Mumbai:
In a major setback to the flourishing science of organ transplants, a complaint made by relatives of a cadaver kidney recipient, Flavian Kandhari (33) has opened a Pandora's Box.
For, the committee of doctors investigating the complaint filed by Flavian's aunt, Alina Horta, has reached the conclusion that the doctors at Nanavati Hospital flouted the Transplantation of Human Organs Act, 1994.
The committee has even raised eyebrows over the Rs 7,40,449 amount, which was deposited in the hospital years before the actual transplant was performed.
After undergoing a cadaver kidney transplant at Nanavati Hospital on May 14, 2009, Flavian died of the Guillain Barre Syndrome (GBS) a severe nervous disorder on July 26 the same year. Only after his death did his family learned of the 17-year-old donor who had died of the same syndrome.
The family has alleged that the doctors did not inform them about the donor's condition. "Flavian had suffered from Stevens-Johnson Syndrome (SJS) a life threatening skin condition in the past and had I been told of the donor's syndrome, I would never have consented for the transplant," said Horta, tears brimming her eyes.
Probe panel
The aggrieved kin filed a complaint with the Directorate of Medical Education and Research (DMER), which then constituted a committee of doctors to inquire into the matter.
The investigation went on for over 18 months. In its report (copy with MiD DAY) to the Directorate of Health Services (DHS), the committee notes that Section 19 of the Transplant Act seems to have been violated.
The Section reads, 'Whoever makes or receives any payment for the supply of, or for an offer to supply, any human organ shall be punished with imprisonment of not less than two years and a fine not less than Rs 10,000'. The punishment may be enhanced.
GBS is not mentioned as a contraindicated (passed on to a person through transplant) disease in ZTCC guidelines, states the report.
The report further observed that Horta had deposited Rs 7,40,449 at the hospital almost two years prior to the transplant.
Although the hospital returned the amount to the family in 2007, the committee feels that "the manner in which the money was deposited prior to the surgery itself flouts the norms under the Human Organs Transplant Act, 1994'.
The committee has also raised suspicion over the money taken by the doctors as fees. The report states that the hospital had paid the nephrologist, Dr Marten D'souza, Rs 9,600 as fee for consultation in Flavian's case.
However, he still demanded Rs 25,000 from Flavian's family, via cheque (number 44534, New India Cooperative Bank on June 30, 2009). Asked why she paid the amount to D'souza, Horta said, and "He constantly said that he would not get any fees from the hospital for the operation, so I paid him the said amount."
However, after Horta's complaint, on April 6, 2011, D'souza returned the Rs 25,000 to her, along with a 10 per cent interest of Rs 5,000 for the period.
The committee is also surprised that the then Zonal Transplant Coordination Committee (ZTCC) Secretary Dr Vatsala Trivedi, who was responsible for allocating the kidney, also performed the transplant at the hospital. Alina has alleged that the family was not informed that Dr Trivedi would perform the transplant until a few hours before the operation.
The committee's report states that on June 20, 2009, Nanavati hospital gave Rs 36,500 to Trivedi as fee for performing the transplant. Hospital records corroborate this. Still, on May 28, 2009, Trivedi took a cheque of Rs 50,000 from Horta (New India Cooperative Bank, cheque number: 353101).
Finally, the committee has observed that according to the Act, taking extra money in spite of being paid by the hospital is wrong.
The transplant
Flavian who was working as a marketing executive in Mumbai was diagnosed of renal failure in 2004. He lived with his widowed mother, Jane, and maternal aunt, Horta.
Tired with the suffering that the disease brought, in 2005, the family decided that Flavian should undergo a transplant. His name was put on the waiting list of ZTCC, which allots cadaver organs to the needy.
It was on May 13, 2009 that the family received a call from ZTCC, telling them that a cadaver kidney was available for transplant. "We were happy and Dr D'Souza told us to hurry up. We followed his instructions," Horta said.
Though D'souza and Trivedi maintain that GBS is non-communicable, the committee report quotes Dr S M Katrak, former head of neurology at a public hospital and professor emeritus, to say that "an 'agent' from the donor could have gone through the kidney route in the body of Flavian, so we cannot rule this out as a cause of death. In such cases, these things come to light only after the post mortem."
Dr Trivedi said, "Nowhere in medical literature are there any cases where GBS is documented as communicable and transmissible. It was just a coincidence that the recipient died of the syndrome. I had performed the operation and had even, seeing the patient's condition, taken the death consent from the family."
Asked why Horta was asked to deposit the amount years before the operation was scheduled, Dr D'Souza clarified that the relatives had collected the amount from various trusts as cheques made out to the hospital and so the amount was deposited with it.
However, Horta stressed that she collected the amount by selling ancestral property and jewellery in Karwar. "Dr D'souza told me that I should start collecting the estimated cost of operation of Rs 6-8 lakh and deposit it in the hospital, so he can press ZTCC to allot the kidney promptly," she alleged.
Jane said, "The doctors first took our son, then emptied our bank accounts and left us hand-to-mouth at this age."
Incidentally, the DMER admits to the negligence. Exactly a year after Flavian's operation, on May 15, 2010, Dr Pravin Shingare, then joint director, DMER, had written a letter (copy with MiD DAY) to Horta assuring her that the inquiry is on.
The letter states, "The inquiry will be completed soon and you will get justice so that in future ZTCC will take maximum precautions to avoid passing unfit organs to the recipients. Also hope that the inquiry committee will punish the doctor and other authorities involved..."
The DHS, which has the damning report, will now decide whether the doctors are guilty of negligence.
The Other Side
When MiD DAY contacted Dr Trivedi, she said, "The allegations made by the relatives are baseless. The amount of Rs 50,000 is my professional fees. The patient belonged to the negotiable class and I, as a professional, am allowed to take fees according to my will."
Dr D'souza said, "I had clearly explained to the relatives and the patient that the donor had died of GBS. And medical literature suggests that GBS is a non-communicable and non-transmissible syndrome and the chances of the disease passing from donor to recipient are zero."
Dr Mohan Desai, Director, Medical Services at the Nanavati hospital said, "We never collect any amount from the patient before they get admitted to the hospital.
On the day of admission, the patient is expected to pay the deposit and the bills are cleared only when they take a discharge. In this case I will have to speak to the doctors concerned to find out why the amount was deposited prior to the admission."
Even after repeated calls and messages from MiD DAY, Dr Pravin Shingare, director, DMER, could not be reached for comment.