Organ Donation



Organ Donation 
Exact data on the number of premature deaths due to heart, liver, lungs, kidneys and pancreas complications has not been compiled.However, there is a huge gap between the demand for and supply of human organs for transplantation. The present annual requirement and availability of commonly transplanted organs is assessed as below:

                            Requirement                      Availability
Kidney                             2,00,000                             6,000
Liver                                 30,000                                1,500
Heart                                50,000                                      15
The Government accords a very high priority for improving awareness on donation of cadaver organs to bridge the gap between the demand for and supply of organs and to save the lives of a large numbers of persons suffering from end stage organ failure. With this in view, the importance of organ donation has been highlighted by the Hon’ble Prime Minister in ‘Mann Ki Baat’ Programme in October and November 2015. Further steps have been taken to make organ donation easier including through provision of updated information to general public on NOTTO website, a 24x7 call centre with toll free helpline number (1800114770), launch of National Organ and Tissue Donation and Transplant Registry. Financial assistance has also been sanctioned for establishing four regional level organizations called Regional Organ and Tissue Transplant Organization (ROTTO) in the States of Tamil Nadu, Maharashtra, Assam and UT of Chandigarh and carrying out awareness and training of transplant coordinators. Hospitals have been advised to display boards outside the Intensive Care Units and at strategic locations in hospitals reminding that the law requires the doctor on duty/transplant coordinator/counsellor to make inquiry and request for organ donation from the family members of brain stem dead persons. Financial assistance is also being provided under the National Organ Transplant Programme for hiring transplant coordinators in Hospitals and Trauma Centres. The Government has also involved religious leaders and Non-Government Organisations, for generating awareness about organ donation.
Government is implementing National Organ Transplant Programme to support organ donation and make transplantation less costly and without delay with following components:-
(a)      Establishing National Networking including National Organ and Tissue Transplant Organisation at National level, Regional  Organ and Tissue Transplant Organisation (ROTTO) at regional level and State Organ and Tissue Transplant Organisation (SOTTO) in States;
(b)       Maintaining National Organ and Tissue Donation and Transplantation Registry;
(c)      IEC activities for improving awareness on organ donation;
(d)     Provision of financial assistance to 100 needy and poor patients in Government hospitals every year for post-transplant immunosuppressant therapy;
(e)      Financial support for maintenance of body of deceased donor when the organ is allocated to a Government Hospital;
(f)       Funding of two transplant coordinators @ Rs. 20000/- per coordinator per month and a computer set for each Government medical college and attached hospitals. Financial support for this component is also available for good performing private centres.
(g)      Support for training of staff involved in transplantation such as Transplant Surgeons, Transplant Physicians, Nurses and Transplant Coordinators;
(h)       Transplant facilities are provided at Government Hospitals at subsidized cost.
Financial Assistance is also provided to below poverty line patients under RashtriyaArogya Nidhi for organ transplantation.
The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.
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Tele-Medicine Services 
Following steps have been taken to strengthen Telemedicine services:- 
I. A Centrally Sponsored Scheme (CSS) amounting to Rs. 103.99 Crores has been approved for establishment of National Medical College Network (NMCN), wherein 41 Govt. Medical Colleges are being networked in the first phase riding over National Knowledge Network- high speed bandwidth connectivity, with the purpose of e-Education and e-Healthcare delivery. 
II. Setting up of new Telemedicine nodes in collaboration with D/o Space (ISRO) at following remote locations: 
i. One districts each in Himachal Pradesh, Odisha, Arunachal Pradesh and Meghalaya. 
ii. Chardhams, Kailash Mansarover, Amarnath and Ayappa pilgrimage places. 
III. Financial and technical support is also being provided to State Governments for strengthening and promoting Telemedicine network under their respective States/ UTs Programme Implementation Plan (PIPs) of National Health Mission (NHM) scheme. 
Ministry has developed Standard Treatment Guidelines for different diseases and the same are applicable to Telemedicine services. 
The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today. 
*****
Anti-Microbial Resistance 
A National Policy for containment of Antimicrobial Resistance (AMR) in the country was formulated in the year 2011 and has been widely disseminated. The said policy envisages enforcement and enhancement of regulatory provisions for use of antibiotics for humans as also for veterinary use.
The Drugs and Cosmetic Rule, 1945 were amended in 2013 to incorporate a new Schedule H1 under the said rules containing 46 drugs which include IIIrd and IVth generation antibiotics, anti TB drugs and certain habit forming drugs for having strict control over the sale of these drugs. The Drugs falling under Schedule H1 are required to be sold in the country with the following conditions:
