Andhra Pradesh High Court - Amravati
Guraja Harshavardhan vs The State Of Ap on 12 October, 2023
IN THE HIGH COURT OF ANDHRA PRADESH: AMARAVATI
THE HON'BLE SRI JUSTICE GANNAMANENI RAMAKRISHNA PRASAD
WRIT PETITION No. 26358 of 2023
ORAL ORDER:
Heard Sri Ch.Madhava Raman, Ld. Counsel
appearing on behalf of Sri K.V.Aditya Chowdary, Ld.
Counsel for the Writ Petitioner and Sri Appadhara Reddy,
Ld. Government Pleader for Medical, Health & Family
Welfare.
2. The prayer made in the Writ Petition is as
under:
"For the reasons mentioned above, it is
hence prayed that the Hon'ble Court may
be pleased to issue a writ, order or
direction more particularly one in the
nature of writ of mandamus to declare that
the Petitioner is entitled for exemption in
his age to be a donor as prescribed under
Section 9 (1) (1B) and Section 18 of the
Transplantation of Human Organs and
Tissues Act, 1994, to donate a portion of
his liver to transplant to his father Guraja
Kanaka Durga Rao,
S/o.Veerabhimanyudu, aged 43 years,
Residing at D.No.2-98, Vijayarai, Nehru
Nagar, Pedavegi Mandal, West Godavari
District-534475, now undergoing
treatment under 4 Respondent Hospital
th
with I.P.No.I0400009547 and
consequently direct the 4 Respondent
th
Hospital Authority to perform their medical
obligation under Rule 18 of the
Transplantation of Human Organs and
Tissues Rules, 2014 and other provisions
of the Transplantation of Human Organs
and Tissues Act, 1994 as if the Petitioner
is a major and if he is medically fit
otherwise to be a donor and pass such
other order or orders as it may deem fit
and proper in the circumstances of the
case"
THE FACTS OF THE CASE:
3. The Writ Petitioner is aged about 17 years and 5
months as on today. His father, who is aged about 43
years, is suffering from liver failure. The Medical Experts
advised that the Writ Petitioner‟s father has to undergo
liver transplantation. The family of the Writ Petitioner‟s
father have searched for a Donor, but they were
unsuccessful. The Writ Petitioner who is a minor (17 years
and 5 months old) through his natural guardian namely
the Mother has filed the present Writ Petition.
4. The Writ Petitioner, in the Affidavit, submits that
he voluntarily intends to donate a piece of his Liver to his
ailing Father through transplantation. It is also submitted
that the funds have been sanctioned on 18.08.2023
through the Chief Minister Relief Fund for the treatment of
the Writ Petitioner‟s father. It is submitted that, having no
other alternative, the Mother of the Writ Petitioner has
made an Application to the Respondent No.4 Hospital to
accept the Writ Petitioner‟s Liver for the purpose of
transplantation, but the Hospital Authorities have declined
to give permission as the consenting age for a family
member to donate an Organ is 18 years and above as per
the statute (Transplantation of Human Organs and Tissues
Rules, 1994 and the Rules).
5. The father of the Writ Petitioner is suffering
from disease called „Decompensated Liver Failure‟ due to
Hepatitis-B viral infection. Needless to state that this
situation has arisen on account of the father suffering from
Hepatitis-B viral infection and as a consequence of the
same, the liver function has permanently and irreversibly
failed. The present Writ Petition has been filed by the son
of the patient with a view that he would voluntarily donate
a part of his liver organ in order to save the life of his ailing
father who is aged about 43 years. By an Interim Order
dated 10.10.2023, this Court had directed the Director of
Medical Education to attend to this case in order to
ascertain the following information:
i) Whether this Court should consider the
paramount interest of the consenting child
(prospective-donor) over and above the
requirement of the ailing parent ?
ii) Whether the liver organ in a child of aged 17
and half years would have fully grown and
whether the donation of a part of the organ
would have any adverse bearing in the future
life of the child ?
iii) Whether health condition of the prospective
recipient is conducive for accepting the organ
vis-à-vis the success rate as per the recorded
data/statistics ?
iv) Whether the Liver Organ has fully grown in a
child aged 17 and half years?
v) Whether organ donation (liver) would have any
adverse bearing on the health of the child in the
future years ?
vi) What is the size of the organ that is required to
be taken from the child for transplantation to
the prospective recipient ?
