For the last three months, Somnath Chaudhary, 39, a resident of Malegaon, has been waiting for a call from a Mumbai hospital for a date for his liver transplant. The tea vendor was all set to get part of his 29-year-old nephew’s liver when the hospital’s CEO refused to sign the documents needed to be submitted to the Directorate of Medical Education and Research (DMER) before the surgery.
The CEO’s reaction was because of a new circular issued by the DMER on April 11, making the hospital heads accountable for verifying and certifying all the documents like Aadhaar, ration cards, and bank statements of both the patient (recipient of the organ) and the donor before submitting them to the authorisation committee.
The circular came after the March 29 Pune kidney transplant row. Four days after undergoing the transplant surgery at Ruby Hall Clinic, a woman (kidney donor) revealed her real identity following a dispute over money.
Chaudhary has been suffering from liver cirrhosis – a late-stage liver disease – for the last one-and-a- half years and has been advised to undergo a liver transplant surgery. He had to rely on his 29-year-old nephew – son of his elder sister – to donate part of his liver as his wife’s blood group did not match his and both his children were below 15 years.
“My brother has hepatitis and all three sisters have diabetes. No near family members could donate and I had to go for the second set of relatives – my nephew,” Chaudhary said.
He said while all the paperwork and medical check-ups were done and he was slated for the surgery, he was told that the surgery had to be postponed because of the DMER circular. “We had spent ₹3-4 lakh on tests, including cross-matching of blood groups of both the donor and the recipient. I cannot even go to any other hospital as the process is done. I am now waiting for the hospital to call us and give us a date.”
Chaudhary spends ₹40,000 a month on medicines and injections and for blood transfusions every week.
Anant P, 54, a resident of Andheri, who was diagnosed with kidney failure, is struggling to get a new kidney from his niece.
“I was supposed to undergo a kidney transplant by the end of April. My wife has hypertension and diabetes. My daughter is an obese and juvenile diabetic patient. In the near family members either the blood group did not match or there was some medical reason because of which they were unfit. While the paperwork was done along with medical check-ups, we were told that the transplant could not be done because of the DMER rule. I am now continuing on dialysis thrice a week,” he said.
Kidney and liver transplant physicians in Mumbai said many patients like Chaudhary and Anant have been suffering because of the new DMER rule.
“The DMER is right in making the hospital accountable as the patient is known to the hospital, doctor, and staff. But every hospital wants to ensure it is safe even if we know the case is genuine. The patient has to suffer and spend more,” a liver transplant surgeon, practising in a western suburban hospital, said.
The doctor said of the total transplant cases, 20% are unrelated/distant donors. “In the last few years, we have been seeing the percentage going up. The main reason is near relatives being unfit because of having diabetes, hypertension, fatty liver etc. We need to review our transplant programme to ensure patients do not suffer.”
While a few hospital heads decided to postpone distant relative/unrelated donor transplants till the DMER changed the rule, a few hospitals introduced new mechanisms to verify documents before signing and submitting them to the authorisation committee.
Officials at Parel’s Global Hospital that runs one of the largest organ transplant programmes in the city said they have introduced new checks like DNA testing and an additional round of interviews if the donor is a distant relative.
“For live kidney transplants, we are only doing surgery where the donor is related. We will wait till the time there is clarity. They can continue on dialysis till then but end-stage liver transplant patients can’t wait longer. If they do not have an immediate relative as donor, we have these extra checks done before submitting the documents to the DMER,” Dr Vivek Talaulikar, CEO of the hospital, said.
Nanavati Max Super Speciality Hospital in Vile Parle has hired an agency to cross-check the documents submitted by the donor and the recipient and to also take their fingerprints. “There is no issue in signing the documents of related transplants. For unrelated/distant relatives as donors, we have introduced new hospital-level protocols after the DMER circular. We have now made DNA testing compulsory along with taking fingerprints. We have an external agency to verify the documents,” said Dr Jatin Kothari, director, nephrology and chief consultant, renal transplant medicine.
Hospitals like Jaslok at Peddar Road and PD Hinduja Hospital in Mahim have also hired an agency to verify the documents. The hospitals, however, agree that the additional checks have led to a delay in transplant procedures by two-three weeks or more.
Meanwhile, an association of hospitals held a meeting on June 24 and discussed the yet-to-be appointed health minister. Dr Sujit Chatterjee, joint secretary and CEO of Dr LH Hiranandani Hospital, Powai, said, “The DMER had earlier stated that the full responsibility for unrelated donor transplant was with the hospital. Now they have said the hospital must take due diligence for an unrelated transplant. This will assist the DMER. The onus still lies with the hospital. However, we think the responsibility should be with the state as it has the wherewithal to do a thorough scan of documents. Hospitals don’t have that required expertise for verification of documents. Private players will only be able to assist the DMER.”