An investigation ordered by the Tamil Nadu government into the retrieval of organs from a brain dead patient at a private hospital in Salem district in May this year has found that the harvested heart and lung were allocated to two foreign nationals in two corporate hospitals in Chennai without adopting the stipulated protocol for allocation.
The organs were harvested and transplanted on the patients on May 21. In one case, the organ was allotted to a foreigner although it was requested for an Indian patient in the waitlist of organ recipients. Recipients of the heart and lung died shortly after the transplant surgeries were performed.
The inquiry officer has concluded that two outsourced staff of the Transplant Authority of Tamil Nadu (TRANSTAN) had violated norms, by allocating the kidney to a different patient, and shifting allocation to benefit recipients admitted to the Chennai hospitals. Engaging of the outsourced staff at TRANSTAN was done in 2014. Both members resigned after the controversy over allocation of organs to foreign nationals was raised.
Letter from Kerala CM
The inquiry committee was set up by the Department of Medical and Rural Health following a letter from Kerala Chief Minister Pinarayi Vijayan to his Tamil Nadu counterpart Edappadi K. Palaniswami seeking an investigation into a complaint that organs were “stolen” from a brain dead patient, P. Manikandan of Palakkad in Kerala, who met with a road accident near Kallakurichi in Villupuram district on May 18.
Referring to the instant case, the inquiry report said, “This again points to the TRANSTAN co-ordinator aiding specific hospitals to get allocation of organs to patients of their choice, denying others ahead of them in the waiting list.” The two TRANSTAN outsourced staff “wilfully put the wrong UID (unique identity number)” to facilitate the bypassing of patients. “In addition they did not update the TRANSTAN registry or the website of the changed recipient numbers,” it said.
The investigation revealed that in one case, the reason given to allocate the organ to an international patient and not an active Indian patient was that the chief surgeon of the hospital was out of station. “However, it was established that he was in station and available” in the private hospital in Chennai on the night of May 21 when the transplant was done.
The report said the offences made out in the Salem case attracted the provisions under Section 18 (Punishment for removal of human organ or tissues or both without authority) of The Transplantation of Human Organs and Tissues Act, 1994, and Section 465 (forgery), 420 (cheating) read with 120B (criminal conspiracy) of IPC.
The inquiry revealed that Manikandan’s family members were reluctant to give their consent to harvest his organs but later gave in after persuasion.
Investigators noted that the counselling for family members, which should have been done by the grief counsellor of the private hospital as per the TRANSTAN guidelines, was done by its Chief Operating Officer (COO).
“Thus, the COO showed interest in pacifying the family members though they were not willing for organ donation and they had declined thrice,” the report said.
The inquiry revealed that the kidney was proposed for one patient but given to another. The heart was allotted to a Ukrainian national, but investigation revealed that it was transplanted on a Lebanese patient, who died hours after the transplant as the “heart did not work.”
The organ utilisation certificate in this case did not mention the nationality of the citizen who underwent the transplant. The then Member Secretary of TRANSTAN who headed the organ transplantation programme told the investigators that he was not aware that the heart harvested from Manikandan was put on a Lebanese patient instead of the Ukrainian national.
The change in allocation was done privately over the personal mobile phones of TRANSTAN coordinators and the transplant team of the corporate hospital.
The report recorded the testimony of a TRANSTAN official that that in one case, a senior bureaucrat in the State government had intervened directing him to “allocate immediately” an organ for a patient in a corporate hospital.
At another Chennai hospital, the report said there were five active Indian patients waiting for lung transplant but the organ was given to an Israeli patient.
Investigation revealed that the hospital authorities gave a variety of reasons to justify the decision. Incidentally, the organs used by the two corporate hospitals in Chennai were refused by other hospitals since they were of “poor quality.”
In the report, the inquiry committee referred to an instance on March 13, 2018, where the outsourced staff of TRANSTAN allowed a corporate hospital in Chennai to take the lung of a donor for an international patient even when active Indian patients were on waiting list in other hospitals. No “decline message” was obtained from the Indian patients.
In another case TRANSTAN coordinators not only allowed a private hospital in a southern district — neither licensed for transplantation nor authorised to declare a patient brain dead — to declare a patient brain dead in November 2016 but allotted the heart of the donor to an international patient in Chennai.
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