6. A direction was given to the Director of Medical
Education to interact with the Respondent No.4 Hospital,
the Medical Experts and the treating Doctors/Surgeons of
the patient and the donor to ascertain the information as
sought for. Dr. D.V.S.L.Narasimham, who is the Director
of Medical Education, in compliance with the Interim Order
of this Court dated 10.10.2023, has swung into action, and
submitted a Report today. This Report dated 11.10.2023,
which is short and crisp is usefully extracted hereunder:
"A team of specialists from DME office
consisting of Director of Medical Education
along with Medical Gastroenterologist,
Psychiatrist and Administrative officer (A.O),
Jeevandan, AP, visited Manipal Hospitals at 11
AM on 11-10-2023 and interacted with
respondent No.4 - Hospital authorities, the
prospective recipient (patient) and also the writ
petitioner (Donor) and his mother.
After careful examination and discussion
with above persons, I would like to ascertain
the following facts:
a. The patient is suffering with
decompensated Liver failure due to
Hepatitis-B viral infection. As per the
patient health condition he needs liver
transplant at the earliest for his survival
and improvement of health. The success
rate of transplant as per the
date/statistics provided by hospital is
90% (ninety percent).
b. As per the information and investigations
reports provided by hospital authorities
and specialist doctors, the liver is fully
grown and healthy.
c. In general, minor complications may
arise. As per the information provided by
treating hospital doctors and psychiatrist
the donor is fully aware of chances of
development of complications.
d. As per the information provided by
treating hospital doctors around 60 to
65% of the right lobe of liver will be
utilized. The remaining liver is sufficient
to maintain health condition of donor.
Also, it is likely to regenerate within 5
(five) months to 92% (ninety two percent)
of original size."
7. The queries raised by this Court in the Interim
Order dated 10.10.2023 have all been addressed in this
Report dated 11.10.2023. The Report would indicate that
the disease suffered by the father of the Writ Petitioner is
irreversible in nature and also that there is an urgent
requirement of transplanting the liver, which is the only
way-out to save the life of the father of the Writ Petitioner.
It is stated that the success rate of transplantation as per
the data/statistics provided by the Hospital is 90%.
Insofar as the Writ Petitioner‟s condition is concerned, it is
stated in the Report that the test conducted by the Hospital
Authorities and Specialist Doctors would indicate that the
liver of the Writ Petitioner is fully grown and healthy. It is
also stated that about 60 to 65% of the right lobe of his
liver will be utilized in the transplant and the residual
portion of the liver is sufficient to maintain good health by
the donor. It is also stated that the removed portion of the
liver from the Writ Petitioner would also be regenerated to
an extent of 92% of the original size within five months.
8. It is also stated in the Report that the Director
Medical Education has conducted a psychiatric evaluation
of the donor and has certified that the donor is not only
competent and fit to donate the organ but is also
voluntarily willing to do the same. This Court has directed
the Ld. Counsel for the Writ Petitioner to produce the Writ
Petitioner in the Court. This Court had the occasion to
personally interact with the Writ Petitioner in the Chamber.
This Court is satisfied that the Writ Petitioner is more than
willing to donate part of his liver in order to save the life of
his father. The Director of Medical Education has also
placed on record a Certificate issued by Prof. Dr. Tom
Cherian, who is acting as the Consultant Liver Transplant
Surgeon in the present case. He has given a Certificate in
favour of the father of the Writ Petitioner. The said
Certificate is also usefully extracted hereunder:
" TO WHOM SO EVER IT MAY CONCERN
Mr. Kanaka Durga Rao a 43/M suffering
from Hepatitis B Virus related Chronic Liver
disease since 2 years and decompensated since
9 months. He was on Direct Acting Antiviral
therapy and other liver supportive medications
and is severely decompensated with a current
sodium MELD score (a marker for assessing
severity of liver disease) of 28 with refractory
ascites and hepatohydrothorax, having
repeated sepsis hence he requires urgent Liver
Transplant surgery as the only curative option
available.
There are no available family donors with
a compatible bold group match in the family
except his son Mr. Harshavardhan. On the
initial evaluation with medical history and
physical examination his son appears to be a
suitable donor and a compatible match for his
father Mr. Kanaka Durga rao. Mr
Harshavardhan‟s approximately 60% to 65% of
the Right lobe of liver will be taken, with a risk
of 0.25% of death as a surgical risk. He will
have a remnant liver volume of 35 to 40%
which is sufficient in a normal individual with
no comorbidities like Diabetes and Alcohol
intake, the remaining liver will regenerate and
grow back to 90 to 92% in a span of 5 months,
meanwhile Harshavardhan will be in close
observation and regular follow-ups as we do
with all the other Donors and take care of him
post operatively.