The supply of a drug specified in Schedule H1 shall be recorded in a separate register at the time of the supply giving the name and address of the prescriber, the name of the patient, the name of the drug and the quantity supplied and such records shall be maintained for three years and be open for inspection.
(1)   The drug specified in Schedule H1 shall be labeled with the symbol Rx which shall be in red and conspicuously displayed on the left top corner of the label, and shall also be labeled with the following words in a box with a red border:
 “Schedule H1 Drug-Warning:
 -It is dangerous to take this preparation except in accordance with the medical advice.
-Not to be sold by retail without the prescription of a Registered Medical Practitioner.”
 An insertion has been made in the Drugs and Cosmetics Rules, 1945 to specify the withdrawal period of antibiotics in case of egg, milk, poultry and fish before these enter the human food chain. The Department of Animal Husbandry, Dairying and Fisheries has also issued Advisories in 2014 addressed to all States and Union Territories regarding judicious use of antibiotics to prevent AMR.
A National Programme for Containment of AMR has also been initiated in 12th Five Year Plan with the following objectives.
§  To establish a laboratory based surveillance system by strengthening laboratories for AMR in the country and to generate quality data on antimicrobial resistance for pathogens of public health importance.
§  To generate awareness among healthcare providers and in the community regarding rational use of antibiotics.
§  To strengthen infection control guidelines and practices and promote rational use of antibiotics.
The antibiotic drug resistance is developed in the micro-organisms. ICMR is carrying out surveillance of drug resistance to antibiotics through its Antimicrobial Resistance Surveillance Research Network (AMRSN) in six pathogenic groups (i) Diarrhoeagenic bacterial organisms (ii) Enteric fever pathogens (iii) Enterobacteriaceae causing sepsis (iv) Gram negative Non-fermenters (v) Gram positives including MRSA (vi) Fungal infections. Four nodal centers for collection of data are CMC, Vellore, JIPMER, Puducherry, PGIMER Chandigarh and AIIMS, New Delhi. The significant findings from last 2 years indicate that Salmonella typhi multidrug resistance (MDR) to ampicillin, chloramphenicol and trimethoprim –sulfamethoxazole is showing a downward trend. However, more than 50% of bacterial isolates of Klebsiella spp. and E. coli were found to be resistant to the currently used 3rd generation cephalosporins, but they are sensitive to carbapenams and colistin.
The Government of India has signed Memorandum of Understanding/Agreement for cooperation in health with several countries. AMR has been identified as one of the area of cooperation in agreements with some of these countries including Sweden, Netherland and U.K.
During the World Health Assembly in May 2015, the Member States have adopted a Global plan for action on AMR.
Further, Indian Council of Medical Research (ICMR) has signed a Memorandum of Understanding (MoU) with the Research Council of Norway (RCN), and also initiated collaboration with National Institute of Health, USA (NIH) and Centers for Disease Control, Atlanta, USA (CDC) regarding antimicrobial resistance.
The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.
*****
Integrated Health Information System 
The Government has plans to set up an e-health body or institution to look after the development of an integrated health information system in the country. National Centre for Health Informatics (NCHI) is being setup under Ministry of Health and Family Welfare. The proposed institution will be registered under the Societies Registration Act, 1860. The setting up of Integrated Health Information Platform (IHIP) in India is one of the objectives of NCHI. 
The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today. 
*****
Urban Centres under NUHM 
A total of 81 Urban Primary Health Centres (UPHC) have been approved for the state of Bihar under NUHM.
NUHM envisages service delivery through a network of Urban Primary Health Centres (U-PHC) and Urban Community Health Centres (U-CHC) to address the health care needs of the poor and the vulnerable population like rickshaw pullers, vendors, construction workers, rag pickers, etc. Besides NUHM envisages provision of healthcare service through outreach service mechanism both regular and special outreach to provide health services to the population residing in slum and other vulnerable population as rickshaw pullers, vendors, etc.
The State-wise list of Urban Health centres including the cities approved under NUHM is given below:
State-wise list of Urban Health Centres approved under NUHM
S. No.
Name of the State/UT
Number of Urban Health Centres strengthened
1
A & N Islands
5
2
Andhra Pradesh
212
3
Arunachal Pradesh
3
4
Assam
45
5
Bihar
81
6
Chandigarh
3
7
Chhattisgarh
36
8
Dadra & Nagar Haveli
2
9
Daman & Diu
0
10
Delhi
263
11
Goa
4
12
Gujarat
309
13
Haryana
146
14
Himachal Pradesh
6
15
Jammu & Kashmir
49
16
Jharkhand
53
17
Karnataka
259
18
Kerala
76
19
Madhya Pradesh
136
20
Maharashtra
611
21
Manipur
9
22
Meghalaya
19
23
Mizoram
8
24
Nagaland
5
25
Odisha
55
26
Puducherry
5
27
Punjab
93
28
Rajasthan
245
29
Sikkim
1
30
Tamil Nadu
420
31
Telangana
245
32
Tripura
7
33
Uttar Pradesh
558
34
Uttarakhand
36
35
West Bengal
320

