Sunil Shroff of the MOHAN Foundation

EDITOR-IN-CHIEF: WHERE WERE YOU BORN AND WHAT WERE YOUR PARENTS LIKE? Sunil Shroff: I was born in Sahibganj, an old English style district railway town on the banks of Ganges and nestled in the tribal mountainous belt of Santhal Parganas, Jharkhand. My roots trace back to Rajasthan, where my ancestors were part of a business family. However, my great-grandfather, in a bold move in the early 19th century, migrated to Bihar, setting the stage for the life that followed. But my early years took an unexpected turn when, at the age of seven, I moved from the familiar charm of my northern hometown to chaotic southern big city of Madras – now Chennai. It was a complete cultural shift – new language, new people, new traditions – an overwhelming experience for a 7-year-old. EDITOR-IN-CHIEF: WHAT WAS YOUR CHILDHOOD LIKE? Sunil Shroff: Let’s just say my childhood was a mix of pampering, curiosity and near-death experiences! My grandparents spoiled me silly, but my curiosity often landed me in big trouble. And then there was also my reckless phase. My elder brother once challenged me to jump off the roof – so, of course, I did. It turns out gravity isn’t a myth, and the experience was almost fatal. EDITOR-IN-CHIEF: WHERE DID YOU GO TO SCHOOL? Sunil Shroff: I absolutely hated my primary school in Sahibganj – it was strict, monotonous and felt very regimental more like a boot camp than a place of learning. Even at that young age, I became a seasoned expert in bunking classes. Things took an interesting turn when we moved to Madras. Having studied in a Hindi-medium school until then, I was suddenly thrown into an English-medium institution – where, to my horror, I was demoted to a lower class. I hated that even more than my old school! Determined to set things right, one morning I gingerly marched up to the principal and gathered the courage to ask her how I could reclaim my rightful class. She set me a challenge: If I worked hard, she’d grant me a double promotion. That was all the motivation I needed. By the time I reached fifth standard, I had put in the effort, and true to her word, she promoted me straight to the seventh standard. It was my first taste of setting a goal, fighting for it and winning – and I loved it! EDITOR-IN-CHIEF: WHEN DID YOU DECIDE TO BECOME A DOCTOR? Sunil Shroff: I was always been a very caring child, and I admired the medical profession from that young age as my uncle was a doctor - but I never really thought I would take up medicine. That all changed when I entered the eight standard. Until then, maths was my favourite subject. Numbers made sense, and I enjoyed the logic behind them. But then came algebra – and suddenly, math felt like an alien language! Meanwhile, biology started to fascinate me. The more I learned about the animal and human body, the more I was drawn to it. This shift felt natural and exciting. I still loved physics and found it deeply interesting, though chemistry remained a bit of a snooze. Looking back, that was the turning point – the moment I realised medicine was my true calling. EDITOR-IN-CHIEF: WHICH MEDICAL SCHOOL DID YOU GO TO, AND WERE YOU HAPPY? Sunil Shroff: I had my heart set on joining a medical school in Madras, but despite meeting all the requirements, I didn’t make it – while some of my friends with similar scores did. Corruption in medical admissions was rampant at the time, and many secured seats by greasing the right palms. After some research, I realised that the only state that would accept my admission, other than Tamil Nadu was my place of birth and that was Bihar. Fortunately, Bihar was conducting its first-ever competitive entrance exam for medical admissions. I took the plunge, appeared for the examination – and made it! I went on to complete my graduation and post-graduation at Patna Medical College, one of the oldest and most prestigious medical institutions in the country, which is celebrating its centenary this year. My time there was nothing short of extraordinary. Patna had a way of keeping life anything but dull. The mighty Ganges frequently overflowed, turning parts of the city and outskirts into a watery maze. As medical students, we were often deployed into flood-hit areas, rolling up our sleeves to administer cholera vaccinations to vulnerable communities. However, the real storm was political. The Emergency and the Jayaprakash Narayan movement threw the city into turmoil, disrupting our studies, delaying examinations and costing us an entire year. The air was electric with resistance, and I often found myself in the midst of charged public gatherings, witnessing first-hand the fire of a revolution but amidst all this, one experience left a lasting impression on me. The revolutionary leader Jayaprakash Narayan was admitted to our hospital with kidney failure, and the renowned nephrologist Dr. M. K. Mani from Mumbai would visit to oversee his dialysis. During one of his visits, I