13 JUNE 2018
On Trump-Kim summit
Trump and Kim have traversed a remarkable distance; they must build on it
The historic summit between U.S. President Donald Trump and North Korean leader Kim Jong-un in Singapore is an affirmation of the power of diplomacy. Until a few months ago, the two countries had been trading nuclear threats, as the North raced along with its nuclear weapons programme. Now, as Mr. Trump shook hands with Mr. Kim, who had once said the U.S. President was “mentally deranged”, it was a reminder of Richard Nixon’s ground-breaking 1972 visit to Beijing. Through the day, both Mr. Trump and Mr. Kim were keen on casting the “comprehensive” meet in a positive light. The two whimsical leaders deserve full credit for this thaw in relations, given the decades of hostility and the quick diplomacy that pulled the Korean peninsula back from the brink of war. It all began with the new South Korean President Moon Jae-in’s expansive outreach to the North. Mr. Kim reciprocated by sending athletes to the Winter Olympics in South Korea in February. As the relationship between the Koreas improved rapidly, Mr. Kim invited the U.S. President for a meeting. Mr. Trump accepted at once, surprising America’s allies and rivals. However, it was not certain whether the meet would take place. Mr. Trump once called it off after threats and counter-threats escalated. But the appetite for rapprochement was clearly greater on both sides, and the rendezvous was back on track.
In the brief joint statement after their meeting, Mr. Kim iterated his “firm and unwavering commitment to complete denuclearisation” of the Korean Peninsula, while Mr. Trump offered security guarantees to the North. Mr. Kim had earlier promised to denuclearise the peninsula in return for security assurances, while Mr. Trump had promised that the North would be welcomed into the international community as a respectable member and be allowed to prosper economically. The two leaders have put these demands and promises into a document that could guide future diplomatic engagement. Mr. Trump also announced that he would end the regular American “war games” with South Korea, a concession to the North. While the summit itself was a big success given the distance both countries covered in a relatively short span of time, it is too early to say whether Mr. Trump and Mr. Kim can pull off a Nixon-Mao type breakthrough.The joint statement provided few specifics on how denuclearisation can take place or how North Korea’s steps to dismantle its arsenal will be monitored. There are no deadlines mentioned. There is no reference to China, North Korea’s only ally. There has been no word on whether the two will establish formal diplomatic ties. Besides, being unpredictable and impulsive, Mr. Trump and Mr. Kim must also stare down hardline elements in their respective administrations. This bold beginning must not be wasted.
On TN organ transplant allocations
There must be an inquiry into how allocations for organ transplants are made in Tamil Nadu
Transplantation of human organs is today a mature programme in many States, making it possible for people with kidney, liver, heart and lung failure to extend their lives. Heart and lung transplants are expensive and less widely available, compared with kidney and liver procedures. State governments, which have responsibility for health care provision, are expected toensure that the organs that are altruistically donated by families of brain-dead people are given to recipients ethically, and as mandated by law. Priority for citizens enrolled in the State and national waiting lists over foreign nationals is laid down in the Transplantation of Human Organs and Tissues Rules. When the law is clear, it is extraordinary that seemingly preferential allotment of hearts and lungs has been made to foreign patients in Tamil Nadu — in 2017, foreigners accounted for 25% of heart transplants and 33% of lung transplants. The State is a pioneer in orderly and transparent allocation of deceased-donor organs, and has worked consistently to eliminate commerce in kidneys procured from poor living donors. The Transplant Authority of Tamil Nadu has served as a model for other States that now have their own programmes. Every effort must be made to ensure that it retains this high reputation, and organs go to the most suitable recipients on the rule-based parameters of domicile, citizenship, Indian origin and foreign nationality, in that order.
Organ transplants display a maturity curve over time, with a rise in the number of procedures improving outcomes and reducing costs. Heart and lung transplants are complicated procedures. Few Indian patients are willing to opt for one, compared to kidney and liver. Kidney and liver programmes have reached a high level of maturity, resulting in rising demand. Most of these organs go to citizens. Tamil Nadu offers a subsidy for poor patients for a liver transplant. Any inquiry into the allocation of hearts and lungs to foreigners should, therefore, shed light on the factors that led to the decisions, including whether registered citizens were overlooked. It should cover such issues as the capacity of district-level hospitals to perform transplants, and arrangements to air-lift organs, since domestic patients are unable to afford flight facilities. Such measures will make it possible to utilise more hearts and lungs, and offer them to domestic recipients.Enrolling all domestic patients through State registries should be the priority for the National Organ and Tissue Transplant Organisation, set up by the Centre with that mandate. Nothing should be done to erode the confidence of the kin of brain-dead people who donate organs with no expectation of gain. Hospitals and professionals who engage in commerce or unethical behaviour should have no place in the system.