Times of India
21 June 2010
By Pratibha Masand
Mumbai, India

When Lamington Road resident Sanjay Dhaetode was pronounced brain dead, it took his family only a few minutes to decide that they would donate his kidneys.

Even as they tried to cope with the death–Sanjay was only 39 years old–the Dhaetodes did not think twice about giving away his organ that might gift a second life to someone; they came to this decision as they still remember how their father died as they could not get a donor.

The Dhaetodes thus saved the lives of two–a 35–year–old housewife from Kalwa and a 55–year–old woman from south Mumbai, both going through dialysis for over four years.

Zonal Transplant Co–ordination Centre (ZTCC) coordinator Sujata Ashtekar said Dhaetode’s donation was the eighth in the city this year. "We have got donations of 12 kidneys and six livers,’’ she said. The ZTCC keeps tabs on cadaver transplants in the city.

Sanjay, who worked in a garment shop, suffered from hypertension. Though he knew about it, he did not take any medicine to control his high BP. On Thursday evening, Sanjay started feeling giddy and vomited before fainting. He was taken to Hurkisondas Nurrotumdas Hospital in Girgaum, where he was diagnosed with intra–cranial bleeding. He was declared brain dead on Saturday night.

"The doctor said we could donate Sanjay’s organs because even though he was brain dead, his other organs functioned. After consulting with the family, we decided that we could at least donate his kidneys, if not all the organs. The decision was unanimous as my father, too, had suffered from kidney failure and had died as he couldn’t get a transplant,’’ said Dattatray Dhaetode, Sanjay’s brother who lives in Borivli.

"When a person is declared brain dead, we explain to his/her family that five organs–eyes, skin, heart, liver and kidneys–can be donated if deemed fit. While most are reluctant to donate at all, some like, the Dhaetodes, give away any one of the organs,’’ said Dr Atul Adania, assistant medical director, Hurkisondas Hospital. Liver transplant: Teetotallers ahead?

Chennai: Should an alcoholic with a damaged liver receive the same priority as a non–alcoholic for cadaver liver transplants? Votes seem to be rolling in for those who stay sober. A team of transplant surgeons has asked state cadaver transplant registry to give priority to patients with non–alcoholic liver cirrhosis. Surgeons fear alcoholics, who undergo transplant, are likely to strain at the leash to break the no–alcohol vow, damaging the liver afresh.

‘‘Organs are hard to come by. They should be used judiciously,’’ says Dr R Surendran, who heads the department of surgical gastroenterology at the Stanley Government Hospital in Chennai.

Transplant is the only option for patients with end–stage liver disease. ‘‘Today, the topmost cause for liver diseases is hepatitis A followed by Hepatitis C. One in five persons coming to the hospital with an endstate liver disease has alcoholic cirrhosis. If this person is given a liver, many alcoholics get back to drinking and reach a point of no return,’’ Dr Surendran says.

Hospitals maintain a wait–list of patients seeking organs. They say alcoholic liver failure patients are first sent for de–addiction and counselling even before they are put on the list. ‘‘The patient needs to be certified by a doctor,’’ says, a psychiatrist, ‘‘that h/she has been sober for at least six months. It’s then that we give them a chance.’’ ‘

There are several others who say time is important. Hepatic surgeon Dr Mohammed Rela says, ‘‘In general, the rule sounds logical and is being followed internationally. But in some cases, the patient might not be left with enough time to prove that he is sober. So why be judgmental or why play god? A better way is to help them reform after the surgery.’’.

Alcoholic liver failure patients pick a hole in the liver–for–sober logic. ‘‘Going by the logic that alcoholics should not be given liver, diabetics should also not be given a kidney. Because like alcohol, diabetes will make the new kidney dysfunctional. It’s denial of the fundamental right to live. We will go to court,’’ says 41–year–old Mahesh Kumar (name changed), who has been wait–listed for organ transplant.

But some feel, the debate fuels ambivalence, just like the one on mercy killing. Dr Thomas George, editor of Indian Journal of Medical Ethics, says it is a difficult decision for doctors or patients. ‘‘As organs are scarce, we must leave the debate to society. Let it decide whether it’s science or fundamental right,’’ he says. Cadaver organ registry coordinator Dr J Amalorpavanathan says the advisory committee of the registry will decide on it.