|HEALTH TRIBUNE||Wednesday, November 6, 2002, Chandigarh, India|
AYURVEDA & YOU
Kidney transplantation — I
KIDNEY transplantation has become firmly established as a preferable way for treating patients with irreversible kidney failure. The associated medical problems have been solved to a large extent, and the limiting factor now is how to get enough organs to provide this treatment to all those who need it. Transplantation in advanced countries is mainly dependent upon cadaver organs retrieved from brain-dead individuals who are maintained on a respiratory and cardiac support system in intensive care units.
Despite all efforts, kidneys that can be made available for transplantation are enough only for a minority of patients. To meet this ever-increasing demand, the procurement of organs by payment or compensation has been resorted to in some countries. Because of swift condemnation by most professional societies, the practice was banned throughout the advanced world. However, needy patients started looking beyond the bounds of law imposed by their own countries and made India a favoured destination in the 1980s. India offered a unique mix of conditions with a vast impoverished population, no laws regulating organ donation, readily available trained physicians and surgeons in the field of renal transplantation and enterprising middlemen who could bring all the interested parties together.
Although kidney transplantation was first performed in India in the early 1970s, the activity remained limited to a few major teaching hospitals in the early years because of poor results. The situation changed dramatically in the 1980s with the discovery of a potent anti-rejection drug called cyclosporine-A. More and more surgeons obtained training in the technique, and kidney transplantation increased rapidly in private hospitals located in metropolitan cities. In fact, many hospitals and nursing home sprang up during this period with kidney transplantation as the only or the main medical activity.
The beneficiaries of transplantation using kidneys from paid donors performed in the metropolitan cities of India recipients from within the subcontinent and from overseas, with the largest number coming from oil-rich West Asian countries, where transplant facilities were not available at that time. Such unregulated transplants continued for over a decade. Horror stories telling the removal of kidneys from unsuspecting individuals without their consent appeared in the Press a regular intervals. At the same time, reports of complications in the medical literature indicated that these transplants were being performed under unacceptably low standards of medical care. Recognising the adverse publicity of rampant commercialisation in transplants, both in lay and the medical Press, the Indian Parliament in 1994 enacted a law banning the sale or purchase of organs. This law prohibited transplantation with organs removed from unrelated living donors and permitted family members such as spouses, brothers, sisters, children and parents to act as donors.
In exceptional situations, the authorisation committee constituted by the government could approve of organ donation outside this group, provided the committee is convinced that the donation is being made out of "love, affection and emotional attachment" for the recipient and no financial transaction is involved. In order to promote cadaver organ donation, the clinical criteria of brain stem death were accepted. Since health is regulated by the states under the Constitution, the law required ratification by the legislative assemblies of individual states. It was hoped that this act would put a stop to the practice of commercial transplants. However, nothing of the sort has happened. It was freely admitted at the last annual meeting of the Indian Society of Nephrology that this activity continued unabated since it could now be done "legally" after permission had been obtained from the Authorisation Committee.
A democratic, society must respect human rights and must make arrangements to safeguard medical practices from corruption and degradation. Payment for organs may not be inherently unethical, and it would be wrong to prohibit this contract without strong reasons.
The major argument offered in favour of paid transplants is that these would allow recipients who have no other option to get transplanted, to get a new lease of life. The term ‘buy or let die" was coined for this situation. Inherent in this argument is the assumption that only those who do not have a suitable related donor look for a paid donor. In reality, rich patients still look into the paid donor market even if a suitable related donor is available. We are aware of several recipients who had suitable donors in the family but still preferred to buy a kidney because they could afford it.
The foremost issue concerning living donors is that they should not be subjected to any harm. The short and long-term medical safety of removal of one kidney from healthy individuals possessing two kidneys is well-established. People who lose one kidney have a normal life-span and face no restrictions in their lifestyles or range of activities. Large families with strong interpersonal ties, combined with the knowledge that long-term dialysis was not a realistic option, frequently made related donors come forward for transplantation. Members of extended families, including cousins, uncles, aunts, nephews and nieces often volunteer to donate. mothers are the most frequent donors, accounting for over one-third of all living donations, followed by siblings.
Altruism, defined as "doing good to others at the expense of one’s own self-interest", has been considered to be the prime motivating factor for living organ donation. In the context of a family or strong emotional relationship such as long-term friendship, the feeling of being the one instrumental in a loved one getting "cured" is a source of strong emotional satisfaction for the donor. The limited risk of surgery becomes acceptable when it benefits somebody one loves and cares for.
Dr Chugh is the Emeritus Professor of Nephrology and Dr Jha is an Associate Professor at the PGI, Chandigarh
(To be continued)
AYURVEDA & YOU
ON the 2nd of this month, just two days before Divali, fell an important festival, Dhana Tryodashi. People across the country celebrated this day by purchasing new utensils as they prepared to celebrate the festival of lights. On the same day, like all the previous years, votaries of ayurveda joined celebrations to worship Lord Dhanawantari, the reigning god of this medical system, who is believed to have incarnated on that day.
In the present scenario, this day assumed special significance because, after remaining neglected for centuries, ayurveda, the ancient medical system of India, seems to be bouncing back with great strength. Its renaissance has also resulted in bringing many other alternative systems of medicine into limelight. Though tradition and treasure of ayurveda is older among all of them, it is also the uniqueness of its holistic approach towards the disease and its treatment which has resulted into its growing acceptance in all parts of the world.
Ayurveda seems to fulfil the aspirations of a large section of people who believe that total health constitutes the well-being of the body, the mind and the soul, and each one of that contributes towards the welfare of the other.
The sudden revival and rise of ayurveda needs careful monitoring so that certain unwanted trends do not creep into the system, obliterating its very essence. One has to understand the duplicity of big pharmaceutical houses, which, on the one hand, are waging resistance to the promotion of ayurveda and on the other, are busy in launching new "herbal" drugs conveniently labelled as ayurvedic medicines. It is surprising to see why so far scholars of this system have not passed any judgement on the introduction of alcoholic or other synthetically derived herbal extracts or cosmetic items by these pharmaceutical giants to be called as ayurvedic.
There are many streams within ayurveda which need greater attention and priority. The herbal wealth, which is the backbone of ayurveda, is fast depleting. There are only knee-jerk reactions to save a large number of precious herbs facing extinction. A clear and effective policy for the rising demand of herbs in the domestic and international market is needed. It should be ensured that within the country also their quality should not be second in comparison to what is sold outside. More and more of our population needs to be made aware of growing medicinal plants so that the damage done by the vanishing forests can somehow be compensated.
The concept of Ayurveda stresses more on living a healthy life for this, one has to follow a balanced life-style incorporating a proper daily routine, eating what is right for a particular individual and also adopting certain regimens supported by body and mind discipline.
The world has now acknowledged that the philosophy of ayurveda has turned itself into a discipline which has its reaches far beyond that of a mere medical system. The present hype has made everybody believe that India seems to be sitting on a gold-mine called ayurveda. But one has to be aware of the commercial reasons which , it appears, have made ayurveda to be hijacked and exploited by those quarters who previously were not only indifferent to it but were also ideologically opposed to it.
The time has come for the exponents of ayurveda to rededicate themselves to preserving and promoting this great system for the good of mankind. This is their professional obligation.
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