After Mumbai arrests, nervous doctors pull back from transplant surgeries

Lokmanya Tilak Municipal General Hospital at Sion in Mumbai is likely to stop kidney transplant surgeries following the resignation of their sole visiting nephrologist, Dr Vishwanath Billa. His resignation is pivotal as it comes after the arrest of five doctors attached with LH Hiranandani Hospital for their alleged involvement in a kidney racket. Billa had been working without charging a fee at Lokmanya Tilak hospital since 2009.

“A doctor is not trained to verify the authenticity of documents,” said Billa, referring to the allegations levelled against the Hirnandani doctors. The five doctors are being investigated for their role in a kidney racket. In the case under investigation, the end-stage organ failure patient, Brijkishore Jaiswal, was to receive a kidney from Shobha Thakur after claiming that Thakur was his wife by the name of Rekha Devi. Thakur, a Gujarat resident, was allegedly going to sell her kidney in exchange for money.

A three-member committee formed by the directorate of health service of Maharashtra found the five doctors negligent in performing their duties. The report found that they failed to establish the relationship between the recipient and donor, a duty assigned to them under the Transplantation of Human Organs and Tissues Act, the law governing transplants in the country.

The lack of clarity and improper responsibility placed on the doctors, alleged Billa, makes it impossible for the community to perform transplants. “I cannot do the transplant because I am incapable," he said. "Perhaps the DHS should do the transplants. We (medical community) are unethical, inappropriate and don’t follow rules.”

Billa’s exit from Sion hospital will also lead to the de-recognition of a the masters course in nephrology at the attached medical college, said sources.

Investigation so far

Nephrologist Dr Mukesh Shete, urologist Dr Mukesh Shah and Dr Prakash Shetty, hospital CEO, Dr Sujit Chaterjee and medical director of LH Hiranandani Hospital, Dr Anurag Naik have been remanded to police custody until August 13. The police are probing to check for their direct involvement in the racket.

“We know of at least two other cases where money was exchanged for a kidney,” said a senior inspector with the Mumbai police. The police, while asking for the remand, stated that they need to investigate if the racket has spread to other hospitals to which these doctors are attached.

Sujata Saunik, principal health secretary, Maharashtra government, said that hospitals were issued a warning on June 3 about a gang using forged documents for transplants. "The response of the association to stop transplants is unwarranted. Instead, we should applaud the efforts of the public health department in exposing the racket," she said.

Saunik said that efforts should be made to harvest organs legally in the shortest possible time and allow life saving transplants to take place. "The exploitation of the poor and the vulnerable should not happen for such commercial gains," she added.

Not just one doctor

Mumbai surgeons, so far, perform anywhere between 70 and 100 kidney transplants every month.

But on Thursday, a nephrologist from a reputed South Mumbai hospital denied his services to an end-stage kidney failure patient. He said, like Billa, he too is incapable of verifying documents.

“We are trained to treat patients," said the doctor on condition of anonymity. "We don’t have the ability to differentiate documents. Till we have some clarity, as a policy I am not going to enrol any new patients. If (the government) wants us to verify the relation, they should give us some tests to perform. Do we do the DNA testing of their children to be assured that they are a couple?”

Other doctors echoed similar sentiments.

“Doctors are trained for doing surgeries and not identify if the donor and recipient are faking a relationship,” said Dr Narayan Prasad, secretary, Indian Society of Nephrology. “Doctors are not an investigating agency, they cannot be expected to monitor the exchange of money.”

Billa said, “There is a feeling of disgust and anger in the community. There is a movement that is building up, just wait and watch.”

The society is in the process of writing to the union health ministry for amending the present law for removing the clause which pins responsibility for document verification on the doctor. On Friday, an emergency meeting of the nephrologist and urologist association was called and it was unanimously decided that doctors of the association will not perform any kidney transplants in Mumbai.

“We want to do transplants but not with our hands trembling,” said Dr Umesh Khanna from the Mumbai Nephrology Society. “We can give the best clinical outcomes but I cannot differentiate between an original and a forged document. Our doctors will only perform the transplants in which the permission is already granted. We want the government to absolve us from the responsibility of certifying the relationship because that’s not the job of the doctor.”

The doctors are, however, willing to perform cadaver kidney transplants.

Khanna insisted that the medical community’s reaction is not unwarranted. “This has been an issue playing in the minds of the doctors but it just precipitated because of this case,” he said.

Dr Shrikant Badwe, head of Mumbai Urologist Society shared a similar sentiment. “We are absolutely scared about operating on anybody,” he said. “Members of the hospital authorisation committee are also scared and they will not hear cases and grant permissions.”

Pressure tactics?

Public health experts said that the medical community is over-reacting. “Doctors cannot withdraw from their ethical responsibility of providing healthcare,” said Dr Abhay Shukla, public health expert and national convener of the Jan Swasthya Abhyan. “If some criminals have been caught, then the ethical doctors should welcome the decision. You don’t throw the baby out with the bathwater.”

As far as the call for amending the law is concerned, experts said that regulatory problems which are restrictive for doctors to carry out transplants should be looked into. “However, we cannot have no regulation. We understand that doctors are busy and in that case, they can partly delegate but not evade from the responsibility altogether,” said Shukla, adding that doctors only need to apply their mind to scrutinise the relationship between an organ donor and a recipient.