The National Medical Commission (NMC) has released guidelines to regulate the conduct and broadcast of live surgeries. This decision follows a Writ Petition (Civil) No.1141/2023 filed in the Supreme Court of India, which raised concerns about the commercial exploitation of patients through live surgery broadcasts in conferences. This public notice was issued on July 26, 2025.
The Petitioner highlighted instances where private hospitals and various companies allegedly exploit patients as “models” for ulterior motives, with advertising, sponsorship, and professional showmanship overshadowing the true educational purpose. Concerns were raised that healthcare facilities showcase capabilities, surgeons flaunt skills, and companies promote products at the expense of patient safety.
Recognizing these serious issues, the NMC constituted a committee to provide recommendations for a regulatory framework. The newly released guidelines aim to address the ethical dilemmas, potential risks to patients, and the commercialization often associated with such broadcasts.
Key Concerns Addressed by the Guidelines
The NMC acknowledges several significant concerns surrounding live surgeries, including:
- The potential for observers to miss key details or nuances, leading to less effective learning compared to pre-recorded videos that offer better analysis and editing.
- Ethical issues concerning the use of patients for educational purposes, where potential discomfort or risks might not justify the educational benefits.
- Patients often being unaware that a surgeon’s attention might be divided due to interaction with an audience, potentially putting them at risk.
- The impact of cameras and a large audience on patient comfort, potentially causing anxiety.
- Public scrutiny of complications arising during a procedure, leading to legal and reputational risks for providers.
- Commercial exploitation of patients, where financial gain from companies and promotion overshadow patient well-being.
- Pressure on surgeons to perform flawlessly during live interactions, which could impair performance.
While acknowledging the counterpoint that live surgical workshops have historical educational value and newer technologies allow high-resolution telecasts for broader learning, the EMRB (Ethics & Medical Registration Board) of the NMC explicitly favors promoting recorded video, wet lab, cadaveric, and simulation-based surgeries/procedures as these entail no risk to the patient.
New Guidelines for Conduct & Broadcast of Live Surgeries (Exceptions Apply)
These guidelines apply to live surgeries/procedures, with an exception for those performed in institutions listed in the schedule of the NMC Act, 2019, for their own students/Registered Medical Practitioners (RMPs).
A. Who can organize (Sponsor/Supervisor):
Sponsor/Supervisor must have Indemnity insurance coverage. A supervisor from the organizing team, from the same specialty, must be part of the operating team.
For Foreign Medical Practitioners (FMPs), temporary permission from EMRB, NMC is required, with a Specialty Expert team nominated by EMRB/NMC to permit the FMP. Prior permission from the concerned State Medical Council is also required before inviting FMPs.
Live broadcasts are prohibited for promoting the operating surgeon, hospital, or product brand. Surgeons must not have financial or commercial interest in equipment or devices used.
B. Where it can be done:
The hospital must be accredited by a recognized body and ensure all necessary pre-operative, operative, anaesthetic, post-operative, laboratory, radiological, and ICU facilities are available.
All essential instruments must be readily available. A contingency plan for complications, with qualified standby staff and equipment, must be in place.
The OT/Procedure Room setup requires approval and screening by relevant authorities (Head of Institution/Sponsor/Associations/SMCs). Inadequate setups will lead to deferral of live broadcast, with only recorded videos permitted.
C. How it is to be done:
- Patient Selection: High-risk procedures, those with incomplete investigations, or unusual anatomy are strictly excluded. Patients must be medically fit with no contraindications.
- Financial incentives for patient participation are not permitted. Patients can be enrolled in insurance coverage, with informed consent on its availability and limitations.
- Any complications during or after the surgery/procedure must be managed free of cost.
- Live broadcasts are recommended for new procedures; recordings preferred for established or high-risk cases.
- Informed Consent: Operating surgeon/team must conduct a thorough informed consent process, explicitly explaining the educational purpose, risks and benefits, anonymity/confidentiality measures, and the patient’s right to withdraw consent.
- Conduct during Surgery:
Operating doctors must not interact with the audience during surgery to maintain focus on patient safety. Step-wise live commentary by the operating surgeon is permitted only in special situations without two-way communication. A designated moderator can provide separate commentary. High-risk procedures or those with high complication potential should be avoided for live broadcasts; edited recordings should be used instead.
- Ethical Considerations:
Patients should not incur any charges related to the surgery/procedures, including implants, medications, disposables, and procedures. Post-operative care must be provided by the operating surgical team. Patient identity must remain confidential. All procedures must strictly adhere to established standard operative procedures.
D. Responsibility:
- Organizer: Responsible for patient safety, confidentiality, and welfare; must obtain explicit, informed, written consent; and ensure adherence to ethical guidelines and data privacy.
- Surgeon: Responsible for professional and ethical standards, prioritizing patient welfare, and being involved in pre-operative, PAC, and post-operative treatment for at least 24 hours.
E. Prior permission of Regulatory Body:
Prior permission from the relevant regulatory body/Association/institution is mandatory. Approval must also be sought from relevant authorities based on the hospital’s sponsorship (Dean for government hospitals, State Medical Council for private hospitals). An apex committee will oversee arrangements for compliance, and professional associations should self-regulate against promotional activities.
F. Additional Recommendations:
Live broadcasts must strictly serve educational purposes and not commercial gain or promotion. Surgeons should avoid glorification; the focus must remain on surgical techniques and patient care. Stringent regulations and insurance coverage should address complications and risks. Recordings are preferred for general educational use in closed groups. Live demonstrations should be reserved for vetted new procedures, with unedited recordings preserved for at least two years (in case of litigation).