Till a month ago, Chhattisgarh resident Kumud Patel, 26, and Mumbai resident Bharti Thakkar, 50, were complete strangers. They have only one thing in common - both suffer from end stage kidney disease and require urgent kidney transplants.
Patel's maternal uncle, Mukesh Kumar, is ready to donate her a kidney but his blood group (B-positive) does not match hers. Thakkar's husband, Prakash, is willing to give his wife a kidney but their blood groups do not match.
Last month, Patel and Thakkar - both registered with the NGO Narmada Kidney Foundation - learned their blood groups matched with members from each other's family. Such 'swap donations' are allowed by an amendment to the Human Organ Transplant Act (HOTA) 1994.
Both Patel and Kumar are however, now waiting for a no-objection certificate (NOC) from the Chhattisgarh government.
"It will take another three months for us to get the NOC. Kumud has been on dialysis for more than three years. Her husband had offered to donate the kidney but was diagnosed with cancer while being screened," said Kumud's brother, Aakash Shrivastav.
Senior nephrologist and founder of NKF, Dr Bharat Shah, said: "Transplants save lives and the paperwork should not take more than a week. The procedural delay is affecting patients," said Dr Shah.
At present, a hospital-based authorisation committee decides permissions for live transplants. The state-level committee reviews cases with unrelated donors, and donors or recipients from outside the state. The procedure is particularly complicated for unrelated donors.
"Any relative other than a parent, grandparent, the spouse and children are considered unrelated," said Dr N Hase, head of nephrology department, KEM Hospital, Parel.
For 27 recognised transplant centres in Mumbai region, the state health department has only one state health official.
In one case, the documents were rejected because the notary's stamp was not visible.
Dr Bhavna Shah, transplant coordinator, Jaslok Hospital, said: "The state officials come up with a new document to submit in every meeting."
According to Dr Pravin Shingare, director of Directorate of Medical Education and Research, a recent Supreme Court judgment states that if a patient is undergoing a transplant surgery outside his domicile state, he needs a NOC from his domicile.
"I sometimes call the state health secretary to request them to set up a system to grant transplant-related NOC at the earliest," said Shingare.