An official from the famous Fortis hospital, a doctor from a prominent Delhi one, a Turkish client, and a poor man's kidney. While this seems to be an eclectic bunch, they're together for all the wrong reasons.
Last month, the UP police sent notices to the Fortis Hospital, and over a dozen leading private surgeons, putting them under the scanner for an illegal kidney racket that potentially runs across hospitals, states, and even countries. The police even arrested 13 people, including the CEO of Pushpawati Singhania Research Institute (PSRI), Dr. Deepak Shukla, with over 10 accused taking his name in relation to the racket.
While the investigation labours on, it is easy to understand the origin of the racket. The demand for kidneys in the country simply dwarfs the availability of the same. Dr. Sunil Shroff, managing trustee of the Mohan Foundation, a Chennai based NGO working on organ donation says "In India, around 200,000 people need a kidney every year, but only around 3% of the demand is met. There is a demand and supply problem. Of these 200,000 in need of a kidney, around 15,000 can afford treatment but only 7,000 of these can afford transplants." The potential to make a profit of up to 70% on each kidney, and with everyone from the doctors, lawyers, gangs, middlemen and the poor donors getting a cut, ensures that the illegal kidney trade continues to thrive in the country.
With trading in illegal organ trade punishable by imprisonment of 10 years or a fine up to Rs. 1 crore and the Transportation of Human Organs and Tissues Act regulating organ donation, how exactly is the illegal kidney trafficking continuing to be a menace?
The trade flourishes on the simple fact that it is, at least in theory, a win-win for all parties involved. The donors are usually people from poor backgrounds, who agree to sell their kidney for money to pay off their debts, support their families, or simply survive. Donors are generally offered around Rs. 2.5- 5 lakh, which may seem a lot, but considering that the going rate for a kidney is Rs 70 lakh – Rs. 1 crore, depending on your urgency to acquire one, the actual donor seems to be getting the short straw when it comes to remuneration. Even when the donation is voluntary, the poor donors talk about the struggles they face post-donation, citing lack of full payment, a threat to life, and health complications as some of the issues faced by them. The donation is not always voluntary though, with people from rural areas brought to the city under the false promise of employment, and then under the pretext of a medical check-up, have their kidneys illegally harvested without their knowledge. Sadly, the human trafficking racket boosts this practice, with several instances reported wherein the dead bodies of missing persons were found without their vital organs.
However, the availability of a donor, legal or not, is not enough. With the Transplantation of Human Organs (Amendment) Bill restricting donations to ones made by family members only, there is a full network of technicians, doctors, and middlemen operating in the shadows, bypassing the laws that prevent organ trade in the country. Doctors, both real and ones possessing fake degrees, carry surgeries while middlemen procure the donors and systematically forge the documents to project the donors as family. The donors are even trained for interviews that are scheduled with the necessary boards and authorities and housed in guesthouses until it is time for surgery. The culture of bribing, corruption and profiteering at the expense of others and a clear lack of importance given to ethical considerations in India further aggravates the situation.
While the suffering patients also indirectly contribute to the racket, there's no market if there's no demand, it is very difficult to blame them. At any given point in India, about 3- 3.5 lakh patients are looking for organ donation, with patients claiming to be on the donor waiting list for years. Many have died on the bed waiting for a donor, which eventually pushes the patient's loved ones to look at alternate sources. The fact that the country does not have a national registry of patients waiting for cadaveric organs, nor a well-formulated plan for potential organ donors furthers weakens the legal donation route. If your loved one is fighting for her life, and you have the financial means to procure a kidney from the black market, you're bound to do so.
So what can be done to improve the situation? Organ donations could be met if the country taps into the pool of people who are brain dead and promote organ donations. According to figures published in the medical journal Indian Journal of Anaesthesia in 2013, of the 205 patients declared brain dead at the AIIMS Trauma Centre in the past five years, only 10 became potential organ donors. "So many accidents happen in the country. Out of those, several people have brain injuries. We need to tap this pool. If this happens, we may not even require living donors," says Dr. Shroff. Spreading awareness about organ donations and having a well-structured donation process in place can further reducing the black marketing of organs.
The situation looks to worsen in the future as more and more people continue to be diagnosed with kidney diseases. A study conducted by AIIMS in Delhi stated that approximately 1,500 in a million people in India have chronic kidney diseases and around 350 to 400 people per million population have end-stage renal disease. Simply put, the number of people requiring a kidney transplant is going to rise rapidly in the future. If organ donation is not controlled, its ill effects could spill into a variety of areas, with it affecting human trafficking, healthcare, exploitation of the poor, etc. and that surely won't be a pretty sight.