PUNE, May 27: When 15 patients with renal failure problems, along with their spouses, attended an enlightening session on cadaver transplant at the KEM Hospital recently, it was the beginning of a silent revolution launched by leading nephrologists of the city.

Cadaver transplant or donation of kidneys (or any other organ) of a `brain dead' person to a living kidney patient is an accepted norm in western countries but is a new concept in India, with Pune and Mumbai taking the lead in recent months.

The Ruby Hall Clinic which conducted the first ever cadaver transplant in the city, on April 17 has enthused medical experts to bring more social awareness in this subject, which becomes a life and death issue when a member of a family is a victim of weak kidneys.

The Transplantation of Human Organs Act that was passed in 1994 legally provides for ``the regulation of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.''

While Maharashtra became one of the earliest states to implement this Act in early 1995, formulating its specific rules, the medical fraternity has taken upon itself to inform the public about the latest technological advances in the field of cadaver transplant.

Till now, dialysis and kidney transplantation from a living related donor has been the common practice for restoring kidney functions. However, says Rohini Sahasrabudhe, dialysis and transplant coordinator of KEM, ``Dialysis is a very expensive proposition as the expenditure comes to about Rs 70,000 yearly.

As for the living organ transplantation, the donors hesitate to donate their kidneys and that's natural because they have fear and doubts of leading quality life and a life of longevity, though that's a misconception.''

Explains, Dr F F Wadia, leading nephrologist, attached to the KEM Hospital in Pune, ``Four hospitals in Pune - KEM, Sassoon, Ruby Hall Clinic and Poona Hospital have been registered under The Transplantation of Human Organs Act and three (besides Sassoon) have been involved in active transplant programmes. Therefore, cadaver transplant is but a natural step now.

The awesome task being of motivating relatives to donate the kidneys of their `brain dead' patient and that's not easy.'' Brainstem, according to medical science, is the most primitive part of the brain, controlling basic life processes such as breathing, the heart beat and the ability of the cerebral hemispheres to maintain consciousness.

If the brainstem dies, the heart will stop within a few hours or days even if the patient is mechanically ventilated. In the early years of intensive care medicine, life support was continued until the heart stopped, even after brain death.

Therefore, leading neurosurgeons, anesthetists and other medical specialists collaborated to draw up guidelines for diagnosing brainstem death. Hence, it has now been medically accepted that a person is no more, if he is `brain dead'. It is well established that such patients cannot recover.

For the relatives of a `brain dead' patient though, acceptance of death if the brain is dead but the heart is beating due to life support system is not easy.

States Dr.Wadia, ``We have to motivate relatives and convince them that your patient is not going to come back but can still give the invaluable gift of life to others. This is done, not by the transplant team but by a different group of doctors. If the relatives give the permission, `brain death' certificate has to be sought. For this, two sets of test are conducted with a gap of six hours to ensure that the patient is confirmed `brain dead.' Each of these tests includes 13 different investigations to confirm the death.''

Transplantation cost is indeed whopping. If it is a living related donor transplant, the cost of the operation is about Rs 70,000 and lifelong medication of Rs 600 to Rs 1200 per month. In case of cadaver transplantation, the operation cost is about one lakh rupees and subsequent medication includes Rs 10,000 per month which will be reduced to Rs 7,000 later.

Copyright © 1997 Indian Express Newspapers (Bombay) Ltd.