attended his guest lecture where, for the first time, I heard about the dark reality of kidney commerce and how organ trade was tarnishing India’s reputation. He spoke about possible cadaver organ donation as a solution to the crisis – an idea that was planted a seed in my mind unknowingly, one that would later shape my journey in medicine. After completing my undergraduate degree, I wanted to pursue surgery. When it was time for post-graduation, I began exploring my options. I again appeared for Bihar’s first-ever competitive post-graduate entrance examination, secured second rank and earned a spot in my preferred surgical unit – setting the stage for the next chapter of my journey. Looking back, my time at Patna Medical College was not just about textbooks and examinations – it was about witnessing history, learning resilience and finding purpose. EDITOR-IN-CHIEF: WHEN AND WHY DID YOU DECIDE TO GO THE UK AND BECOME A UROLOGIST AND TRANSPLANT SURGEON? Sunil Shroff: After earning my MS in Surgery, I began searching for job opportunities, only to realise that most positions offered meagre salaries, barely better than what I was earning as a post-graduate resident. This financial frustration ignited a fire in me – I knew that if I wanted to break free from the system, I had to escape it altogether. Initially, I set my sights on the USA, but my visa was denied. Undeterred, I pivoted to the UK and set off to take the PLAB entrance examination. What was meant to be a temporary move turned into a 12-year journey. During this time, minimally invasive surgery was revolutionising the field, but what truly captured my interest was Urology – a specialty where most surgeries were performed through endoscopes using the body’s natural passages. The precision, innovation and elegance of the field drew me in, and before I knew it, I was completely hooked on Urology – a decision that would later define my career in transplant surgery as kidney transplants was a sub-speciality of urology. EDITOR-IN-CHIEF: WHY DID YOU COME BACK TO INDIA AFTER BEING APPOINTED A LECTURER AT THE ROYAL LONDON HOSPITAL AND INSTITUTE OF UROLOGY? Sunil Shroff: During my final 3 to 4 years in the UK, I had the privilege of working under some of the best minds in Urology and Kidney Transplantation, and I was deeply enjoying the intellectual and professional growth that came with it and I knew that my next move as a consultant would be more permanent and in a prestigious hospital. Yet, despite this fulfilment, several deeply personal factors played a crucial role in my decision to return to India after spending almost a decade abroad. First and foremost, I had made a promise to my mother before leaving for the UK – that I would return. That promise became a binding thread, one that she never let me forget. Every conversation with her was a gentle reminder, and it was a bond that I couldn’t ignore, no matter the professional opportunities I was enjoying in England. The second, and perhaps more profound reason was the kidney trade that seemed impossible to escape. Working in the kidney transplant unit, I became increasingly disturbed by the constant media coverage of organ trafficking – it was almost a regular headline. The shame I felt over the practice was compounded by the taunts I received from my English colleagues. Representing a nation of almost a billion people and having to constantly defend its dignity became emotionally exhausting and, frankly, unbearable. Finally, there was the subtle, yet undeniable, racism that permeated the system. Despite having settled well in the UK, I often felt like a second-class citizen – a feeling that extended even to my children, born there. The sense of alienation pushed me to reflect on my identity, my values and where I truly wanted to belong. Ultimately, returning to India was not just a professional decision – it was a call to somewhat reconcile my career with my values, a way to reconnect with my roots and an opportunity to start afresh in my own country. I knew it wouldn’t be easy, but I took the plunge, trusting that if things didn’t work out, the option to return to the UK would always be there. EDITOR-IN-CHIEF: YOU STARTED THE KIDNEY TRANSPLANT PROGRAMME IN THE SRI RAMACHANDRA MEDICAL COLLEGE AS WELL AS THE DECEASED DONATION PROGRAMME THERE: WHAT DIFFICULTIES DID YOU FACE? Sunil Shroff: When I returned to India in April 1995, the Transplantation of Human Organs Act had just been fully implemented in February that year and made it operational. To me it felt as though the universe was aligning to guide me in this direction. However, there was widespread scepticism within the medical fraternity about the feasibility of donation after brain death declaration happening in India. Many believed that the concept of brain death would not be acceptable, and the government made little effort to promote the concept. Moreover, commercial kidney trade persisted despite the law because of