Owing to exceptional circumstances, a 47-year-old advocate from Mumbai with end-stage kidney disease has been allowed to receive a kidney from his 45-year-old brain-dead brother, bypassing 3,000 people in line for a transplant.
The decision to approve the transplant was taken on Wednesday. Dr Jagdish Prasad, director general of the Directorate of Health Services (DHS), Delhi, decided to allow Nitin Vhatkar, the recipient, to jump the queue on humanitarian grounds as he has no blood relatives other than his younger brother Sandeep, who was declared brain-dead last Friday, after suffering a brain haemorrhage. A kidney is more likely to be compatible with a recipient if the donor is a blood relative. Dr Prasad also took into account the fact that Nitin is willing to donate his brother’s heart, liver and one of his kidneys – provided he gets the other.
The director of DHS, Maharashtra, had approved the transplant on Tuesday night but there was a debate on whether it contravened the law, so the matter was sent to DHS, Delhi. Dr Prasad said that he gave his approval as the two are blood relatives and because others will benefit from Nitin’s decision to donate his brother’s organs.
“I was informed about the condition that [Sandeep’s] organs will be donated only if [Nitin] gets a kidney. I gave the approval in the morning because they are brothers and because others will benefit from the donated heart and liver. We will now include a clause in the law that will allow us to bypass the usual conditions in such cases,” he said.
Officials from DHS, Maharashtra, and the Zonal Transplant Coordination Committee (ZTCC) said they discussed the matter until late on Tuesday night. They said Nitin, an advocate, said he would consent to donating Sandeep’s other organs provided he received one his kidneys.
Both brothers are unmarried. Their parents died two years ago and their elder brother more recently. Sandeep, a doctor with the Maharashtra Medical Council, suffered a brain haemorrhage on Friday and was found unconscious at his home in Airoli. He was pronounced brain-dead at SevenHills Hospital, Andheri.
“[Nitin] has been on dialysis since he suffered complete renal failure two years ago. We checked for possible financial gains or other possible vested interests in the case but found none,” said a DHS official, who did not wish to be named.
If not for the exceptional circumstances, Nitin would have had to wait years for a new kidney. A person’s eligibility for a new organ depends on his or her position on a list maintained by ZTCCs. “Nitin is on the Mumbai ZTCC’s recipient list, but he would have got a chance to undergo a transplant after probably five years, considering the number of end-stage kidney disease patients,” said a DHS official.
Some experts cautioned that allowing such exceptions for blood relatives could make the rules governing cadaver organ donations more vulnerable to fraudsters. “The existing norms for cadaver donations are foolproof and don’t allow for any fraudulent activity. But considering the recent kidney scam, which documents were forged to prove a relationship, it is possible that people will misuse the [exception] clause for personal benefit,” said a senior urologist from Mumbai.
But Dr Gustad Davar, president of ZTCC, Mumbai, said there is a very little room for foul play as such cases are rare. “Unlike with live donations, there is an elaborate system for identifying cadaver donors and recipients. Moreover, this the first time we have come across such a case, which proves how rare it is. Such decisions will be taken case-to-case and won’t be generalised,” he said.