IMPORTANT POINT
Kidney transplantation is not a miracle therapy for kidney failure.

S.M. Kantikar, Member—“Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients’ specific conditions, by a multidisciplinary approach before proceeding to transplantation”.

This is a peculiar complaint, before this Commission, that two distinct grounds of negligence were advanced on behalf of the complainant, Smt.Jyoti Chopra The first one is concerned with removal of both kidneys (bilateral nephrectomy), whereas the second arm of the complaint is concerned with the management of patient after nephrectomy. It was contended that the OP doctors failed to perform a renal transplant despite availability of kidney donor.

The facts:

1. The complainant Smt. Jyoti Chopra’s husband named Mr. Praveen Kumar Chopra, (since deceased- herein referred as “Patient”) consulted Dr. Vijay Kher, a Nephrologist of Indraprastha Apollo Hospital i.e. OP-1 on 13.2.1998. The patient was diagnosed as a case of Chronic Renal Failure (CRF) with bilateral Nephrolithiasis (stone). But, further, Dr.Kler neither investigated the patient nor advised any treatment or dialysis. As a mandatory requirement of OP hospital, patient was asked to sign authorization for operation, complainant alleged that, it was contrary to the principles enshrined in the Code of Medical Ethics.

2. In the month of September, 1999, patient consulted Dr. Ramesh Kumar, Head of Department of Nephrology, at Batra Hospital, New Delhi, wherein he was diagnosed as B/L obstructive Uropathy with CRF and advised urgent kidney transplant. The expenditure was informed as Rs.3,00,000/-. Thereafter, on 17.09.1999, patient approached Dr. M.R. Rajasekar, (OP-3) at OP-1 hospital, who advised urine Culture and Sensitivity(C/S) for Urinary Tract Infection (UTI). Same day, the OP-3 told that patient’s condition, as per C/S report, Norflox, was sensitive. It came as a surprise to the complainant that, how OP-3 decided without report of C/S, because, C/S test reporting will usually take three days. Therefore, it was negligence and dereliction of duty by OP-3. On the same day, Dr. A.S.Soin, Sr. Consultant, Department of Multi-Organ Transplant/Hepato Billary Surgery, issued a certificate that the patient was suffering from Chronic Renal failure (End Stage Renal Disease (ESRD)

3. On 30.09.1999, Dr. Rajasekar, issued another certificate that “patient is being treated under my care” and before the kidney transplant, he must undergo laparoscopic Bilateral Nephrectomy operation and the additional cost will be around Rs. 2.00 lakhs. It was further informed that, after removing both the kidneys, patient will need dialysis, thrice a week, until the transplantation. Therefore, it was alleged by the complainant that, that Dr. Rajsekar made a diagnosis on the basis of old records, without conducting any tests. Thereafter, the patient was forced to be admitted to OP-2 hospital on 17.09.1999 for B/L laparoscopic nephrectomy. The evaluation of the patient was normal, there was no severe UTI, and hence there was no pyelonephritis.

4. OP-3 removed both the kidneys on 08.10.1999, whereas the confirmatory test was done on 11.10.1999 and patient was discharged, but the patient was readmitted for 2nd time, from 24.10.1999 to 6.11.1999, and again on 3rd time, on 15.11.1999, for various complications and infections in various parts of body. Therefore, it was wrong on part of OP that, soon after the B/L nephrectomy, OP should have transplanted the kidneys. It was alleged that, dialysis was carried only from 28.09.1999 to 05.11.1999 and thereafter no dialysis was done for the reasons best known to OP-3.

5. It was alleged that, with malafide intention, the OP-3 removed both kidneys, before receiving report of serum oxalate. The patient was kept 51 days waiting for transplantation, without dialysis. Subsequently, patient died on 26.12.1999. Therefore, the OPs indulged in series of mal-practice and negligence. The