TOTAL
4325

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

*****
Platform for redressal of medical negligence cases 

MCI and the appropriate State Medical Councils has been empowered to take disciplinary action against a doctor for violation of the provisions of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002 including cases of medical negligence. MCI is an Appellate Authority in such matters. As reported by MCI, it has received 27 numbers of appeals on medical negligence during the period 01.01.2014 to 31.12.2015, of which, 13 have been decided by it. 

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today. 

*****
Panel for promoting organ donation 

An Inter-Ministerial Committee headed by Secretary, Ministry of Health & Family Welfare has been constituted to coordinate all activities related to promotion of organ donation in the country. 

Government has launched National Organ Transplant Programme. Inter alia, the programme has a provision for giving awards for promoting cadaver donations to institutions, doctors, transplant coordinators, and donor families. 

The National Organ and Tissue Transplant Organization (NOTTO) has become operational only in 2014 and is, as such, at a very nascent stage. Presently, it is functioning under the Directorate General of Health Services, Ministry of Health and Family Welfare. It will, alongwith Regional Organ and Tissue Transplant Organizations (ROTTOs) and State Organ and Tissue Transplant Organizations (SOTTOs), be strengthened over a period of time. 

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today. 

*****
New Medical Colleges 

This Ministry administers a Centrally Sponsored Scheme namely, “Establishment of new Medical Colleges attached with existing district/referral hospitals”. Under the Scheme, 58 District/referral hospitals in 20 States/UTs are to be upgraded. A list of these 58 identified districts is placed in the table given below.

Districts covered are those which did not have a Medical College. The total cost of establishment of one Medical College under the scheme is Rs.189 crore. The fund sharing between the Central Government and State Government is in the ratio of 60:40 and 90:10 for NE/special category States.

Up-gradation of existing infrastructure is covered under the Scheme.  The Scheme is being implemented by the respective State Governments. One district namely Gondia in Maharashtra has been identified for establishment of new medical college.

List of identified States/districts under the scheme for "Establishment of new Medical Colleges attached with district/referral hospitals"
S.N.
State/UT
No. of District/Referral Hospitals
Districts
1
A & N Islands
1
Port Blair
2
Arunachal Pradesh
1
Naharlagun
3
Assam
4
Diphu
Dubri
Nagaon
North Lakhimpur
4
Bihar
3
Purnia
Samastipur
Saran(Chhapara)

5
Chhattisgarh
2
Rajnandgaon
Sarguja
6
Haryana
1
Bhiwani

7
Himachal Pradesh
3
Chamba
Hamirpur
Nahan (Sirmour)
8
Jharkhand
3
Dumka
Hazaribagh
Palamu
9
Jammu & Kashmir
5
Anatnag
Baramullah
Doda
Kathua
Rajauri
10
Madhya Pradesh
7
Chindwara
Datia
Khandwa
Ratlam
Shivpuri
Shahdol
Vidisha
11
Maharashtra
1
Gondia
12
Meghalaya
1
West Garo Hills, Tura
13
Mizoram
1
Falkwan
14
Nagaland
1
Naga Hospital
15
Odisha
5
Balasore
Baripada (Mayurbhanj)
Bolangir
Koraput
Puri
16
Punjab
1
SAS Nagar
17
Rajasthan
7
Alwar
Barmer
Bharatpur
Bhilwara
Churu
Dungapur
Pali
18
West Bengal
5
Birbhum (Rampur Hat)
Cooch behar
Diamond harbour, South 24 Paraganas
Purulia
Raiganj, North Dinajpur
19
Uttar Pradesh
5
Faizabad
Bahraich
Basti
Firozabad
Shahjehanpur
20
Uttarakhand
1
Almora
Total
58














































