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SOTTO: Government, Private Hospitals to Share Organs in 60:40 Ratio

As hundreds in Gujarat stand in queue for that proverbial new lease on life by getting an organ — either from their relatives or a brain-dead person — a GR on State Organ and Tissue Transplant Organization (SOTTO) has set the ball rolling in streamlined organ donation. Experts say the ‘Gujarat Model’ is a mix of guidelines for NOTTO and regulations prevailing in other states, most notably in southern India. The biggest takeaway from the newly formed rules is the distribution of organs — something which was a point of concern for private hospitals. According to the rules, the organs will be distributed on a 5-point roster where 1, 3 and 5 will go to government hospitals whereas 2 and 4 will go to private ones —giving an effective 60:40 distribution ratio. Likewise, the crux of entire initiative – brain death declaration of patients – will be made compulsory with a new resolution. Such rules are already in place in a few southern states. “Government hospitals will have the first right over the organs if the brain death is declared in their set-up. Medicity (entire Civil Hospital campus) finds a special mention as it gets a huge bulk of these patients,” said a senior government official.

“Organs not utilized by government set-ups will then go to the common pool where it can be utilized by the private hospitals. The organs will be available for regional (ROTTO) and national (NOTTO) pools if it’s not required by state domicile patients,” he added. The Institute of Kidney Diseases and Research Center (IKDRC) at Civil Hospital will be the seat for SOTTO. Once the State Advisory Committee for Organ and Tissue (SACOT) Transplant and Gujarat Network for Cadaver Organ Sharing (GNCOS) is formed, the website would be up with the computerized records and regular updates. A state-level coordinator will be appointed for smooth implementation of the rules, said officials. The state government also included a suggestion from multiple quarters in the GR — the relatives of the organ donor will get preference in getting an organ if they need one. A card will be issued to the family which can be used only once for the same, said officials.

Who decides who gets donated organs?

A 9-member SACOT headed by ACS (health) and the in-charge of Cadaver Organ Transplant Program as member secretary will be the apex body deciding who gets the organs. It will have lawyers and NGO representatives as members and will carry out regular inspections and monitor the website by GNCOS.

Who will get the organs?

Different sets of rules will apply to different organs. For kidneys, a point system considering factors like genetics, serology, age, antigen match, gender etc will determine the overall score. For liver, conditions like hepatic artery thrombosis, primary non-function and fulminate hepatic failure will decide the preference. For tissue and organs such as heart and lungs, it will be the urgency and roster number in the pool.

How will the organs be retrieved?

Hospitals — both public and private — will first have to get identification as either Organ and Tissue Retrieval Hospital (OTRH) or Transplant Hospital (OTTH). The organs can only be retrieved from brain dead persons — the person should be declared brain stem dead — in ICU or emergency set-up where the person’s other organs can be retrieved. A panel of doctors – headed by a neurologist/neurosurgeon – will have to certify the brain death. The declaration has to be signed by not less than two doctors. For private hospitals, there has to be a panel of five doctors. In case of any doubt by the family, they can opt for review. The organs can be retrieved after consent of the family.

How SOTTO rules will change the current scenario?

It lays down clear rules — for example, the person should have Glasgow Coma Scale of 5 or less to be declared brain dead for the purpose of organ donation. Procedures such as postmortem have been simplified. The rule is in offing where brain death notification will be made compulsory on the lines of birth and death certificates. With a centralized website, the government will know the number of patients on ventilator for more than 24 to 48 hours real time. Private hospitals have also been asked to publish transplant rates on their websites. – TOI