On July 26, 2024, the MOHAN Foundation and the Network and Alliance of Transplant Coordinators (NATCO) organized a masterclass on "Living Donation Documentation and Establishing Relationship" for their employees and NATCO members. Dr Hemal Kanvinde, Quality Assurance Officer at MOHAN Foundation Chennai moderated the session.
Living donation is a vital process where a person donates an organ or tissue while still alive. It requires careful documentation and a clear establishment of the relationship between donor and recipient. This involves thorough medical and psychological evaluations to ensure the donor's suitability and informed consent, along with legal and ethical safeguards to protect all parties involved. Establishing the donor-recipient relationship is crucial, often requiring proof of biological or social connection, especially in unrelated donations, to prevent coercion or financial inducement. Legal documentation, including consents and insurance details, is also necessary to formalize the donation and cover associated expenses. These steps, governed by ethical guidelines and legal regulations, ensure that the donation is voluntary, informed, and conducted with the highest standards of care and integrity.
The main objective of this masterclass was to provide participants with a strong understanding of the documentation and verification processes in living organ donation to ensure ethical and legal patient support. Accurate and thorough documentation not only facilitates high-quality patient care but also protects healthcare providers in legal situations. It emphasizes the importance of detailed records, including patient history, consent, and care provided, as these documents can be critical in resolving disputes and ensuring compliance with healthcare regulations. Additionally, transplant coordinators from different hospitals were invited to share real-world cases and experiences to help identify common pitfalls and areas for improvement.
Mr. Prashant Ajmera, an Indian Immigration Lawyer and Co-Founder of OneIndiaOneLaw, was the invited expert for the masterclass. The transplant coordinators who shared real-life cases were Ms. Trilly Mathew, Lead Officer, Organ Transplant at Manipal Hospital; Mr. Gururajan M, Transplant Coordinator at JIPMER, Pondicherry; Mr. Hareesh Devina, Transplant Coordinator at Virinchi Hospital, Hyderabad; and Ms. Pranitha Rani Vutukari, Transplant Coordinator at Apollo Hospital, Bengaluru.
Mr. Prashant emphasized the need for proper training and qualifications for members of transplant committees, especially those from government bodies. He noted that many committee members lack expertise in medical or legal matters, which is crucial for making informed decisions. He suggested including trained professionals like lawyers or retired judges in these committees. Additionally, in cases involving recent marriages, Mr. Prashant advised careful assessment to ensure donations are voluntary and not influenced by coercion or financial incentives. He has recommended these changes to the central government to improve the functioning and ethical standards of transplant committees.
Mr. Gururajan presented a real-world case involving a non-related donor, which was submitted to the state-level authorization committee. Following their review, the committee approved the transplant, which was successfully conducted last year. He emphasized the challenges that arise in transplant cases when there is a mismatch between genetic and legal documentation.
Ms. Trilly Mathew presented a case of a male with chronic kidney disease who had been on dialysis for five years and sought a kidney transplant with his wife as the donor. Discrepancies emerged during the evaluation: the donor's ID showed she was under 18, and there was minimal proof of their relationship. Additionally, a birth certificate for their child showed no genetic match with the father, despite claims that the child was conceived via IVF but without supporting documents. The transplant committee faced challenges in verifying the donor's eligibility due to inconsistent information and inadequate documentation, highlighting the complexities of ensuring legal and ethical compliance.
Ms. Parinitha presented a case of a recipient's family who struggled to prove relationships for a kidney transplant due to missing key documents like the donor's wife's death and marriage certificates. They provided alternative proof, including a non-availability certificate and property documents. The transplant committee required verification through additional documents, including a school certificate, before approving the transplant.
Mr. Hareesh presented a case where the recipient's wife couldn't donate a kidney due to her kidney issues, and the son was ineligible due to being unmarried. The donor was the recipient's wife's aunt, but establishing the relationship required extensive documentation, including old family photos, police verification, and residential certificates. The family faced challenges as the state authority (DME) requested more proof, including reasons why other family members couldn't donate. DNA tests confirmed a 50% match, and eventually, the necessary form was issued, allowing the transplant to proceed.
Participants asked the following questions during the masterclass:
• Many international patients do not have bank statements from the last three years in cases other than near-related donations. What are your recommendations in such cases?
• What is the minimum marriage duration required for spousal donation according to Telangana state regulations?
• Is the Nikahnama accepted as a valid marriage certificate?
• Can a person with a criminal record be a living donor?
• What documents are needed for a SWAP/ABO incompatible transplant?
• Is donation by a stepson or step-relative considered as a near-relative donation?
Close to 100 participants attended the webinar.
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