Draft organ donation rules propose stiff penalty on illegal trade

The revised rules for organ transplant propose stiff fine for illegal organ trade and change in the definition of “near relative” for the purpose of donation. The Central government has invited public comments on the revised rules by June 5. The rules were framed after the Transplantation of Human Organs (Amendment) Bill, 2009 was passed in August, 2011.
The Union Ministry of Health and Family Welfare (MoHFW) will consider suggestions from the public before drafting the final rules.

The revised definition of near relative now includes grandparents as well. “Earlier only son, daughter, mother, father, wife, husband and siblings were in the near relative category. The fine on illegal trade has now been increased from Rs 10,000-20,000 to Rs 20 lakh to 1 crore,” says Jagdish Prasad, director general of health services, MoHFW.

Key proposals The revised definition of near relative now includes grandparents as well, not just parents and siblings Fine on illegal trade has now been increased from Rs 10,000-20,000 to Rs 20 lakh to 1 crore New rules say that an organ cannot be retrieved from the mentally challengedÔÇöpeople with low IQ, as well as the mentally ill Mandatory to ask relatives about organ donation when the patient is taken into the ICU In cases where there is no cause of any suspicion, post-mortem can be carried out along with organ retrieval. Earlier, the doctor retrieving the organs had no authority to conduct post-mortem New rules allow smaller health centres to have organ retrieval licence

A key change in the rule is the definition of mentally challenged people. “The definition was ambiguous earlier. The new rules say that an organ cannot be retrieved from the mentally challenged—people with low IQ, as well as the mentally ill,” said an official of MoHFW.

Request law mandated for ICU patients

Experts in the field call it a comprehensive improvement compared to the rules framed after the original act of 1994. However, some crucial issues still need to be addressed. The new rules make it mandatory to ask relatives about organ donation when the patient is taken into the ICU. This can make it a sensitive matter as families are normally not inclined to talk about the possible death of the patient.

“There is a required request law in the western world. If a person becomes brain dead, the hospital authorities are required to make the request to the family for organ donation. There is no such rule in India. Doctors declare a person dead after the heart stops beating. In the absence of declaration of brain death, counsellors are also unable to convince families about donation. We will recommend this clause be entered in the new rules,” says Lalitha Raghuram, country director, MOHAN Foundation. The Foundation promotes and counsels volunteers for organ donation in the country.

Raghuram adds that the new rules address many issues that health activists have been raising. “The original Act and rules therein were skeletal. Now they are more elaborate. Sixty per cent of cadaver donations come from persons who meet with road accidents, which are medico-legal cases. While asking for organ donation, their families would ask if post-mortem would also be taken care of because they would not like the body to be opened twice. Earlier, the doctor retrieving the organs had no authority to conduct post-mortem. Now, in cases where there is no cause of any suspicion, post-mortem can be carried out along with organ retrieval. This will give a boost to the process,” she says.

Another key change has been registration of organ retrieval centres. The earlier law was silent on where the organ retrieval could happen. Only a health facility offering organ transplant service could retrieve organs. This would discourage families from transferring their patient to another hospital if he was not admitted into a facility with organ transplant. The new rules allow smaller health centres to have organ retrieval licence. The organs can be retrieved at these health centres and sent to other organ transplant centres.“This will promote cadaver donation further,” says Raghuram.

India lacks clear data on transplant centres and has no transplant registry at the national level. The proposed new rules make it mandatory for the government to develop a registry. “Another important change needed is to declare it on the driver’s licence if a person has donated organs. For this the amendment has to happen in Motor Vehicles Act, 1988,” adds Raghuram.
 

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