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Vatsala Trivedi

In February 1994 the Indian Parliament passed the TOHA (Transplantation of Human Organs Act), which was adopted by Maharashtra Government in 1995. Two important aspects of this law are; in the state.
1. Recognition of brain stem death as death.
2. Declaring commercialization of transplant illegal and punishable.
After adopting the law in 1995 the State Government quickly appointed the state authorization committee (SAC), state appropriate authority (SAA), banned all transplant activities of the state, freshly invited applications from various
institutions interested and geared for transplantation activities, inspected all of them and recognized the centres and the local brain death committees. The SAC chaired by DMER handles the living kidney transplant and SAA chaired by DGHS monitored the development of cadaver transplant programme in the state.
On March 27th 1997 the ?rst ever cadaveric transplant was successfully carried out by LTMG Hospital which led to a new leaf being turned in the history of transplant activities of the state. During the initial stages the hurdles of the programme
were evident. There was total lack of inter hospital co-ordination. Distribution of organs were not standardized. The occasional transplants were due to individual efforts and not as an established programme.
In September 1998 the SAA sent a letter toLTMG Hospital to put up a proposal for forming a ZTCC which could address various complex scienti?c, ethical, social issues of cadaver transplant programme. Accordingly after going through the
literature of other organ distribution agencies like UNOS (USA), UKTS (UK), ET (European) transplant service a comprehensive proposal was put up to SAA. The ZTCC was formed and started functioning in 2001 and got itself registered with charity commissioner under the society act and formed its own constitution.
  • To standardize the cadaver organ transplantation in the state of Maharashtra
  • To improve organ donation.
  • To increase the availability and access to donor organs for the patients with end organ failure.
    1. Promote organ procurement.
    2. Fair distribution of organs so as to reduce wastage of precious organs.
    3. To improve transplantation technology to achieve longterm therapeutic results.
    1. To prepare centralized blood group wise registry for waiting recipients.
    2. To prepare city priority waiting list as per the guidelines issued by SAA.
    3. To help various institutions to procure the organs.
    4. Impartial and effective organ distribution programme.
    3. To monitor transplant outcome as long term graft and patient survival itself will be a ?rm foundation to get support from society.

    India is a developing country riddled with innumerable controversies. There is no political initiative to curb primitive practices such as sati, human sacri?ce, female infanticide, etc. Health is given least priority. Even in health budget the major chunki reserved for the treatment of preventable and communicable diseases. Though end organ failure
    is rampant in India due to pollution, adulteration, urbanization and change in life style it has not caught the fancy of government. Even if government understands in principle the constant empty government coffers cannot give ?nancial
    support to any transplant programme.

    As Abrahm Lincon said “a democracy is a government by the people for the people and of the people”. It is imperative that as lawabiding citizens and doctors we design a body which functions in accordance with TOHA 1994, as a task force of SAA, which is self sufficient and self-funding. Apart from organ procuring, fair distribution and
    monitoring of transplant, the other aims are to have an immunosuppressive drug bank to make available preservative ?uid, hold public awareness programme and CMEs for the professionals.
      There are ?ve categories of members:
    1. Hospitals recognized for transplant programme must be primary members of the ZTCC and the CEOs/deans must attend all the meetings of the ZTCC. This ensures the active participation of the policy makers of the hospital and also implementation of all the decisions taken by the ZTCC.
    2. NGOs : Representatives of NGOs who are registered and committed to the cause of organ donation too are part of ZTCC.
    3. Experts : Invited experts in the subject of transplantation of various organs are a part of the ZTCC as transplantation is a highly complex subject and time to time scienti?c
    4 Society at large : This will include membership of lawyers, journalists, social workers. Other socially prominent personalities and patient representatives, etc. This group will be the mirror of the society at large. Active
    participation by the society will make functioning of the ZTCC and the cadaver transplant programme absolutely transparent.
    4. Government Representative : As per the TOHA 1994 the state government has to monitor all the transplant activities of the state. The DGHS is designated as SAA in Maharashtra. The living kidney transplant programme is
    monitored by the authorization committee under the chairmanship of DMER. Hence the representatives of both are members of ZTCC.
    To maintain the waiting recipient registry the ZTCC invites for the details of the patients from each of the registered hospital through CEO of that hospital. The scoring of each of renal recipient is done as per the guidelines and norms issued by the state government in 1998 where the consideration is given to the following facts.
    1. Age of the patient.
    2. Period on dialysis
    3. HLA
    4. Failure of dialysis access
    5. Failure of previous graft
    6. Circulating antibodies
    7. Any other medical emergencies
    In the ?rst week of each month a priority list of waiting recipients for kidney, liver and heart of the entire city is prepared. Each hospital is informed about their waiting patients. This ensures transparency of distribution system without
    jeopardizing privacy of the patient.
    Distribution process
    In the event of availability of a cadaver said the hospital informs the ZTCC. The coordinators in turn go through the list and inform the said hospital about their recipient who should receive the kidney as per the list. They also inform the other hospital where as per city waiting list the second kidney should be utilized. Liver and heart being single organ the harvesting institution is giving the priority and in case the recepient is not available the organ is offered to other member hospitals of the ZTCC. The decision of sending the liver and heart outside Mumbai to nonmember hospitals is not yet taken as the committee felt that it needs to study the medico legal aspects of the process and needs more time
    develop to the infrastructure.
    How does the patient get registered to ZTCC?
    Any patient desiring to enter the cadaver transplant programme register him/her self with any of the 13 registered hospitals. The hospital in turn after completing all the formalities at local level sends the form to the ZTCC with all
    necessary details. The ZTCC enters the details into the computer, the scores are given and the priority waiting list is prepared.
    Financial aspects of ZTCC
    ZTCC is a self-financing organization which had a very modest beginning. Initially all the private hospitals contributed Rs. 25,000/- each. LTMG Hospital and LTMMC donated a room in its premises with all facilities for the of?ce. Sir. HN
    Hospital donated the of?ce furniture.
    Charges for the Services of ZTCC
    For each organ distributed the ZTCC charges the recipient hospital a sum of Rs. 30,000/- only. The ZTCC does not charge the hospital where organs are retrieved as reimbursement of the cost of maintanence of the cadaver.
    1. To have an immunosuppressive drug bank so that needy patients can get medicines at a minimal cost.
    2. To centralize tissue typing lab service so that lymphocyte cross matching can be done outside of?ce hours at a reasonable cost.
    3. To standardize and provide preservative ?uid.
    4. To make every effort to promote cadaver transplant programme so that no prospective recipient of any organ dies during the waiting. The ZTCC is unique as it is a result of cooperation of all the registered hospitals of Mumbai irrespective of whether they are public or private institutions. The working of the ZTCC is transparent and impartial
    which has led to a leap in the transplantation activity evident from the fact that 71 renal transplants along
    with 2 liver transplants have been done in the last 2.5 years. Other agencies in the country working for a similar cause like MOHAN (Chennai) FORTE (Bangalore), SORT (Cochin) and ORBO (Delhi) have admired the work done by the ZTCC. The aim of the ZTCC is that every deserving patient shout get a suitable organ. There should be no wastage of organs as they are national resources. This is the basic objective of this patient oriented

    The study of Hughes and colleagues is a stimulus to investigate the possible role of nebulised magnesium in a protocol with multiple inhaled drugs for the treatment of acute severe asthma.

    Lancet, 2003; 361 : 2095-96.

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