Mystery surrounds organ donation for Sasikala's husband M Natarajan; did state transplant body indulge in foul play?

On Monday, the Madras High Court will give its verdict on a petition challenging the appointment of Dr P Balaji as member secretary of the Transplant Authority of Tamil Nadu (TRANSTAN), a key government body to regulate and monitor organ transplant and cadaver harvesting.

The petition, filed by the Change India NGO, alleged that the appointment was a case of quid pro quo, and Balaji became a beneficiary for having attested former chief minister Jayalalithaa's thumb impression on Form B that was submitted to the Election Commission in October 2016, ahead of by-elections to Thanjavur, Aravakurichi and Thiruparankundram constituencies, which were to be held on 19 November.

Balaji, then a professor of minimal access surgery at Madras Medical College, certified on the document on 27 October, writing about Jayalalithaa, "Since the signatory has undergone tracheostomy recently and has an inflamed right hand, she is temporarily unable to affix her signature. Hence she has affixed her left thumb impression on her own in my presence."

File image of VK Sasikala. PTI

File image of VK Sasikala. PTI

Four days later, Balaji bagged the top job at TRANSTAN and the appointment was regularised on 5 May this year.

This particular case has acquired greater significance because TRANSTAN is the nodal body that takes care of organ transplants in Tamil Nadu. And the latest recipient of a kidney and liver transplant is M Natarajan, the 74-year-old husband of VK Sasikala, the ousted general secretary of the AIADMK. From 22 September to 5 December, when Jayalalithaa was hospitalised, Sasikala was the most powerful person in the AIADMK. That her detractors are connecting the dots today seems a natural consequence.

And while fingers aren't being directly pointed at Balaji in Natarajan's case, the manner in which organs were hastily organised for Sasikala's husband has left many questions unanswered.

Natarajan, admitted to Gleneagles Global Hospital in Chennai for critical liver and kidney failure, had been in dire need of the two organs. He was on the waiting list with the Tamil Nadu organ sharing for donor liver transplantation since April. This last week, a 19-year-old daily wage labourer N Kartik, said to be in a critical state following a head injury, was driven from Thanjavur's Government Medical College Hospital to Trichy, and then airlifted to Global hospital in Chennai on Monday night. He was declared brain dead on Tuesday morning. His liver and kidney were donated to Natarajan, who underwent surgery the same day.

The petitioner in the case against Balaji, A Narayanan, has alleged that the manner in which organs were arranged for Natarajan makes it a case of criminal conspiracy. He pointed out that this seems to have been motivated by the fact that the hospital where the patient is declared brain dead gets first right to harvest his organs, depending on the family's willingness.

"The patient was possibly brain dead in Thanjavur, but he was allowed to be airlifted by saying he is critical, only to ensure the Chennai hospital got the home hospital status. Or maybe the doctors in Thanjavur didn't make an effort to save him and instead allowed him to fly out," Narayanan said.

He also pointed out that Kartik's family isn't very affluent, and it's unlikely that they would afford an air ambulance that costs upwards of Rs 1 lakh per hour. The law states that there should be no monetary consideration in the case of organ donations. So does this mean the travel formalities were taken care of by other, more affluent parties?

A press release put out by the Global Hospitals states that the family decided to move Kartik from Thanjavur to a private hospital for a "second opinion and specialised care, against medical advice''.

Another doubt is whether the decision not to declare Kartik's availability as a donor was because of a December 2015 TRANSTAN advisory, that said, "When potential donors are shifted to another hospital at the insistence of their families, the hospital receiving the donor will not be entitled to any local organs. The local organs of this donor will be allocated to the first hospital where possible brain stem death identification was done."

This would have again meant the Thanjavur hospital. But by declaring him brain dead only in Chennai, Global Hospitals got first right to "in-house organ donation".

With TRANSTAN guidelines dividing Tamil Nadu into three zones, organs are first offered in the same zone that the donor is declared as brain dead. Thanjavur falls in south zone while Chennai is in the north zone, which meant it would not have received Kartik's organs. Does that explain the decision to shift Kartik to Chennai, and rather coincidentally, the same hospital that Natarajan was admitted to?

In their defence, Tamil Nadu health ministry officials say it is ironic that the government was initially accused of deliberately denying Natarajan the organs he needed because of political reasons. And now that it has been arranged, to accuse the same government of bending the rules. They say TRANSTAN is only a regulatory body that does not get into the nitty-gritties of how every organ was made available.

Balaji's attestation has been under a cloud ever since Tamil Nadu minister C Sreenivasan clarified that no AIADMK leader had access to Jayalalithaa while she was in hospital. If that is indeed so, who took the decision about the three candidates, and whether Balaji's attestation was truthful will have to be examined. Change India has also written to the Election Commission to check the integrity of the thumb impressions.

In fact, since the Chief Minister of Tamil Nadu is TRANSTAN president, only Jayalalithaa could have appointed Balaji as a member secretary. Given that she was not in a position where she could be consulted, who took the call to appoint Dr Balaji — whose specialisation incidentally is laparoscopy and not organ transplant?

Updated Date: Oct 05, 2017 19:30 PM

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