Sunday , 24 March 2019

Allow Organ Transplant Strictly On Merit

After nearly a year of the kidney transplant unit in the Goa Medical College and Hospital remaining ‘inoperative’, the state government has decided to reactivate it. Kidney transplants were hampered due to the absence of a full-time nephrologist, a pre-requisite for the purpose. The government has now decided to take the services of Dr Sheetal Lengade and designated him as full-time transplant nephrologist. His appointment will help the urology department in carrying out kidney transplants routinely. Though the role of a nephrologist is vital in carrying out kidney transplants, the government, for reasons unknown, allowed Prof Dr J P Tiwari, professor of nephrology, to go on a sabbatical for two years and join a college in Uttar Pradesh to take up a teaching job there. Curiously, Dr Amol Mhaldar, another nephrologist at the GMC, was also allowed to quit his post. Dr Mhaldar offers his services on honorary basis but is not involved in cases of transplant. The departure of two senior doctors rendered the nephrology department ineffective. It has come to light that due process was not followed in granting sabbatical to Dr Tiwari and allowing Dr Mhaldar to quit.

The role of nephrologist is vital in not only detecting cases of kidney failure and other kidney ailments but also recommending cases for transplant. Goa records quite a large number of kidney failure cases. It is for nephrologists to recommend the cases for transplant to the urology department after completing the groundwork on examining the recipient and the donor. The process is thereafter set in motion for authorization of transplant. The grant of sabbatical to Dr Tiwari and acceptance of resignation of Dr Mhaldar severely affected the functioning of the nephrology department, and the cases involving dialysis and other procedures had to be handled by the medicine department and junior doctors. Many in the field of medicine suspect that there was a design behind letting the nephrology department become dysfunctional and bringing kidney transplants to a halt by ‘taking away’  consultants. The departure of the consultants began even as the Deen Dayal Swastha Seva Yojana (DDSSY), under which cases of kidney transplant were also provided for, was rolled out. The state government should probe whether there was indeed a conscious design by vested interests to make the kidney transplant facility defunct. The government needs to fix responsibility and punish those in the state administration found involved in furthering the design.

It needs to be noted that the composition of the Appropriate Committee set up to give permission for organ transplant facility at a private hospital was changed four times within one year. It is equally intriguing that the health secretary was named as the chairman of the appropriate committee, when in the past the same committee was headed by the health director. In a deviation from the established norms, the health secretary also assumed the charge of the post of chairman of advisory committee to the appropriate committee. It has come to light that the three committees were changed after they refused to give ‘all clear’ to grant permission to the hospital in question for carrying out transplants as it was found lacking in  specialists and supporting manpower. It has been alleged that while the three earlier committees found deficiencies at the private hospital, the fourth committee after expressing serious reservations over the issue of conducting inspection at short notice gave way following ‘coercive’ tactics of vested interests and a few members signed blank inspection forms. The matter was brought to the notice of Health Minister Vishwajit Rane who directed the health secretary to hold back the approval till further orders.

As the Health Minister himself has stated that doubts have been raised over the inspection of the hospital and subsequent ‘approvals’ given by the committee members, it would be in the interest of patients needing organ transplant in particular and the Goan people at large that the facilities be inspected again by a team of experts and medical professionals known for high integrity. As charges of favouritism have been levelled against the health secretary, he should be excluded from the committee and a fresh committee headed by experts in the field should be formed to grant permission as per the set norms.The government should at the same time pursue inquiry to find out whether conscious actions were taken by vested interests to make the kidney transplant facility at the GMCH inoperative. Now that the Health Minister has sought to revive the kidney transplant facility at the GMCH, he must equip the nephrology department with all facilities and adequate manpower. Rane should also ensure that permission for organ transplant is given only on merit and not on any other considerations.

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