People with intellectual disability cannot donate organs even to their kin

Health Care, Heart Care Foundation of India, Medicine Comments Off

Such people cannot give informed consent, which is one of the primary criterion for organ donation

New Delhi, 14 January 2018: Recently, the Bombay High Court refused a plea seeking permission to a ‘intellectually disabled’ person to donate his kidney to his brother. The Hon’ble High Court of Bombay held that as per the provision of Section 2(f) of the Act, the donor must be a person who is not less than eighteen years of age and who voluntarily authorizes removal of his organ or tissues. Further, the provisions of Section 9(1C) of the Act puts bar on removal of human organ or tissues or both from body of a mentally challenged person.

In another major decision, the Kerala state legislature granted permission to prisoners in the state to donate their organs to immediate family members. To do so, the prisoners will have to first seek permission from the medical board and also from the particular court that prosecuted them. This decision to allow organ donation was inspired by a Kannur prison inmate’s appeal to donate his kidney to a family member.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “There are five aspects to an informed consent: competence, which is the legal term for the capacity to make a rational choice; amount and accuracy of information; patient understanding; voluntariness, which is a personal choice; and authorization, which refers to active agreement to the course of action. In the case of a mentally challenged person, none of these five tenets of an informed consent are present. Therefore, the person who is mentally challenged and represented by natural guardians — father and mother — cannot be a donor for removal of his organs or tissues within the meaning of Section 2(f) of the Transplantation of Human Organs and Tissues Act, 1994.

Organ donation is still an unsolved problem in our country. However, there has been a recent amendment to the Organ Transplant Act 2014, according to which it is now compulsory for every doctor to follow mandatory required request for organ donation. This means that once a person is declared dead, the doctor on duty must call the relations and give them an option: if the patient is declared dead, give them an option for corneal donation and if the person is declared brain dead, then give them the option of giving all body organs or tissues for donation.

Adding further, Dr Aggarwal, who is also Vice President, Confederation of Medical Associations of Asia and Oceania, said, “Required consent is a good thing. However, the law in most of the other countries makes it mandatory to donate organs unless opted out and this should be the case in India also. We need to also communicate to people that they can live even after death through organ donation. We are still waiting for any such popular person who can become a brand ambassador for this cause, because he/she chose to donate their organs — cases which can be cited as examples of people living through donation of their organs to someone. These people should be respected and honored.”

Some other facts about organ donation are as follows.

  • One does not have to be in perfect health to become a donor. Even those who smoke, drink or don’t have a healthy diet can donate.
  • Organ and tissue donation do not disfigure the body in any way.
  • In case of an accident, the doctor will always try to save the life of the victim first. Organ donation is considered as an option only when the person dies or the brain dies due to certain circumstances.

President Trumps Health

Health Care Comments Off

President Donald J. Trump underwent his first official health check-up since he entered the White House in January 2017.

Age 71 Examined on: January 12, 2018 Examined at: Walter Reed National Military Medical Center in Bethesda, Maryland Physician: White House physician, Navy Rear Adm. Ronny L. Jackson, MD Report made public by: Dr Jackson and Sarah Sanders, the White House press secretary

Report: Healthy

His last health information: September 2016 by Harold Bornstein, MD.

  • Height: 6 feet 3 inches     ·         Weight: 236 pounds     ·         BP: 116/70     ·         Fasting sugar: 99     ·         HDL: 63     ·         LDL: 94     ·         TG: 61     ·         Coronary artery calcium score (in 2013): 98     ·         Chest X ray and ECG: Normal     ·         PSA: 0.15     ·         Colonoscopy (in 2013) found no polyps     ·         Testosterone: 441.6     ·         LFT and TFT: Normal     ·         TTE: Normal

Medications: Rosuvastatin, low-dose aspirin, finasteride (baldness) and antibiotics for rosacea.

This 2016 as well as 2018 information does not mention cognitive health.

The mental health of the President has come into question several times in the first year of his Presidency in his speeches, his Tweets and TV appearances.

The day before the physical, a group of 75 physicians had urged the President’s physician to evaluate Trumps neurological health, including cognitive and mental health functions, as is called for in Medicare guidelines.

In a letter, they expressed what they called “increasing concern” over what they said was Trumps “declining faculties for complex thought, rambling speech, difficulty completing a thought; episodes of slurred speech; failure to recognize old friends; frequent repetition of the same concepts; decreased fine motor coordination; difficulties reading, listening and comprehending; suspect judgment, planning, problem solving, and impulse control; and, markedly declining vocabulary in recent years, with over reliance on superlatives.”

Trumps father died at 93, after having developed Alzheimers disease in his 80s. Suspecting that President Trump may have early Alzheimer’s disease, they recommended that the exam include a basic dementia screen.

However, it is not clear whether cognitive health was also evaluated in the annual exam. The President has been declared in excellent health, although no details have been released. The results of his physical exam are likely to be made public by next week with the consent of the President.

The question here arises whether it is right to comment on the mental health of a person without actually examining the person. Can the mental health of a person be judged simply on the basis of a person’s behavior?

The American Psychiatric Association (APA) does not think so and has called clinicians out for making “armchair” diagnoses, and recommended they heed the APAs Goldwater Rule, which proclaims it unethical to diagnose without examination.

APA guidelines

  • “A proper psychiatric evaluation requires more than a review of television appearances, tweets, and public comments,”
  • Diagnosis requires a review of medical and psychiatric history and records, and a complete examination of mental status.
  • “The Goldwater Rule embodies these concepts and makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement

Section 7 of the APA’s Principles of Medical Ethics is widely referred to as the Goldwater rule and it says as follows: “On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement (3)”.

New guidelines adopted by the American Medical Associations Council on Ethical and Judicial Affairs for Ethical Physician Conduct in the Media in November 2017 also state that physicians should “ Refrain from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine”.

To an extent, things are open in the public in the US. The reports of the annual physical exam of the Presidents are released by the White House, of course, with their consent.

Individuals such as Presidents are important public figures. Their decisions and statements, while in office, affect not only their country, but also have an impact on world affairs. Hence, they should be in the best of health, physical as well as mental, as they are at the helm of affairs.

But this is not the case in India.

Should public figures, politicians in particular disclose their health issues or release results of their annual physical exam to the general public?

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA