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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.
programme. |
| 1. Recognition of
brain stem death as death. |
| 2. Declaring commercialization
of transplant illegal and punishable. |
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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. |
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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. |
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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. |
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| PURPOSE OF
ZTCC |
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To standardize the cadaver organ transplantation in the state of
Maharashtra |
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To improve
organ donation. |
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To increase
the availability and access to donor organs for the patients with
end organ failure. |
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| HOW TO ACHIEVE
THESE GOALS? |
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| 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. |
|
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| AIMS AND
OBJECTIVES |
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| 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. |
|
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| STRUCTURE
OF ZTCC |
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|
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There
are ?ve categories of members: |
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|
| 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. |
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| FUNCTIONING
OF ZTCC |
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| 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. |
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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 |
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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. |
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| Distribution
process |
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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. |
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| How does
the patient get registered to ZTCC? |
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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. |
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| Financial
aspects of ZTCC |
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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. |
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| Charges for
the Services of ZTCC |
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| 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. |
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| FUTURE GOALS
OF ZTCC |
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| 1.
|
To
have an immunosuppressive drug bank so that needy patients can get
medicines at a minimal cost. |
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|
| 2. |
To
centralize tissue typing lab service so that lymphocyte cross matching
can be done outside of?ce hours at a reasonable cost. |
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| 3. |
To
standardize and provide preservative ?uid. |
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| 4.
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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 |
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NEBULISED
MAGNESIUM IN ASTHMA : THE RIGHT SOLUTION FOR AN OLD REMEDY?
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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