For three decades, Chennai has been synonymous with human kidneys.
In the eighties and early nineties, a roaring illegal racket where hundreds of poor people had their kidneys sold off illegally brought international disrepute to the city.
But in the 1990s, despite the continuing trade, the city also established itself as a centre of excellence in cadaver transplant, the transplant of kidneys and other organs from brain-dead people.
Yesterday, Chennai recorded a landmark milestone: the century-old government Rajiv Gandhi Government General Hospital affiliated to the Chennai Medical College performed its 1,000th kidney transplant, the highest in any government hospital in the country.
About 90 of them were cadaver transplants, another record.
The most noteworthy feature of this feat is that all the surgeries have been free and the transplant recipients get lifelong medicines which cost Rs. 10,000-15,000 day. The 1,000th surgery was done by Dr. Jayaraman and his team of the urology department. The first ever transplant surgery in the hospital was done in 1987, then a sensational feat here, then as big as an expedition to the moon.
Since then, kidney transplants have become standard procedures, followed by routine heart and liver transplants. The evolution of medicines, particularly that are given to the recipients to keep their immunity suppressed so that body doesn’t reject the organ, has made the procedure increasingly successful. The skills of surgeons also have improved enormously.
The milestone brings to focus the significance of the government hospitals and the need for universal access to healthcare in a country where tertiary care is associated with expensive corporate and private hospitals. Interestingly, Chennai also recorded the first ever liver transplant in the government Stanley Medical College in the 1990s with very humble infrastructure and highly skilled doctors.
Since the first ever transplant, when even a 70 percent one year survival rate was considered successful, transplant medicine has come a long a way with increasing survival rate and more standardised procedures. Presently, surgeons and doctors are aiming for a one-year survival rate of 90-95 % or more. However, some of the cutting-edge techniques such as the profusion tests, in which the kidney, harvested from a donor or cadaver, is tested for its health and suitability, are yet to come to the city.
Another spin off of the city’s pre-eminence in transplant surgery is the establishment of a cadaver transplant programme by the government at the Chennai Medical College. This programme has a regular transplant-coordinator and a computerised network linking government and private hospitals.
As in the West, patients with renal failure across several hospitals in the city and elsewhere in the state are put on the list and whenever there is a cadaver kidney available, the most suitable patient based on his/her waiting period is called in for surgery. The city has also developed standard protocols in ethical practice, harvesting and transporting.
Although the first priority to receive an organ are patients of government hospitals, private hospitals routinely receive kidneys.
However, the involvement of private and corporate hospitals has raised some ethical questions. In their urge to undertake a transplant, sometimes doctors at these hospitals overlook the quality of cadaver kidneys which lead to imminent failure. These hospitals charge the patients several lakhs of rupees for the surgery, but do not advise the patient and his/her family on the possibilities of failure.
Recently, one of the hospitals has transplanted a kidney from a person who was brain-dead because of dengue fever. The patient, in this case, was not informed about the condition of the donor. A few years ago, there was another case, in which the kidney belonged to a person who died of snake-bite. Although organs from snake-bite related brain-deaths are admissible, ethically the patient needs to be consulted and informed.
The city’s kidney trade in the eighties was an story that brought the international media to city suburb Villivakkam which since then had been known as “kidneyvakkam”. The Transplantation of Human Organs Act in 1994 has meant that the illegal kidney trade has more or less given way to donation of organs from relatives, which is also sometimes circumvented by desperate patients and their families.
Doctors say that the illegal trade may still be prevalent, but mostly exists in second tier cities such as Coimbatore and international locations like Singapore where rich patients take their paid donors.
The success of the General Hospital and the Chennai Medical College couldn’t have come without systematic investment by the government and skill-development of its doctors, although the resources are still grossly small compared to the demand.
Despite the attempts at reform made by donor agencies, the state government has maintained its welfare policy in public health. For instance, the state had pioneered an institution for centralised drug and equipment procurement and distribution called Tamil Nadu Medical Services Corporation (TNMSC) as early as 1990s, which was subsequently replicated in states such as Andhra Pradesh and Rajasthan.
For transplant patients alone, TNMSC supplies immuno-suppressants worth Rs 2 crore every year at the general hospital.
In the state, public health is a political issue. Despite their limitations, both the leading Dravidian parties demonstrate visible political commitment to improving the government hospital facilities. That is precisely why the Chief Minister, J Jayalalithaa thought of hospitals when she wanted to convert the symbols of Karunanidhi legacies such as the flashy secretariat building and the public library into public utilities.