Kidney Black Market Alive And Well

by Ranjit Devraj

The National Human Rights Commission, a statutory body, was acting on a complaint filed by former federal law minister Ram Jethmalani and other human rights activists, who said that impoverished people were selling their kidneys to stave off starvation.

The commission also took notice of a number of media reports that spoke of a revival of the kidney trade across India in recent months.

On Jan. 11, police in western Punjab state arrested Parveen Kumar Sarin, a leading transplant surgeon, who according to police arranged for thousands of kidney transplants by conniving with O. P. Mahajan, chairman of the state's 'authorisation committee' that must approve all kidney donations among unrelated people.

Mahajan, who has been suspended from his job as principal of the Punjab Government Medical College, had, according to police, facilitated kidney deals worth at least $30 million. Many of the organs were sold for high prices to foreigners, they said.

According to Vijay Pratap Singh, police chief in Amritsar, police in Punjab have been on the alert for an international racket in kidneys ever since the de registration by the General Medical Council in Britain in August of a doctor of Punjabi Indian origin, Bhagat Singh Makkar, for alleged involvement in the trade.

Makkar was trapped in a sting operation by journalists from the 'Sunday Times', who produced tapes in which he was shown offering to arrange for transplants and showed a "reprehensible disregard for the interests of potential donors who, you indicated, would be Asian".

When the Indian Parliament passed the Human Organs Transplantation Act in 1996, there was reason to believe that it would curb a flourishing export trade in kidneys that had earned India notoriety as 'kidney bazaar' to the world.

The act, which dealt with all transplantable organs, banned unrelated donors unless authorised by a special committee such as the one Mahajan headed and also sought to promote a cadaver based program through the building of a national 'organ bank'. But

S. Tamboli, president of the voluntary Organ Transplantation Society of India, which has been trying to get the government to implement cadaver based kidney donation programme, said the act was never followed in spirit and that the trade continued as before.

"The trade is worth millions of dollars and kidney patients in affluent countries like the United Kingdom, Germany, the oil rich Arab countries and Canada and Japan always found India with its fine medical facilities on the one hand and poor people on the other an attractive place to shop for kidneys," Tamboli said.

Soon after the act was passed, kidney racketeers lay low for a while and resorted to sending donors on "guided tours" overseas, where they were deprived of their kidneys and then sent back to India where they could collect their payments.

Tamboli said part of the reason for the revival of the trade was the attitude of the powerful Indian Medical Association (IMA), which tended to rally around doctors who, in spite of the passage of the act, continue to be involved in the kidney business. At times, the association has even tended to justify the kidney trade as a lifesaver for well heeled clients.

After the arrest of Mahajan and Sarin, R.. C Garg, president of the Punjab branch of the IMA, demanded that an amendment to the organs transplantation act that would make the sale and purchase of kidneys legal. "What other option does an end kidney failure patient have?" he was quoted as saying.

The Indian Medical Association recently came to the rescue of doctors in southern Kerala state who were found involved in kidney transplants. This involved two private hospitals that were found to have sourced kidneys from impoverished tribals living in the remote Idukki district.

"Were the doctors so dull as to not suspect money transactions when poor tribesmen come forward to donate kidneys to unknown patients? The IMA has succeeded in making surgeons look like idiots," said Dr. Soman, a health expert and chairman of the voluntary group Health Action by People (HAP).

Dr. Soman said that organisations like IMA, which were supposed to help the principle of 'self regulation', were in fact doing a disservice to the medical profession by trying to cover up lapses on the part of doctors and hospitals involved in the lucrative kidney trade.

The scandal broke after two tribals Kalapuura George and Paarathani Kunju were presented at a press conference by opposition politicians and told how they had been duped by middlemen. They said that they were now in poor health as a consequence of their organ donations, and had no money even to get themselves medical care.

But that is a familiar scenario. A few years ago, four doctors were arrested from a posh private hospital in the national capital after a rickshaw puller went to the police, complaining that he was paid a fraction of the S6,000 he had been promised for giving a kidney.

Samiran Nundy, one of India's leading transplant surgeons, said it is high time the government cracked down hard on doctors who were violating well established laws on organ transplants. "There can be no excuse for doctors profiteering from human misery," said Nundy.

But law enforcement in the country is so lax that independent investigations into the racket in Bangalore, capital of southern Karnataka state, showed that foreign organ recipients nowadays are flying in with donors from their own countries to take advantage of willing doctors and cheap medical facilities.