Organ Transplantation

Context: A petitioner seeking a kidney transplant died waiting for permissions to come through. While there are stringent rules for organ transplantation, the court has said that timelines must be followed in the true spirit of the transplant law.

Background:

• The Delhi High Court ruled on a plea from a retired Indian Air Force officer diagnosed with  kidney failure in 2017.
• By 2019, two hospitals had recommended a renal transplant for the petitioner.
• The Army Hospital in New Delhi rejected his transplant application, citing the non-availability of a "near relative" donor under Sections 2(i) and 9(1) of the 1994 Act.
• Section 2(i) defines a "near relative" as a specific set of family relations, and Section 9(1) requires the Committee's prior approval for organ removal and transplantation unless the donor is a "near relative."
• The petitioner, facing hypertension and chronic kidney failure, sought the transplant through a plea to the High Court in 2020.
• In February 2021, the HC directed the Authorisation Committee to decide on the petitioner's application within two weeks.
• However, by October 2021, the court learned that the petitioner had passed away before the Committee's decision.

The Transplantation of Human Organs and Tissues Act, 1994

• The 1994 Act in India regulates human organ and tissue transplantation, addressing both deceased and living donations.
• The law applies to healthcare providers and hospitals, imposing penalties for violations.
• Transplants can involve organs from deceased persons donated by relatives or living donors known to the recipient.
• Living donations are generally permitted from close relatives, including parents, siblings, children, spouses, grandparents, and grandchildren.
• Altruistic donations from distant relatives, in-laws, or long-time friends are allowed with additional scrutiny to prevent financial exchanges.
• Documentation, family trees, and pictures are required for living donations from close relatives, whether Indian or foreign.
• Unrelated living donations necessitate proof of a long-term association or friendship, examined by an external committee to prevent illegal dealings.
• Offering to pay for organs or engaging in organ trade can lead to a jail term of up to 10 years and a fine of up to Rs 1 crore.
• The Authorisation Committee plays a crucial role in overseeing the transplantation process.

Authorisation Committee

• The Authorisation Committee oversees and approves non-relative organ transplant procedures.It ensures ethical compliance and prevents illegal practices, particularly when organs are donated for reasons of affection or attachment.
• Section 9(4) states that the committee's composition is determined by the Central Government, and state governments or Union Territories must constitute one or more committees with nominated members.
• Section 9(5) mandates the committee to conduct a thorough inquiry during the transplant approval process, focusing on verifying the authenticity of the donor and recipient and preventing commercial motives.
• Section 24 empowers the Centre to make rules, subject to parliamentary approval, for various purposes of the Act, such as donor authorization, certification of brain-stem death, and preservation of removed human organs.

2014 rules

• Rule 7 of the 2014 Rules outlines the constitution of the Authorisation Committee and its role in conducting an inquiry and evaluation.
• Rule 7(3) mandates the Committee to ensure that non-relative transplant cases do not involve commercial transactions.
• Rule 7(5) allows expedited evaluation if a recipient is in critical condition and requires transplantation within a week, permitting the hospital to be approached for faster assessment.
• Rule 10 focuses on living donor transplantations, requiring joint applications from the donor and recipient.
• Rule 21 necessitates personal interviews by the Committee to determine the eligibility of applicants for living donor transplantations.

Recent ruling of the court

• The Centre argued that the Committee adhered to the prescribed timeline for decision-making under the 2014 Rules.
• The petitioner's counsel argued that the lack of a timeline for Committee interviews causes delays in deciding cases, leading to prolonged suffering for patients.
• The court agreed, emphasizing that all aspects, including interviews, form processing, and decision-making, must follow fixed timelines, as reflected in provisions like Rule 23(3) requiring a final decision within 24 hours.
• Despite urgency, the court found an absence of timelines in Rules 21 and 23 for pre-transplantation interviews, leading to delays and, in some cases, recipients passing away while awaiting decisions.
• The court noted that non-adherence to timelines resulted in extended waiting periods of 2 to 3 years in some cases, contradicting the intent of the 1994 Act and the 2014 Rules.
• The court suggested that the Committee should schedule interviews within 2 weeks after 4-6 weeks of receiving the application, facilitating meetings and conducting multiple interviews.
• The entire process, from submission to decision, should ideally not exceed 6 to 8 weeks, according to the court.
• The Delhi High Court has set a timeframe of 6-8 weeks for completing the process of organ transplantation from living donors. This decision aims to streamline and expedite the organ transplant process in India. The court's directive is in line with the laws governing organ transplantation in the country, which include regulations for the donation of organs after death.