some lacuna in it and inadequately low penalty of Rs. 20,000 for violations. The major barriers (in order of importance) that have existed since the inception of the programme included: Lack of awareness: This existed both among the medical fraternity and the general public. They were both unfamiliar with the concept of brain death and organ donation Infrastructural limitations – Hospitals were not well-equipped to support deceased donation programmes including simple intensive care unit (ICU) instruments such as an arterial blood gas machines to do blood gas for apnoea test and ventilators. This deficiency was more in government hospitals Resistance from ICU doctors – Many were unwilling to approach grieving families for organ donation, fearing that asking while the patient was still on a ventilator with an electrocardiogram trace might provoke an angry response Religious and cultural concerns – Some families and religious sects had deep-rooted beliefs that made families hesitant to consider organ donation Mismatch in affordability and equity leading to distrust in the system: A significant challenge in the organ donation ecosystem has been the disparity between where organs are generated and where transplants are performed, leading to a perceived lack of fairness and trust in the system. Most potential organ donors are victims of road traffic accidents, and since these cases are classified as medico-legal, they are first admitted to government hospitals. However, many of these hospitals lack the necessary infrastructure to properly maintain brain-dead patients, certify them and facilitate organ donation. In addition, most government hospitals do not have active kidney transplant programmes, meaning that even if a donor was identified, their organs could not be transplanted within the same institution. On the other hand, the majority of transplant recipients are generally waiting in private hospitals, where transplant facilities are well-established but deceased organ availability is limited. This imbalance between public and private healthcare systems has contributed to a sense of inequity and distrust in organ allocation, as it often appears that organs from government hospitals are primarily benefiting private hospital patients. To address some of these challenges, I conducted extensive groundwork, including a large-scale survey in Chennai, which revealed a willingness among many to donate eyes and even carry an organ donor card. At my hospital, we started with education workshops on brain death and initially asked families for eye donations to gauge their responses. This step-by-step approach built confidence and soon we began certifying brain death and facilitating deceased organ transplants. Within the first 2 years, we had performed more deceased donor kidney transplants than living donor transplants. To streamline the process, we introduced transplant coordinators – though initially met with resistance from some colleagues but the strong support from hospital leadership helped the programme move forward. This experience reinforced my belief that a national-level effort was necessary to expand deceased donation beyond my hospital. EDITOR-IN-CHIEF: WHY DID YOU START THE MOHAN FOUNDATION? Sunil Shroff: My experience at Sri Ramachandra Medical College made me realise that to scale up deceased organ donation across the country, a structured, non-profit organisation was essential. There was a dire need for a body that could: Raise awareness about organ donation and brain death Train and place transplant coordinators in hospitals to facilitate organ donation discussions Advocate for better policies and infrastructure to support deceased donation programmes. With this vision, we formally launched MOHAN Foundation in January 1997 during the of the of Transplantation in Chennai. To the we donor families from my hospital and planted at Sri Ramachandra Medical College The turning point came in when we a large-scale for all organ donor families in Chennai. families including one from the It was an but also an – many families despite to donate all the organs of their loved only a were and This the need for an to the of In hospitals in Tamil Nadu and for the next MOHAN Foundation organ through a the in and the of organ that we to as the for the organ donation even MOHAN we have been to lasting and awareness to a field that had been EDITOR-IN-CHIEF: WHAT TO OF MOHAN FOUNDATION? Sunil Shroff: MOHAN Foundation has played a role in deceased organ donation in significant over the The first and has been the belief that deceased donor transplants is possible in India despite all the This shift in has in growth of the field and India an for both and also for Some of its an a decade of organ we a and organ system. This has the way to the and made it to accept and the best The we to guide the organ donation and Medical in the we realised that better systems and and that awareness among and hospital was