit / moderate the content and type of messages as little as possible, while reflecting the diverse interests, needs and views of all participants.
Karmayog has also at no time claimed to be an expert on any of the issues raised or views being expressed; instead the main objective is to get people to help each other in the ways and means that they all separately have experience and expertise in.
With specific reference to the kidney transplantation matter, it would be appreciated if those who are aware of the legal and medical aspects of the matter could at an early enough stage inform the group of the appropriate measures to be taken, and thus educate and enlighten all those who may be unaware of the same.
From the point of view of the messages that are received, there appears to be people who are genuinely or otherwise in need of a kidney donation, for themselves or for their loved ones. It would be appreciated if anyone from the group could provide such persons with the right advice and options that they may have in such a situation.
At Karmayog, we believe in and practise “selfless service” and we would prefer to unequivocally and frequently state this to be our guiding principle and it is hoped that this will lead to a better understanding of what we do and why we do it.
Vinay Somani ,Karmayog
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Source: Karmayog Yahoo Groups