Education and Training for Ethical Practice of Telemedicine for Registered Medical Practitioners in India

The Telemedicine Practice Guidelines (TPG) released in 2020 provide legal framework for registered medical practitioners (RMPs) to consult with patients deploying Information and Communication Technology. Necessary compliance requirements have also been included. This article analyses the effectiveness of the ‘Train to Practice’ course designed by the Telemedicine Society of India to train doctors in India to follow ethical and safe standards of practice of telemedicine. The online course was taught by a faculty of 18 members, over a period of 6 months using four modules. The course comprised of a pre-course assessment, live lectures, and a post-course assessment to ascertain the level of preparedness and knowledge imparted to the RMPs by way of the course. The article highlights that the RMPs had a preliminary understanding of the concept of telemedicine prior to the course. Post-course assessment indicated improvement in knowledge levels. Pre- and post-course assessments were conducted using multiple choice Yes or No response-based questionnaires. Participating RMPs exhibited a real drive to understand the legalities and operational procedures of the practice of telemedicine as was evidenced by queries posed to the lecturers. While the course was rated generously by all the attendee RMPs, there were also evidences of a lack of seriousness from certain RMPs who did not have to pay for participating in the course. The researchers have also suggested that the presence of a TPG qualification paper online and the swift introduction of TPG aligned courses in medical schools would streamline implementation challenges in the future. The researchers have also recommended the amendment of the TPG and the Medical Council of India (MCI) Code of Ethics Regulations, 2002, to provide better protection to RMPs from possible litigation occurring during telemedicine practice.

Deceased-Donor Organ Transplantation in India: Current Status, Challenges, and Solutions.

Tamil Nadu, Gujarat, Telangana, Maharashtra, Kerala, Chandigarh, Karnataka, National Capital Territory of Delhi, and Rajasthan are states and union territories having active deceased-donor organ transplant programs in India. Transplant data (2013-2018) have been collected by the National Organ and Tissue Transplant Organization from all states and union territories of India and submitted to the Global Observatory on Donation and Transplantation. From 2013 to 2018, 49155 transplants were reported in India, including 39000 living-donor organ recipients and 10 155 deceased-donor organ recipients. These transplants were for kidney (living donor = 32584, deceased donor = 5748), liver (living donor = 6416, deceased donor = 2967), heart (deceased donor = 895), lung (deceased donor = 459), pancreas (deceased donor = 78), and small bowel (deceased donor = 8). According to 2018 data, India was the second largest transplanting country in the world in terms of the absolute number of transplants. Here, we discuss the status, progress, challenges, and solutions for deceaseddonor organ transplantation. The plan to increase rates of organ donation in India include the following points: teamwork and focus by intensive care unit doctors; public education on organ donation using social media; professional education and family donation conversation programs for brain death declaration and donor management; organ procurement organizations; international collaboration and regular meetings and updates for organizations working in the field of organ transplantation; grief counseling and reporting of potential donation for families of recently deceased people; nonfinancial incentivization to families of potential organ donors; expert committees and standard operating protocols for use of marginal donor organs, donation after circulatory death programs, and machine perfusion; maintenance of transparency and ethics in organ donation, allocation, and transplantation as directed by governmental, nongovernmental, and intergovernmental entities; and regular audit of progress and registry data.

Benefit to Few Versus Risk to Many: An Ethical Dilemma During Coronavirus Disease 2019 Pandemic for Deceased-Donor Organ Transplant in a Resource-Limited Developing Country.

The tools in our armamentarium to prevent the transmission of coronavirus disease 2019, known as COVID-19, are social distancing; frequent handwashing; use of facial masks; preventing nonessential contacts/travel; nationwide lockdown; and testing, isolation, and contact tracing. However, the World Health Organization's suggestions to isolate, test, treat, and trace contacts are difficult to implement in the resourcelimited developing world. The points to weigh before performing deceased-donor organ transplant in developing countries are as follows: limitations in standard personal protective equipment (as approved by the World Health Organization), testing kits, asymptomatic infections, negative-pressure isolation rooms, intensive care unit beds, ventilator support, telehealth, availability of trained health care workers, hospital beds, the changing dynamic of this pandemic, the unwillingness of recipients, education updates, and additional burdens on the existing health care system. This pandemic has created ethical dilemmas on how to prioritize the use of our facilities, equipment, and supplies in the cash-strapped developing world. We believe that, at the present time, we should aim to resolve the COVID-19 pandemic that is affecting a large sector of the population by diverting efforts from deceased-donor organ transplant. Transplant units should conduct case-bycase evaluations when assessing the convenience of carrying out lifesaving deceased-donor organ transplant, appropriately balanced with the resources needed to address the current pandemic.

Renal Transplant Guidelines with Reference to COVID-19 Infection.

Development of COVID-19 pandemic has affected organ transplant activity significantly. To start with, government of India had adviced stoppage of "elective" surgeries so as to cope with resources and manpower for COVID-19 patients. As majority of hospitals are having both COVID and Non-COVID patients, there is obvious fear of cross-infection. Also, transplant patients being immunocompromised, there is higher risk of acquiring COVID-19 infection along with atypical presentation and unpredicted course of the disease. Result was that across India, elective living related kidney transplant came to a halt. Cadaver renal transplant, being emergency in nature still done, though very few. With passing time, once it became clear that pandemic is not going to be controlled sooner, need has been felt to restart renal transplant activity. Keeping various issues in mind in relation to elective living related renal transplant and emergency deceased donor renal transplant, these guidelines have been framed to help transplant professionals for restarting renal transplant program again in the country, while keeping both health care workers and patient safe.