saving lives

How Tamil Nadu taught Rajasthan and Kerala to encourage organ transplants

Thanks to the state government's excellent work, people in Tamil Nadu are aware of the importance of organ donation. And now others are learning too.

June 16 was a routine Tuesday for the youngsters manning 104, the medical advice helpline set up by the Tamil Nadu government. At 11.30 am, a call came in from Paramakudi in the south-eastern Ramanathapuram district. On the line was N Gnanasekaran, seeking immediate assistance. His sister, 65-year-old K Premavathy, had died of natural causes about 15 minutes before the call and Gnanasekaran wanted to donate her eyes.

The 104 personnel quickly contacted the Paramakudi chapter of the Lions Club, which sent across a team to Gnanam’s house. “In the meantime, we gave some simple dos and don’ts to the family,” said B Prabhudoss, head of marketing and hospital relations at GVK-EMRI, which runs the 104 service for the government. “We asked them to switch off the fan, keep the head elevated and to place a moist cotton ball on the eyes of the deceased to prevent dehydration.”

Enucleation, or removal of the eye, was completed successfully by noon, a half-hour after the call to 104, and someone in Tamil Nadu got the gift of eyesight.

Even as the 104 team was cheering, a call came in at 7.30 pm the same day. G Senthil Kumar, a resident of Bodinayakanur in Theni district, wanted to donate the eyes of his 80-year-old uncle, D Muthaiah, who had passed away 15 minutes before. The team contacted the closest eye bank, Aravind Eye Bank, and enucleation was carried out at the caller’s residence by 10.30 pm.

“I am glad we were able to donate his eyes and give sight to someone else,” said Kumar.

Miles ahead of others

The 104 helpline, launched in December 2013, has a staff of 40, including doctors, paramedics and psychologists. It is connected to all hospitals in the state through a Closed User Group and receives on average 2,000-2,500 calls a day. Still, it wants to do more by aggressively promoting awareness on eye donation and informing the public that it is a one-stop shop for access to eye banks.

Its success is reflective of Tamil Nadu's success in creating an excellent organ transplant programme that has become a model for the rest of the country. Every week increasingly more patients come from far and wide to Chennai for transplants. And routinely the government's work is visible on the street as the administration comes together in emergencies to create green corridors for transportation of a heart or a liver from another city for transplant.

This path perhaps was paved by organ transplant pioneer Dr KM Cherian. “In 1994, we were the ones who initiated and pushed the Centre to pass the Transplantation of Human Organs Act,” said Dr Cherian. “On the government’s request I conducted a public meeting at Vijaya Hospital in Chennai to garner public support from people from all walks of life. It is only after that the law was passed legalising brain death. This law is key to allowing organ transplants.”

By 2013, Tamil Nadu had a deceased organ donation of 1.8 per million population. In the rest of India, the figure was 0.26 per million population.

Government's industrious work

In 2009, Dr Cherian carried out the first inter-state transplant on two-year-old Yadharth from Noida, the youngest child to undergo such a procedure. For this, the heart of three-year-old Tamannah was harvested in Bengaluru and flown to Chennai in 2 hours and 52 minutes.

Five years later, in September, the heart of a 32-year-old brain dead woman in Bengaluru’s BGS Hospital was flown to Chennai on an Air India flight. Green corridors were created by the traffic police in both cities and the heart made its way to Chennai’s Fortis Malar Hospital, where 21 hours after the donor died her heart began to beat inside a 40-year-old man.

In 2014 alone, the Chennai police created 25 green corridors to help transport organs to hospitals within the city. There are three reasons why Chennai is so good with transplants, says Cherian.

“The first is awareness – the Tamil Nadu public is very aware about organ donation,” he said. “The second is that the state has an excellent Organ Sharing Registry, which is transparent and foolproof. Patients in need of organs are waitlisted and receive organs in order of the waitlist. There is no question of jumping the queue illegally.”

The third reason, Cherian says, is the government’s industrious work – “the police helps immediately in transporting organs, the state government itself has made the process of post-mortem and handing over of the body very quick and smooth so that grieving relatives are not made to wait while organs are harvested. So the government, police, the people and doctors have come together to create an excellent ecosystem”.

Role model for states

The system works so well that even former Maharashtra Chief Minister Vilasrao Deshmukh was flown to Chennai for a liver transplant after attempts to treat him for liver cirrhosis at Mumbai’s Breach Candy Hospital failed. Within days, a donor was found, but before the transplant could take place, Deshmukh succumbed to multiple organ failure.

