Legal hurdles loom large for 3rd domino procedure

Yet another domino kidney transplant is facing legal hurdles. This one, which is the country's third and involves four donors and four recipients, is stuck because one of the donors hails from Karnataka and the authorisation committee of that state has refused to give its go-ahead for the procedure.

The Karnataka resident and his niece is one of the four donor-recipient pairs. He was to donate his kidney to the recipient of another pair, and the chain of donations would have ensured that his niece received the organ from the donor of another pair.

However, the state authorisation committee of Karnataka said maternal uncle and niece cannot be treated as close relatives, thus stalling the entire plan to save four lives.

In India, kidney transplant performed as per Human Organ Transplant Act (HOTA), 1994, which was amended in 2001. The law says the donors and recipients should be close relatives.

"The committee has found that as per HOTA, maternal uncle and niece are not closely related. Hence, permission was denied," said Vinod Kumar, transplant coordinator of state authorisation committee, Karnataka.

Of the four transplant procedures, two were to be conducted at Hinduja hospital and two at Hiranandani hospital.

Nephrologist from Hinduja hospital Dr Jatin Kothari said, "Karnataka's C Swami had approached the state authorisation committee for an NOC but was denied permission on the ground that it's against the law. But it is very strange, other states' authorisation committees have given permission in similar situations. We don't really know why it was denied in this case."

To make one domino kidney transplant possible, it takes one year. "We really don't understand why the government denied the permission. Without the domino method, patients have had to wait for seven to nine years for a transplant," said Dr Ganesh Sanap, who maintains the swap registry at Shushrut hospital in Chembur.

With the other donors and recipients being from Maharashtra, permission of the state authorisation committee here will have to be obtained, which has already been assured and will be granted formally in the next two weeks.

"We have given permission for transplant in our state even in cases concerning unrelated people. We first go through all legal documents, because if they are related, permission is granted in the hospital level. When the donor and recipient are unrelated, only then does the matter come to us," said Dr Pravin Shingare, chairman, state authorisation committee, Maharashtra.

For a regular organ transplant, it is necessary that the blood and tissue of the donor and recipient match. When that doesn't happen, a domino transplant is resorted to. In this procedure, the donor of one pair gives the organ to the recipient of another pair, the donor in which then gives to the next pair and so on.

The previous domino transplant, consisting of six donors and six recipients, was held on January 25, 2014, in Mumbai.

(Some of the patients' names have been changed to protect identities.)

What is domino kidney transplant procedure?
The donor of one pair donates a kidney to the recipient of another pair. The transplant is then carried out in a series till the last donor in the chain donates to the first recipient in the line-up.