 The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.
*****
Import of Stents 
Currently, Cardiac and Drug Eluting Stents are notified as ‘Drugs’ under the Drugs and Cosmetics Act, 1940. 
Health is a State subject, and data regarding annual requirements of Stents in the country is not complied centrally. 
The Department of Pharmaceuticals has informed that the National Pharmaceutical Pricing Authority under the Department of Pharmaceuticals has, during a study conducted on pricing of stents in the country, observed that bulk of medical devices including stents consumed in the country are imported and the difference between the landed cost and the MRP thereof is very high. These medical devices fall under non-scheduled category of Drugs Price Control Order (DPCO), 2013 and as such, no ceiling price has been fixed for these devices. However, DPCO, 2013 provides for monitoring the prices of these devices and also ensures that no manufacturer/importer/distributor is allowed to increase the MRP by more than ten percent of MRP during preceding twelve months. 
As per the direction of Hon’ble High Court of Delhi, a sub-committee has been constituted by the Ministry of Health and Family Welfare, seeking its views on the essentiality of coronary stents and their inclusion in the National List of Essential Medicines. 

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today. 
*****
Improving the Healthcare Facilities in Rural and Tirbal Areas 
 Public Health being a State subject, the primary responsibility to ensure adequate healthcare facilities including in the rural backward and tribal areas is that of respective State/ UT governments. As per Rural Health Statistics Bulletin, 2015, the State-wise information on the number of Primary Health Centres (PHCs), Community Health Centres (CHCs) and shortfallis in the table given below:
SHORTFALL IN HEALTH INFRASTRUCTURE AS PER 2011 POPULATION IN INDIA 
(As on 31st March, 2015)

State/ UT
PHCs
CHCs
R
P
S
%
R
P
S
%
Andhra Pradesh
1197
1069
128
11
299
179
120
40
Arunachal Pradesh
48
117
*
*
12
52
*
*
Assam
954
1014
*
*
238
151
87
37
Bihar
3099
1883
1216
39
774
70
704
91
Chhattisgarh
774
792
*
*
193
155
38
20
Goa
19
21
*
*
4
4
0
0
Gujarat
1290
1247
43
3
322
320
2
1
Haryana
550
461
89
16
137
109
28
20
Himachal Pradesh
212
500
*
*
53
78
*
*
Jammu & Kashmir
327
637
*
*
81
84
*
*
Jharkhand
966
327
639
66
241
188
53
22
Karnataka
1306
2353
*
*
326
206
120
37
Kerala
589
827
*
*
147
222
*
*
Madhya Pradesh
1989
1171
818
41
497
334
163
33
Maharashtra
2201
1811
390
18
550
360
190
35
Manipur#
80
85
*
*
20
17
3
15
Meghalaya
114
110
4
4
28
27
1
4
Mizoram
25
57
*
*
6
9
*
*
Nagaland
68
128
*
*
17
21
*
*
Odisha
1315
1305
10
1
328
377
*
*
Punjab
578
427
151
26
144
150
*
*
Rajasthan
1861
2083
*
*
465
568
*
*
Sikkim
18
24
*
*
4
2
2
50
Tamil Nadu
1251
1372
*
*
312
385
*
*
Telangana
768
668
100
13
192
114
78
41
Tripura
109
91
18
17
27
20
7
26
Uttarakhand
238
257
*
*
59
59
0
0
Uttar Pradesh
5194
3497
1697
33
1298
773
525
40
West Bengal
2153
909
1244
58
538
347
191
36
Andaman & Nicobar Islands
8
22
*
*
2
4
*
*
Chandigarh
0
0
0
0
0
2
*
*
Dadra & Nagar Haveli
8
7
1
13
2
1
1
50
Daman & Diu
2
3
*
*
0
2
*
*
Delhi
13
5
8
62
3
0
3
100
Lakshadweep
0
4
*
*
0
3
*
*
Puducherry
13
24
*
*
3
3
0
0
India
29337
25308
6556
22
7322
5396
2316
32
The National Rural Health Mission (NRHM) was launched in in 2005 to provide accessible, affordable and quality healthcare, especially to the poor and vulnerable sections of the population, particularly in rural areas. Under the National Health Mission (NHM) which now subsumes the NRHM as a Sub Mission, support is provided to States/UTs to strengthen their healthcare systems including for setting up new /upgrading of existing public health facilities, health human resource on contractual basis, drugs, equipment, diagnostics, Ambulances, Mobile Medical Units etc based on requirements posed by the States in their Programme Implementation Plans.

All tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts are expected to receive more resources per capita under the NHM as compared to the rest of the districts in the State. These districts also receive focused attention and supportive supervision. Norms for infrastructure, Human resource, ASHAs, MMUs etc. under NHM are relaxed for tribal and hilly areas.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

*****
High Incidence of Anti-Microbial Resistance 

It is generally believed that availability of antibiotics over the counter and lack of awareness about using antibiotic drugs only as prescribed by doctors results in inappropriate use of antibiotics.

As per a recent report (2015) released by Global Antimicrobial Resistance Partnership (GARP), it is reported that resistance among common pathogens is increasing worldwide though regional patterns of resistance vary.

Common bacterial pathogens becoming resistant to antimicrobials are Staphylococcus aureus, Enterococus, S. pneumoniae, N. gonorrhoeae, N. meningititidis, E.coli, Klebsiella pneumoniae, Typhoidal Salmonella, Shigella species, Vibrio cholerae, Mycobacterium tuberculosis and in other diseases such as Malaria, Kala azar, HIV etc.

It is estimated that the prevalence of Multi-Drug-Resistant Tuberculosis (MDR-TB) in India is 2-3% among notified new pulmonary TB patients and around 15% for re-treatment pulmonary TB patients.

While separate data on disease burden of the Indian population caused by infectious diseases is not available, it is estimated that over-all communicable disease contribute to 37% of the entire disease burden.

ICMR is carrying out surveillance of drug resistance to antibiotics through its Antimicrobial Resistance Surveillance Research Network (AMRSN) in six pathogenic groups (i) Diarrhoeagenic bacterial organisms (ii) Enteric fever pathogens (iii) Enterobacteriaceae causing sepsis (iv) Gram negative Non-fermenters (v) Gram positives including MRSA (vi) Fungal infections. Four nodal centers for collection of data are CMC, Vellore, JIPMER, Puducherry, PGIMER Chandigarh and AIIMS, New Delhi. The significant findings from last 2 years indicate that Salmonella typhi multidrug resistance (MDR) to ampicillin, chloramphenicol and trimethoprim –sulfamethoxazole is showing a downward trend. However, more than 50% of bacterial isolates of Klebsiella spp. and E. coli were found to be resistant to the currently used 3rd generation cephalosporins, but they are sensitive to carbapenams and colistin.

To further regulate the sale of antibiotics, the Government of India, in the year 2013, amended the Drug and Cosmetics Rules, 1945 to incorporate a new Schedule H1 containing 46 drugs which also includes IIIrd and IVth Generation antibiotics and anti-TB drugs for a strict control over the sale of these drugs. The Drugs falling under Schedule H1 are required to be sold in the country with the following conditions:

(1)   The supply of a drug specified in Schedule H1 shall be recorded in a separate register at the time of the supply giving the name and address of the prescriber, the name of the patient, the name of the drug and the quantity supplied and such records shall be maintained for three years and be open for inspection. 

(2)   The drug specified in Schedule H1 shall be labeled with the symbol Rx which shall be in red and conspicuously displayed on the left top corner of the label, and shall also be labeled with the following words in a box with a red border:

“Schedule H1 Drug-Warning:

-It is dangerous to take this preparation except in accordance with the medical advice.

-Not to be sold by retail without the prescription of a Registered Medical Practitioner.”

An insertion has been made in the Drugs and Cosmetics Rules, 1945 to specify the withdrawal period of antibiotics in case of egg, milk, poultry and fish before these enter the human food chain. The Department of Animal Husbandry, Dairying and Fisheries has also issued Advisories in 2014 addressed to all States and Union Territories regarding judicious use of antibiotics to prevent AMR.

A National Programme for Containment of AMR has also been initiated in 12th Five Year Plan with the following objectives.

§      To establish a laboratory based surveillance system by strengthening laboratories for AMR in the country and to generate quality data on antimicrobial resistance for pathogens of public health importance.

§      To generate awareness among healthcare providers and in the community regarding rational use of antibiotics.

§      To strengthen infection control guidelines and practices and promote rational use of antibiotics.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

*****

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