How state’s organ transplant order is killing people it meant to save

Chennai: The 25-year-old mother had passed every medical test. Her liver was healthy, her blood type a match, and the surgeons ready to begin the transplant on Sunday — the last chance to save her two-year-old son with acute liver failure. What stood in the way was a govt order.The child had been referred from JIPMER for a liver transplant on Saturday. The state’s authorisation committee required genetic tests, a letter from the local tahsildar confirming the mother-child relationship, and a pile of personal and medical documents. The family scrambled. Late Sunday night, the window closed. The child had developed multi-organ failure and irreparable brain damage. By Monday, hospital counsellors were preparing the family for the worst.On Sept 2025, state health department had issued an order routing all living organ donations — related or unrelated — through a reconstituted state-level authorisation committee and four zonal bodies. The order followed investigations that had uncovered a network of hospitals and brokers selling organs for profit. That, and the wave of organ trafficking complaints that followed, had exposed dangerous gaps in oversight. “But in closing those gaps, the state created a new and deadlier one,” said Dr J Amalorpavanathan, former convenor of Transtan, the state organ transplant network.The Transplantation of Human Organs and Tissues Act, 1994 explicitly distinguishes between donations by relatives and those by strangers. A mother donating a portion of her liver to her own child was never meant to require state-level clearance. A lighter hospital-level body, the competent authority, was designated for near-relative cases — parents, children, siblings, and spouse. The state’s order has removed that distinction. “It treats near-related and non–near-related donations alike, contrary to the Act,” Dr Amalorpavanathan said. The volumes for clearance are heavy in a state that does nearly 2,000 renal transplants and hundreds of liver transplants.Many hospitals are now debating whether they can legally disregard the order, given that it appears to override provisions in both the Act and its rules.The delays are not merely procedural. They are expensive and medically punishing, hospitals said. Doctors at two leading transplant hospitals in the city told TOI that their patients have been waiting more than a month for approvals. In one case, the committee sent birth certificates to a civic body in Salem for verification and is still awaiting a reply. In another case, after a hospital submitted genetic test reports establishing the mother-child relationship, the committee asked for the father’s genetic tests too. Additional genetic testing, doctors say can cost families up to ₹25,000. “Delay in the approval increases the cost incurred on dialysis in patients waiting for the treatment,” said Dr Rajan Ravichandran, senior nephrologist and head of the nephrology unit at MIOT Hospitals. “Fitness for transplant may also change due to delays,” he said.The stakes are highest in paediatric liver transplants. Young children have little physiological reserve, their condition can shift from critical to irreversible within days. “Many liver transplant patients are critically ill. For them transplantation is often a race against time,” said Dr K Elankumaran, who heads the liver diseases and transplant unit at Apollo Hospitals. “Delay in transplant especially in a deteriorating patient can potentially affect outcomes,” he said.