Was a Critical Patient Airlifted Just to Save Sasikala’s Husband?

As M Natarajan gets a liver transplant, ethical questions loom over airlifting the patient who became his donor.

VK Sasikala’s husband M Natarajan.

(Photo: The News Minute)

A controversy is brewing after VK Sasikala’s estranged husband M Natarajan underwent a lifesaving dual organ transplantation on Wednesday. This after a 19-year-old man, who had suffered severe head injuries, was airlifted “against medical advice” from Thanjavur Medical College and brought to the Gleneagles Global Hospital in Chennai on Monday night.

Hours later, the teenager was declared brain dead, and his organs were donated, with Natarajan being the recipient of his liver and kidney.

In-house Organ Donation

Gleaneagles Global Hospital attempted to set the record straight, issuing a press release on Wednesday.

Karthik, a young gentleman hailing from Thanjavur, was admitted at the local hospital on 30 September 2017 (Saturday) with severe head injuries and associated injuries like long bone fractures. The doctors at the hospital apprised the family of his poor outcome. Against the medical advice, the family decided to move him to a private hospital for second opinion and specialised care.

Hospital statement

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It goes on to say that following counselling, Karthik’s parents consented to donate his organs.

The press release states, “As per the guidelines of TRANSTAN, Government of Tamil Nadu, liver, heart, lungs and one kidney were allocated to Gleneagles Global Health City, Chennai as this was an in-house organ donation. The other kidney was allocated to the common pool as per government regulations.”

TRANSTAN Guidelines Followed in Theory

Among the questions that are being raised is why a critically-ill patient was transported from Thanjavur by road to Trichy and then airlifted to Chennai? Especially, when doctors at the Thanjavur Medical College had advised against this.

As per guidelines of the Transplant Authority of Tamil Nadu (TRANSTAN), Tamil Nadu is split into three zones – North, South and West.

The organs are first offered in the same zone that the donor was declared as brain dead, with each zone having their waitlist. If there are no takers in that zone, then it goes as per zonal rota.

TRANSTAN Source

The guidelines also state that the hospital that identifies brain stem death is entitled to receive the donor’s heart, lungs and one kidney.

So, what does this mean in Natarajan’s case? It means that TRANSTAN’s guidelines were followed in theory. The nagging ethical question, however, remains. Why was a critically-ill patient shifted against medical advice?

If the 19-year-old had been declared brain dead in Thanjavur, as a donor, his organs would have been allocated in the South zone, as against Chennai, which falls in the North.

DT Next cited a 7 December 2015 advisory from TRANSTAN that states, “When potential donors are shifted to another hospital at the insistence of donor families, the hospital receiving the donor will not be entitled to any local organs. The local organs of this donor will be allocated to the first hospital where possible brain stem death identification was done.”

This means, that in this case the organs should have been sent back to Thanjavur, if possible brain death had been identified by doctors at Thanjavur.

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However, the source at TRANSTAN is dismissive of such questions and said the extract from the 2015 advisory was misleading. “Anyone can move a patient from one hospital to another. That is the family’s right. He was not identified as a potential donor in Thanjavur,” he says.

According to TRANSTAN, the teenager was declared brain dead at 10:38 am on Tuesday, when the first apnea test was carried out. “TRANSTAN received the first alert at 2:07pm on Tuesday of a potential donor. But there has to be a gap of at least six hours before the second apnea test is carried out to ensure that that the donor is suitable,” said the source.

The second apnea test was conducted at 6:06pm the same day.

74-year-old Natarajan, who has been receiving treatment at the Gleneagles Global Hospital for the last nine months for chronic liver disease, was on the waitlist for a liver since April this year and was on the top of the hospital’s waiting list, says the source at TRANSTAN.

How Did Daily Wage Labourer’s Family Afford Air Ambulance?

Another important question that has surfaced is how the family of a daily wage labourer was able to afford the expense of airlifting him to Chennai.

Reports suggest that the cost of an air ambulance is Rs 1 lakh per hour. The Indian Express quotes a senior professor from a government medical college, who says,

How did a daily wage labourer’s family pay the bills for an air ambulance (around Rs 2 lakh)? Was this orchestrated to save the life of a privileged patient while denying the same to those on the TRANSTAN waiting list? Was there an organised network on behalf of the VIP patient to track down all potential donors in hospitals across the state?

While these suspicions are being raised, an official in the Tamil Nadu government maintains that the issue has not “come to the government level” yet.

(This article was first published on The News Minute and has been republished with permission.)