By doing this his father will benefit by
getting a new Partial liver and have a survival
estimate of 90% with good quality life as
normal person by the end of 5 months.
Prof. Dr. TOM CHERIAN
MBBS, FRCS (Gl Surg), FRCS (I-COLLEGIATE), CCST (UK)
Consultant Liver Transplant Surgeon
APMC/FMR/Regd. No. 79287
MANIPAL HOSPITALS
TADEPALLI, GUNTUR-522 501. A.P."
9. The Report submitted by the Director of Medical
Education and the certificate issued by the Prof. Dr.Tom
Cherian, Consultant Liver Transplant Surgeon dated
11.10.2023 are taken on record.
10. The Law does not permit the person who is
below the age of 18 years to donate his or her organ except
in exceptional circumstances. Rule 5(3)(g) of the
Transplantation of Human Organs and Tissues Rules,
2014, has on one hand laid a bar on utilisation of human
organs which are donated by living persons who are under
the age of 18 years, but it has also created an exception on
certain medical grounds to be recorded in detail with full
justification and appropriate authority. In this regard,
though the Appropriate Authority had the power to permit
the persons under the age of 18 years to donate human
organs in exceptional circumstances, in the present case,
the Appropriate Authority has not exercised this
discretionary power. While all the attendant
circumstances being in favour of the Writ Petitioner being
able to donate a part of his liver to his father, the Writ
Petitioner was constrained to approach this Court only
because the Appropriate Authority did not permit the Writ
Petitioner who is presently aged about 17 years and 5
months to donate part of his liver to his ailing father.
11. In this view of the matter, this Court has been
called upon to decide whether exceptional medical grounds
would exist in the present case by which the Writ Petitioner
could be permitted to be a donor.
12. Having regard to the facts and circumstances of
the present case and having regard to the facts narrated
herein above, this Court is of a firm view that there are
exceptional medical grounds to permit the Writ Petitioner
to donate a part of his liver to his ailing father. This apart,
this Court is also fortified by a Judgment rendered by the
Ld. Single Judge of the Hon‟ble High Court of Kerala in
Devananda P.P., Aged 17 years vs. Department of
Health and Family Welfare and others (in W.P.(C)
No.36826 of 2022, dated 20.12.2022). The facts of this
case are very much identical to the facts of present case.
The only distinction is that the Writ Petitioner therein was
a daughter of the patient who had approached the Hon‟ble
High Court of Kerala; while in the present case, the Writ
Petitioner is the son of the patient. The common aspect in
both the cases is that the prospective donors were above
17 years of age but below 18 years of age. The Writ
Petitioner in the present case is presently about 17 years
and 5 months old. The Kerala High Court had dealt with
the case where the patient‟s liver was affected by
carcinoma and one of the Expert Committee Report has
opined that the chances of success are very remote.
However, having regard to the facts and circumstances and
also taking into account the sentiments of the daughter
who wanted to donate a part of her liver to her ailing
father, the Hon‟ble High Court of Kerala had allowed the
Writ Petition thereby allowing the Writ Petitioner to donate
part of her liver to her father.
13. In the above premise, this Court is inclined to
allow the Writ Petition. Accordingly, the Writ Petition is
allowed. Before parting with this case, this Court places its
appreciation on record to both the Ld. Counsel Sri
Ch.Madhava Raman, Ld. Counsel appearing on behalf of
Sri K.V.Aditya Chowdary, Ld. Counsel for the Writ
Petitioner and Sri Appadhara Reddy, Ld. Government
Pleader for Health & Family Welfare to have acted swiftly,
befitting the occasion. This Court also places its deep
appreciation on record to Dr. D.V.S.L.Narasimham,
Director of Medical Education and also the Respondent
No.4 Hospital for having acted very swiftly and had
submitted a Comprehensive Report within the shortest
time possible. The Director of Medical Education, who is
personally present in the Court today, had also informed
this Court that he had interacted with the patient and
having gone through the previous medical record, he is of
the opinion that there is an element of urgency for the liver
transplantation. Needless to state that the sacrifice
undertaken by the Writ Petitioner to save his ailing father
is invaluable. There shall be no Order as to costs.
14. Interlocutory Applications, if any, stand closed
in terms of this Order.
________________________________
G. RAMAKRISHNA PRASAD, J
Dt: 12.10.2023.
Note: Issue C.C. by today.
B/o.
SDP
THE HON'BLE SRI JUSTICE GANNAMANENI RAMAKRISHNA PRASAD
WRIT PETITION No. 26358 OF 2023
12.10.2023
W
Note: Issue C.C. by today.
B/o.
SDP
