Transplantation of kidney: Indian professor’s views

By Our Special Correspondent

KARACHI, March 23: While condemning the unethical practices associated with kidney transplantation from unrelated living donors. Prof Kirpal Singh Chugh made a fervent appeal to the medical profession to spread the message to the public for the need for cadaveric transplantation of organs.

Dr.chughHe was speaking on the “Ethics of Transplantation” at a symposium organised at a local hotel on Friday. Dr Chugh, who is the Professor of Nephrology at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, was in Karachi to attend the Dow Medical College Annual Symposium on March 20-22.

He pointed out how the increasing demand for renal donors and their shortage on account of the absence of a cadaveric programme had given rise to ethical, social and legal problems.

According to statistics, approximately 80-100 persons per one million of the population suffer from end-stage kidney failure every year. In India alone, 60,000 patients needed renal replacement therapy. Providing dialysis to a patient is not only very expensive — Rs. 60,000 a year for one patient in India — he is also never in the fittest state of health. On the other hand a patient who receives a kidney transplant can raise a family and work normally, Dr Chugh said.

Posing the question whether it is correct to obtain kidneys from living related donors, the speaker emphasised that this was quite ethical. In view of the fact that a person’s health can be quite normal if he has only one kidney, his life span is not affected by the removal of one organ, no extraordinary risks are involved in the operation and no religion has raised objection to kidney donation and transplantation, Dr Chugh said that he thinks that it is perfectly ethical for a person to donate a kidney for his next of kin who is suffering from renal failure. He, however, felt it was essential that the consent should be informed and voluntary, and not given under social pressure.

Prof. Chugh, who is an “indigenous product” of India in terms of his medical education and has 250 publications to his credit, was highly critical of the practice of taking kidneys from unrelated living donors for commercial profit. He said that some centres in India, notably in Bombay, Hyderabad and Madras, had embarked on this unethical practice. He said that rich patients from India as well as other neighbouring countries were advertising for donors and jhuggi dwellers in India who are illiterate and uninformed are lured into providing their organs for what was a handsome amount for them. Surgeons and their agents have become millionaires in this way, he remarked.

Dr Chugh was emphatic that the only solution to this problem was to create public awareness about cadaveric transplantation and introduce laws to make it possible for surgeons to obtain organs from cadavers. In India a bill has been before the Lok Sabha on this issue for the last six or so years but it has not been passed because the necessary political will is lacking.

Giving his own impressions on the subject, Dr Adeeb Rizvi, Professor of Urology, Dow Medical College Karachi, appealed to the people not to go for unrelated living donor transplant on a commercial basis since it only benefited the rich and deprived the poor even further.

He said that we should now be talking of organ transplantation which should include heart, liver, pancreas and not just kidney transplant. This was only possible if a cadaveric organ programme was undertaken on a big scale. Citing the example of Saudi Arabia which has an active transplant programme from cadaveric donors, Dr Rizvi asked why could not Pakistan follow suit.

Source: Dawn 24 March 1990