A kidney from New York
Though governments are increasingly funding (kidney) transplantation through special schemes, Kountz’s dream of transplantation for all those who need rather than those who afford is still a distant pipe dream.
Sanjay Nagral
Nov 14, 2022, Hindustan Times
Mumbai: 1976 was a tumultuous year for India. Those old enough would remember that the country was under emergency rule. Indira Gandhi the Prime Minister ruled with an iron hand. Several Opposition leaders were in jail. One of the tallest amongst them was Jaiprakash Narayan known as JP. Around the same time he was diagnosed to have kidney failure. After an uproar, he was allowed to travel to Bombay and admitted to Jaslok Hospital, one of the few centres with a specialised kidney department and dialysis facilities at that time. JP’s kidney ailment was daily news and in 1979 thanks to the over enthusiasm of a reporter his death was wrongly announced in the Parliament by Morarji Desai, the then PM and later detracted. When JP was informed he just smiled.
Around the time, JP was in Jaslok, a 45-year-old homemaker Manju Datta was diagnosed with kidney failure. Like others, she was started on dialysis. This went on for a year. Her doctors suggested a kidney transplant as a better option to the family. However there was no suitable donor amongst her relatives. This was a time when there was no concept of cadaveric transplantation in India. By that time, the US and the UK had legalised brain death, in which organs could be removed when the heart was beating and used for transplantation.
Early morning on December 26, 1976, the Dattas received a call from Dr Kuruvilla, her nephrologist, who informed that Manju was to be brought to the hospital immediately as Santa Claus had brought her a Christmas Gift. We may have a kidney for Manju’. “Who is giving it?” they asked in surprise. ‘A woman from New York’, he answered. As an intrigued family listened, Kuruvilla explained how a surgeon from New York had planned to fly kidneys donated by a woman to Bombay as a gesture of global solidarity & they wanted to test Manju’s blood for a match along with other patients at Jaslok. The family readily agreed.
The first successful kidney transplant in the world had been performed in Boston in 1954 by a team led by Joseph Murray. This was performed from one identical twin to another which is the reason it worked. Dr Samuel Kountz, an African-American kidney transplant surgeon from the US performed the first kidney transplant between individuals who were not identical twins in 1961. Whilst working at the University of San Francisco he also developed a machine to preserve the kidney so that it could be carried from one hospital to another for transplant. Dr Kountz believed that access to kidney transplantation must be available to everyone irrespective of their ability to pay. He served as an advocate to get Congressional approval for free Medicare coverage for kidney failure. He travelled the world for this cause.
In December 1976 a 42-year-old white woman’s family in New York agreed to donate her kidneys after she was declared brain dead after a road accident. Kuntz had Indian surgeons with him who had told him that kidney transplant was hardly performed in India. In an audacious act of imagination he asked them to contact colleagues in India to prepare themselves to receive these two kidneys. Kuruvilla & team at Jaslok were willing. They contacted 3 patients who were waiting for a transplant & two matched including Manju Datta.
On the 27th of Dec 1976, Kountz & three others Drs Rao, Gupta and Laungani landed at Santa Cruz airport on a New York Bombay commercial Air India flight with two kidneys which had been stored in a machine & kept on a separate table through the 30-hour journey. They drove straight to Jaslok & transplanted them with help from local surgeons led by Dr Fardoon Sonawala. Kountz thanked Air India for its help with ensuring that the kidneys were protected by ensuring a smooth take off & landing. He also announced that this was the longest a human kidney had travelled for transplantation. The recipient of the New York woman’s gift whose name we still don’t know were Manju Datta & Sheikh Jamaluddin, a young Bangladeshi sailor. Both Manju & Jamaluddin passed away in a few months of the transplant with working kidneys from seemingly unrelated problems. Perhaps the strong doses of immunosuppressive drugs may have contributed.
In 1977, on a visit to Africa to popularise kidney transplantation Kountz contracted a crippling brain disease which left him neurologically impaired and confined to bed for the rest of his life. His illness was not diagnosed and he died in 1981. Five years later the world’s First International Symposium on kidney failure and transplantation in blacks was dedicated to his memory.
Meanwhile in India the emergency was lifted in 1977. JP passed away in late 1979 of renal failure after successfully steering the Janata party to power. India & Mumbai went through a shameful period when rich foreigners travelled to buy kidneys from poor Indians. Many doctors colluded in this act. The 1994 Human Organs Transplant Act banned commerce in transplantation & legalised brain death paving the way for cadaveric transplant.
A large majority of people in the Global South still do not have access to kidney transplantation. In India kidney transplants are now performed in large numbers. However limited donations and high costs means that only those who have money or power receive transplants. Though governments are increasingly funding transplantation through special schemes, Kountz’s dream of transplantation for all those who need rather than those who afford is still a distant pipedream for those at the bottom of social hierarchy. Whether it is Afro Americans or ordinary Indians.
I would like to acknowledge the information provided by Mahua Datta Ghoshe, Manju Datta’s daughter