Indian doctors debate incentives for organ donors
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《英国医生杂志》
New investigations in India of alleged trade in human kidneys have sparked a debate among doctors about whether the law on transplantation of organs should be changed to allow incentives to donors.
This month police in New Delhi probed the alleged role of public and private hospitals in the kidney trade. At the same time doctors warned that the number of renal transplants is dropping because hospitals are refusing cases involving donors unrelated to patients.
About 150 000 patients are diagnosed with end stage kidney disease in India each year. But the number of kidney transplants has fallen from an estimated 3600 in the year 2002 to 2800 in 2003, and 2000 so far this year, said Devinder Rana, president of the Delhi Nephrology Society.
Doctors say that dishonest recipients and donors have exploited a loophole in India抯 decade old Human Organ Transplantation Act. "For the police, doctors have become soft targets," said Umesh Oza, a urologist at the Bombay Hospital and Medical Research Centre.
The act outlaws trade in human organs and defines brain stem death to allow organ harvesting from beating heart donors. Only parents, children, spouses, and a brother or sister can donate organs. Government approved authorisation committees are required to screen all other donors to ascertain that they are not donating organs for material gain.
Doctors have caught some patients trying to use forged documents to claim that donors are near relatives. Indian police have also arrested several doctors for their alleged role in the kidney trade over the past two years (BMJ 2004;328:246 and 2003;326:180). This month, police began probing allegations that four hospitals in New Delhi had done transplants involving payments.
Transplant surgeons say that they cannot be held responsible for transplants approved by authorisation committees. "All this is making us wonder whether transplants are worth such troubles. We don抰 rely on transplants to make a living," said Dr Oza.
At a recent meeting of the Indian Society of Organ Transplantation in Bombay, some members suggested changes in the act to introduce incentives for unrelated donors.
"About 60% of 200 respondents in a survey favoured life and health insurance for donors, while some members suggested payments," said Raj Kumar Sharma, head of nephrology at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, and former secretary of the society.
"The payments should be absolutely transparent, overseen by the government," said Dr Oza.
The suggestions have evoked sharp reactions from other doctors, however. "Incentives will legalise trade in organs, always from the poor to the rich," said Samiran Nundy, a senior gastrointestinal surgeon who had helped frame India抯 Human Organ Transplantation Act. "There is nothing wrong with the existing law. We won抰 have any trade today if authorisation committees did their job honestly and efficiently," said Dr Nundy.(New Delhi Ganapati Mudur)
This month police in New Delhi probed the alleged role of public and private hospitals in the kidney trade. At the same time doctors warned that the number of renal transplants is dropping because hospitals are refusing cases involving donors unrelated to patients.
About 150 000 patients are diagnosed with end stage kidney disease in India each year. But the number of kidney transplants has fallen from an estimated 3600 in the year 2002 to 2800 in 2003, and 2000 so far this year, said Devinder Rana, president of the Delhi Nephrology Society.
Doctors say that dishonest recipients and donors have exploited a loophole in India抯 decade old Human Organ Transplantation Act. "For the police, doctors have become soft targets," said Umesh Oza, a urologist at the Bombay Hospital and Medical Research Centre.
The act outlaws trade in human organs and defines brain stem death to allow organ harvesting from beating heart donors. Only parents, children, spouses, and a brother or sister can donate organs. Government approved authorisation committees are required to screen all other donors to ascertain that they are not donating organs for material gain.
Doctors have caught some patients trying to use forged documents to claim that donors are near relatives. Indian police have also arrested several doctors for their alleged role in the kidney trade over the past two years (BMJ 2004;328:246 and 2003;326:180). This month, police began probing allegations that four hospitals in New Delhi had done transplants involving payments.
Transplant surgeons say that they cannot be held responsible for transplants approved by authorisation committees. "All this is making us wonder whether transplants are worth such troubles. We don抰 rely on transplants to make a living," said Dr Oza.
At a recent meeting of the Indian Society of Organ Transplantation in Bombay, some members suggested changes in the act to introduce incentives for unrelated donors.
"About 60% of 200 respondents in a survey favoured life and health insurance for donors, while some members suggested payments," said Raj Kumar Sharma, head of nephrology at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, and former secretary of the society.
"The payments should be absolutely transparent, overseen by the government," said Dr Oza.
The suggestions have evoked sharp reactions from other doctors, however. "Incentives will legalise trade in organs, always from the poor to the rich," said Samiran Nundy, a senior gastrointestinal surgeon who had helped frame India抯 Human Organ Transplantation Act. "There is nothing wrong with the existing law. We won抰 have any trade today if authorisation committees did their job honestly and efficiently," said Dr Nundy.(New Delhi Ganapati Mudur)