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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