Transtan, The Organisation Behind Tamil Nadu’s Numero Uno Status In Organ Donation, Transplantation In India

Tamil Nadu has been a trendsetter in quite a few fields, starting with social equality. Be it the Congress governments that ruled until 1967 or the successive Dravidian governments thereafter and till today, there have been some pioneering efforts made.

During the Congress rule under Kamaraj, Tamil Nadu pioneered the concept of free noon meal in schools to lure kids into education. Later, the late M G Ramachandran expanded it and then the late leaders M Karunanidhi and J Jayalalithaa came up with their own modifications, adding eggs, vegetables, and health foods.

Similarly, the state has been in the lead in slum development and health, too. Thus, it comes as no surprise that Tamil Nadu is the leading state in organ transplantation. There is some history behind this initiative that started way back in 1998 during the Dravida Munnetra Kazhagam (DMK) rule under Karunanidhi.

According to Mohan Foundation, a pilot project was begun under the Indian Network for Organ Sharing in Tamil Nadu with five hospitals being a part of it. Organ transplantation took off from there and seemed to go on smoothly until a scam in kidney donations in Tsunami-affected areas hit the state in 2007.

A doctor, involved in organ transplantation during the initial days, says that the DMK regime came out with a government order “Cadaver Transplant Program” in September 2008 after the scam broke out. Transplant Authority of Tamil Nadu (Transtan) says the government came out with the order after a workshop that discussed live donors, transplantation formalities, cadaver transplant and coordination organisation to regulate organ transplantation.

According to Transtan, a series of government orders were issued on norms to supplement the Transplantation of Human Organs Act (THOA) and its rules. A framework was set up through which organs could be allotted in a transparent and fair manner to potential recipients awaiting organ transplantation.

The government also came out with regulations on organ sharing, appointments of convenor, and formation of an advisory committee to supervise the functioning of transplants.

The feature of Tamil Nadu organ donation regulation is that nine organs and tissues can be harvested from a brain-dead person. It is seen as a perfect private-public sector coordination.

According to the regulations, organs cannot be utilised unless a systematic waiting list is maintained for the various organs. Further, to ensure fair allocation, a sharing network is in place wherein the various private and government hospitals (with transplant units) in the state are a part of it.

What has made the people of Tamil Nadu more considerate in organ donations was the death of a 15-year-old school boy Hithendran in 2009. The boy, whose parents are doctors, died while driving his father’s motorcycle in suburban Chennai. The parents decided to donate his organs, giving a big boost to organ donation in Tamil Nadu.

“The media attention made people realise the utility of the programme and made it more visible. Since then, organ donations have picked up, vaulting Tamil Nadu as the primary state in this effort,” says the doctor involved in the initial stages of organ donation.

Then on 12 December 2014, the All India Anna Dravida Munnetra Kazhagam (AIADMK) government went a step further. Organ transplantation was brought under a registered society, Transtan. The late Jayalalithaa, who was then the chief minister, decided to head the society as its chairman, changing a proposal of having the health secretary as the chief.

The state health and finance ministers were made part of a 21-member general body, while an executive committee that included the health secretary was asked to supervise the entire operations of Transtan.

“Tamil Nadu has been leading the country in organ transplantation, though Telangana seems to have overtaken it now,” says the doctor.

Since 2008, when organ donation was regularised by Tamil Nadu, organs of about 1,200 persons have been harvested till now. Over 6,800 organs, tissues, and bones have been transplanted.

But Dr R Kanthimathi, Transtan’s current member-secretary, says Tamil Nadu is the leading state doing more organ donations and transplantation. “In 2017-18, we did 192,” she says in an email response to Swarajya’s queries. This means, organs from 192 persons were harvested and utilised for transplantation in patients. In comparison, a state like Delhi does only two organ transplants a year.

According to Mohan Foundation, Telangana leads in organ transplantation this calendar year up to 4 November, with organs being harvested from 141 persons. That has resulted in 496 transplants. In comparison, organs have been harvested from 113 persons in Tamil Nadu, though 766 transplants have been done.

Organ transplantation involves harvesting heart, liver, pancreas, lungs, kidneys, corneas, heart valves, skin, small bowel, hand, bone, spine, and disc tissue. In Tamil Nadu, 205 kidneys have been transplanted this year while 169 corneas have been harvested.

While 210 kidneys have been transplanted in Telangana, 131 livers have been harvested there. The state harvests only heart, liver, lungs, kidneys, pancreas, corneas, and heart valve, thus witnessing lower transplants compared to Tamil Nadu.

Transtan has taken the lead in enlisting organ donors. About 9,700 persons have pledged to donate their organs while nearly 5,300 persons have been waitlisted to receive organs. “Kidney is the organ more in demand,” says Kanthimathi.

No organ is sent out from Tamil Nadu, though transplantation is done for people from other states or even abroad, going by the regulations put in place by the state government. Transtan has a system in place that ensures there are no violations of rules in transplantation in private hospitals. “We ensure that there are no violation by following guidelines and protocols,” the Transtan member-secretary says, adding that all checks and balances are in place for organ transplantation.

Transtan has a wonderful understanding with the police while transporting harvested organs. The police ensure that vehicles carrying the organs are not held up in traffic with the creation of a green corridor. “Chennai police has an officer specifically to take care of this. When you tell the police that a harvested organ has to be transported, they take care of hurdle-free transport,” says a medical officer, who has been associated with Transtan, on the condition of anonymity.

Despite the exemplary work that it has been doing, Transtan isn’t free from some allegations made against it. One is that it failed to intervene when the organs of a poor youth killed in an accident in Thanjavur were harvested and transplanted in M Natarajan, husband of Sasikala, who was the aide of Jayalalithaa, in October last year.

The brain-dead youth was airlifted from Thanjavur to a city hospital and his kidney and liver were put to use for Natarajan. However, Natarajan survived only six months after that, breathing his last in March this year.

“It was a total failure on the part of Transtan to check such a transplant. Also, the mainstream media didn’t cover itself with glory by failing to question it,” says the medical officer associated with Transtan. “Natarajan was in a poor shape and transplantation in no way would have helped him. That harvest shouldn’t have been done at all, but doctors went ahead,” he adds.

Kanthimathi says she is not aware of the issue as she took charge in June this year. “Since I took over, we have made a lot of changes in our organisation. Many old hands have left and we have put in place a new efficient team whose motto is service. The whole team is working for a good cause,” she says over the phone.

There are other charges, too, like no meetings of the executive or board of Transtan, but Kanthimathi denies them saying the executive committee had met on 28 March this year. Another charge against Transtan is that the state Health Minister C Vijay Bhaskar wants more advertisements issued highlighting his work, but the member-secretary outrightly rejects it, saying it is false.

There are rumours suggesting that Transtan is under pressure from the centre. Efforts are on for the centre to take control of Transtan, say sources, though Tamil Nadu officials deny any pressure.

As of now, Transtan has been carrying out its operations diligently. Not surprisingly then, Tamil Nadu Health Department has won the Union Health and Family Welfare Ministry’s award for its organ donation programme for the fourth time in a row.