“Since the 1990s the government and doctors have worked towards bringing about awareness on this subject,” said Dr Sunil Shroff, founder of Mohan Foundation, a non-profit organisation that promotes organ donation. “Since then we have done a lot of public education. The government has conducted awareness campaigns, so the Tamil Nadu public is generally aware about it. In fact, 15% to 20% of organs are donated voluntarily by the families of brain dead patients.”

After the Tamil Nadu Cadaver Transplant Programme was set up in September 2008 by the state government, the Organ Sharing Registry came into existence. The idea was to put patients requiring organs on a waitlist so that as and when organs with matching blood type became available, the system would throw up a matching recipient.

Kerala and Rajasthan too are working towards replicating the Tamil Nadu model. “We have set up a registry in Kerala similar to Tamil Nadu’s,” said Dr Sunil Shroff of Mohan Foundation. “Now we have been approached by Rajasthan too. Things are more complicated in Rajasthan, but the government there is keen to make it work. The success of the scheme in Tamil Nadu is such that now there is a reverse flow of organs from private hospitals to government hospitals. That is a welcome sign.”

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German expats talk about adapting to India, and the surprising similarities between the two cultures.

The cultural similarities between Germany and India are well known, especially with regards to the language. Linguists believe that Sanskrit and German share the same Indo-Germanic heritage of languages. A quick comparison indeed holds up theory - ratha in Sanskrit (chariot) is rad in German, aksha (axle) in Sanskrit is achse in German and so on. Germans have long held a fascination for Indology and Sanskrit. While Max Müller is still admired for his translation of ancient Indian scriptures, other German intellectuals such as Goethe, Herder and Schlegel were deeply influenced by Kalidasa. His poetry is said to have informed Goethe’s plays, and inspired Schlegel to eventually introduce formal Indology in Germany. Beyond the arts and academia, Indian influences even found their way into German fast food! Indians would recognise the famous German curry powder as a modification of the Indian masala mix. It’s most popular application is the currywurst - fried sausage covered in curried ketchup.

It is no wonder then that German travellers in India find a quite a lot in common between the two cultures, even today. Some, especially those who’ve settled here, even confess to Indian culture growing on them with time. Isabelle, like most travellers, first came to India to explore the country’s rich heritage. She returned the following year as an exchange student, and a couple of years later found herself working for an Indian consultancy firm. When asked what prompted her to stay on, Isabelle said, “I love the market dynamics here, working here is so much fun. Anywhere else would seem boring compared to India.” Having cofounded a company, she eventually realised her entrepreneurial dream here and now resides in Goa with her husband.

Isabelle says there are several aspects of life in India that remind her of home. “How we interact with our everyday life is similar in both Germany and India. Separate house slippers to wear at home, the celebration of food and festivals, the importance of friendship…” She feels Germany and India share the same spirit especially in terms of festivities. “We love food and we love celebrating food. There is an entire countdown to Christmas. Every day there is some dinner or get-together,” much like how Indians excitedly countdown to Navratri or Diwali. Franziska, who was born in India to German parents, adds that both the countries exhibit the same kind of passion for their favourite sport. “In India, they support cricket like anything while in Germany it would be football.”

Having lived in India for almost a decade, Isabelle has also noticed some broad similarities in the way children are brought up in the two countries. “We have a saying in South Germany ‘Schaffe Schaffe Hausle baue’ that loosely translates to ‘work, work, work and build a house’. I found that parents here have a similar outlook…to teach their children to work hard. They feel that they’ve fulfilled their duty only once the children have moved out or gotten married. Also, my mother never let me leave the house without a big breakfast. It’s the same here.” The importance given to the care of the family is one similarity that came up again and again in conversations with all German expats.

While most people wouldn’t draw parallels between German and Indian discipline (or lack thereof), Germans married to Indians have found a way to bridge the gap. Take for example, Ilka, who thinks that the famed differences of discipline between the two cultures actually works to her marital advantage. She sees the difference as Germans being highly planning-oriented; while Indians are more flexible in their approach. Ilka and her husband balance each other out in several ways. She says, like most Germans, she too tends to get stressed when her plans don’t work out, but her husband calms her down.

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This article was produced by the Scroll marketing team on behalf of Lufthansa as part of their More Indian Than You Think initiative and not by the Scroll editorial team.