Asia-Pacific, Civil Society, Development & Aid, Headlines, Health, Human Rights

HEALTH-INDIA: Will To Stop Live Kidney Sales Missing

Praful Bidwai

NEW DELHI, Feb 8 2008 (IPS) - The arrest of Indian kidney transplant racketeer Amit Kumar alias Santosh Raut has lifted the lid off a huge well-ramified illicit international organ trading ring with operations running into billions of dollars across several countries.

Kumar, who was tracked down in a resort in neighbouring Nepal on Thursday, has been absconding from the law since Jan. 24, when the police raided his clinic in a Delhi suburb and arrested his associates. He is thought to have been responsible for some 600 illegal kidney transplants.

The global kidney transplant racket is one of the most obnoxious manifestations of North-South inequality and of the repugnant practice of stealing organs from the poorest of the poor in the Third World, usually for patients in rich countries suffering from end-stage organ failure.

India is a major source of organs sold in the illicit international bazaar. Donors are usually induced into selling a kidney – for as little as 1,000 US dollars to a maximum of 2,000 dollars – just to survive.

The bazaar itself is highly evolved, with extensive cross-border transactions and a hierarchy of preferences and prices.

Thus, kidneys from South Asian countries, the Philippines and much of sub-Saharan Africa are sold for as little as 1,000 – 2,000 dollars according to a medical professional who has tracked organ trading, but who insisted on anonymity.

“A Romanian kidney goes for 3,000 dollars,” he says. “A kidney from Turkey costs 10,000 dollars plus. Mexico, Brazil and South Africa fall in between. These base prices are marked up by middlemen, and further jacked up by the high fees that unscrupulous doctors charge.”

The source adds: “The recipient can end up paying anything between 35,000 and 125,000 dollars for kidney donation, including hospital stay and operation charges.”

Trade in human organs poses a series of ethical and practical challenges to the medical profession, healthcare regulators, governments and the larger public.

But it also opens an opportunity for investigative and oversight agencies to develop innovative methods to track down and bring to justice those who profiteer on the backs of the destitute.

Kumar has been conducting his ghoulish business, since 1994, from numerous facilities spread across India’s national capital region. Earlier, he was based in the central Indian city of Nagpur and in the western metropolis of Mumbai.

According to the police, multimillionaire Kumar was not a surgeon or physician trained in mainstream modern medicine. He had a degree in the traditional Ayurvedic system of indigenous medicine.

His operation in and around Delhi was run on a massive scale and involved three hospitals, five diagnostic centres and 10 laboratories. Besides he relied on a network of more than 50 accomplices, including doctors and nurses, “spotters” and touts who would lure potential donors with the promise of jobs, and thugs who would force them to part with their kidneys.

The kidney donors were typically extremely poor, unemployed people from backward states like Uttar Pradesh and Bihar, who have become victims of India’s neoliberal economic policies and are often in deep debt.

The kidney recipients were nationals from several countries, including Canada, Greece and Turkey.

The racket was unearthed thanks to the initiative of an earnest young woman police officer. “But it is inconceivable that it could have been conducted for years without police collusion,” says K.S. Subrahmaniam, a scholar and former senior police officer.

Evidence suggests that Kumar evaded arrest last month because he was tipped off by the police. According to one of his chauffeurs, he was arrested some years ago in Delhi with a surgeon who collaborates with him, but was let off upon paying a bribe of Rs 1.8 million (45,000 dollars).

What demarcated Kumar’s operation from the kidney trade which flourishes in many Indian cities, including relatively prosperous Chennai, is the use of muscle power against the donors. Typically, extreme economic distress compels poor people to sell their body parts.

But Kumar’s goons would abduct and illegally detain their dirt-poor victims, and drug them or beat them into agreeing to the removal of their kidneys.

“This outrageously criminal angle only highlights the gravity of the failure of the police in enforcing the law of the land,” adds Subrahmaniam.

Besides flagrant corruption, the kidney scam underscores the dysfunctional state of India’s regulatory systems and laws in respect of healthcare and medical ethics. Thus, Kumar could operate his hospitals and clinics in different cities without registering them.

“Some recently passed laws do mandate the registration of such facilities in some states,” says Dr Subhash Gupta, a gastrointestinal and liver transplant specialist at Delhi’s Indraprastha Apollo Hospital. “But there are few inspectors, and the concerned agencies don’t bother to implement the mandate.”

Professional self-regulatory bodies like the Indian Medical Council concern themselves only with the registration qualifications of physicians formally trained in mainstream medicine.

However, an estimated third or more of all self-styled medical professionals or healers in India belong to other streams, including Ayurveda, Unani medicine and homeopathy. They escape the regulatory net altogether.

Voluntar organisations like the People’s Health Movement and Medico Friends’ Circle have long complained of the absence of authoritative medical practice guidelines.

Again, India’s state-level food and drug administrations are notoriously weak, ill-equipped and understaffed. They only inspect a minuscule proportion of pharmaceutical factories or chemists for quality.

Virtually anyone who calls himself a doctor can prescribe a range of medicines and be reasonably confident that the chemist will sell them. This is true even of drugs that can only be sold on the recommendation of a qualified medical practitioner.

In 1994, India enacted the Transplantation of Human Organs Act (THOA), which illegalised the sale of human organs and facilitates organ donations from the brain-dead (cadaverous transplants). But it came years after illegal transplants had become established.

The Act allowed organ donations by close relatives without government clearance. But all other relatives or strangers who wish to donate must be cleared by an expert Authorisation Committee.

In practice, such committees are rarely formed before a potentially illegitimate transplant is carried out. THOA also has a big loophole. It dispenses with prior approval if the donor feels “affection” or “attachment towards the recipient”. This is so vague as to permit extensive mercantile abuse.

In India, like in most other Third World countries, the donors’ consent is typically secured through coercion or under extremely exploitative and unequal conditions. It cannot be remotely termed free or informed.

The donors are usually quickly discharged without being warned of risks from their surgery. There’s no follow-up treatment, nor any attempt to monitor if the remaining kidney malfunctions. Many donors end up ill and even more destitute.

The medical profession’s involvement in the organ trade racket betrays the Indian elite’s contempt for human life and the principle of inviolability of the human body, which is fundamental to any civilised society.

This view justifies the raiding of flesh-and-blood people to steal their vital but non-regenerating organs. It places an abysmally low value on the bodies of vulnerable people and accepts their ‘cannibalisation’.

The Indian medical profession has long been complicit in all kinds of malpractices, including female foeticide, leading to “27 million missing women” through a falling sex ratio. But only 66 cases have been registered against doctors for sex selection, so far.

“Yet, there is a smart way of detecting and zeroing on clandestine organ transplants,” says Dr Gupta. “All transplant recipients are given immuno-suppressant drugs, such as cyclosporin, tacrolimus and mycophenolate. These are only made by a handful of companies like Novartis Roche and Panacea, which know exactly which hospitals/clinics order them.”

If the Indian government and its police agencies muster the will, they can easily track, monitor and raid these centres of crime, said one conscientious doctor.