MOHAN Foundation has conducted over awareness workshops and programmes to address this of our has been the and of transplant coordinators in hospitals across India. This once has now a and part of the organ donation In in the transplant coordinators became part of the for hospitals to a for organ the years, MOHAN has over transplant coordinators and they have been for over of the donations that take place in By with government and hospital we have for better infrastructure and to support deceased organ donation. This has in the transplant law of transplant in of brain death and of the of organ donation on the in India in Hospitals – that government hospitals the potential for deceased organ donation, as they most By working with we have donation in public healthcare institutions in Tamil Rajasthan, and has of with and government hospitals to promote the the – In the MOHAN Foundation began working in the of with where the infrastructure for facilities like organ transplants was limited. At that time, only one private was kidney and no government hospitals were such The began with awareness and by of and intensive care doctors in the government the first government kidney transplants in at by the of first deceased organ donation in deceased donations and living kidney have place in the government hospitals in the and have to first eye and facilitating the first transplant in The have now other like to MOHAN Foundation from to had a very with – and Transplantation of the UK to the best in the field of organ This in the of the of The of this is to best and organ and donation and of transplant for the of all EDITOR-IN-CHIEF: WHAT DIFFICULTIES THE AND WHERE AND Sunil Shroff: The of and care in healthcare in India is very The and do better on then and and this in organ donation and transplants to be for deceased donation in these of the country. Despite our and Lack of to across – of the and only do deceased donation in significant do living donations and kidney in many having to to a transplants. some have well-established lack leading to in donation and and – donation and transplants is still not a healthcare for many leading to in and in Hospitals – we have made some many government hospitals still lack the necessary and support systems to deceased organ donation programmes and – large-scale awareness programmes and transplant coordinators which a for an in this field to organ commerce time and again and – Despite and about organ donation to many families from to donate organs of their loved The media has been a in the years it was very helped but it has more by organs donation in very of to a a is a in many Despite some of these the Foundation to and for a where organ donation is and to all in EDITOR-IN-CHIEF: WHAT YOUR WHEN YOU Sunil Shroff: Looking at the we need to and work more to streamline organ and The distrust with private healthcare has meant that this concept has not really that even are not and are on to the programme The between and of organs to it a challenge we never fully than on I the also in the in are an in kidney and and – for and – the of organ an a approach – public and on If we take I we start within the next EDITOR-IN-CHIEF: WHY TO INDIA Sunil Shroff: factors to the of organ transplants in India. – Medical and – Many hospitals transplants are medical care to the best hospitals in the – such as and have for from and where to transplant facilities is and – The of the and has to medical and now with doctors for and time and With its of medical and India has as a preferred for organ transplants and this to over a of However, we have to that these are and the organ commerce EDITOR-IN-CHIEF: WHAT YOU THE OF IN Sunil Shroff: India is a leader in living kidney and the of such However, when our organ transplant very This is because only – out of and – organ leaving Despite these challenges, the of organ in India is the next India is to one of the transplant in the just behind in transplant With in surgical organ and transplant the is well on its way to a for all of India has as a leader in the of such As awareness and medical to India not only the in deceased donation but also set new in transplant EDITOR-IN-CHIEF: WHAT YOU IN A IN Sunil Shroff: Transplantation is one of the most yet a very both and It precision, and a sense of – but the to and it young doctors a career in are my of the – a strong as is a field, and the be not only in the but also in the – opportunities to at transplant to donor and care is crucial for and – The field is with such as and medicine. with new set – Transplantation is not just about it and their and working with ICU coordinators and Advocate for – and trust is the of to organ allocation, and deceased organ donation to a on trust and and – The journey is with cases and However, the of a second at life effort Finally, never learning. Transplantation is a field that to and innovation and leadership make the support and of interest There are no of