From rural Gujarat to financial capital: How the kidney racket flourished

So are Chatterjee, hospital director Anurag Naik, nephrologist Mukesh Shete, and urologists Prakash Shetty and Mukesh Shah. All five doctors are now out on bail.

Over a month since the transplant was stopped, what has unfolded is a series of illegal kidney transplants at the hospital, four of which are already under investigation. The hospital ranks second, next to Hinduja Hospital, in the number of live kidney transplants in Mumbai — it conducted 27 live kidney transplants this year, 48 in 2015 and 41 in 2014. The transplants escalated especially after social worker in the medical field Nikhil Kamble — now an accused — joined the hospital in 2014 as its main transplant coordinator. He even won a Zonal Transplant Co-ordination Centre award for his work in organ transplants. After his arrest, police found Rs 8 lakh in his house, the fee he allegedly charged for clearing forged documents at Hiranandani hospital for Jaiswal and Shobha, who had presented themselves as husband and wife.

With this, 116 kidney transplants handled by Kamble since 2014 may come under scanner.

***

While the cleverly laid-out racket ends at the niche private hospital, it begins in a much contrasting setting of rural India.

Early last year, in the Nadiad village of Kheda district in Gujarat, 45-year-old driver Yusuf Shah had considered approaching his friend Ghanshyam more than once, but could not summon the courage to do so. Finally, when Shah’s economic condition nosedived after his truck got stolen, coupled with the responsibilities of his wife and aging parents, the allure of earning a few lakhs could no longer be resisted. “I know you have donated your kidney for money. I am in desperate need of money and want to donate my kidney too. Please help me,” Shah is alleged to have asked Ghanshyam last year. His friend quickly handed over a piece of paper that had a mobile phone number. It had the number of a man who the Mumbai Police suspect has been arrested twice in the past, once for his alleged involvement in a kidney racket in Gujarat in 2007 and another time for a similar 2008 case in Madhya Pradesh.

Shah was subsequently arrested as an accused in the racket.

The entire kidney racket, says a police officer, feeds on the desperate times of people. Most donors would be people like the driver who lost his truck, a domestic help like Shobha Thakur who has to support five children, migrants from UP and West Bengal struggling to make a living — such as the donors in the Apollo kidney racket busted in New Delhi — or thousands of debt-ridden farmers and impoverished tea garden workers reportedly duped by T Rajkumar Rao, the alleged kingpin of the Delhi racket.

The will to sell off one’s kidney, however, is not the only factor that determines if you can donate a kidney. It should be further backed by your health. After a prospective donor decides to sell kidney, and gets in touch with the touts, the agent gets his or her blood test done, says a senior officer with Mumbai’s Powai police station who is overseeing the Hiranandani case. In the case of Yusuf Shah, says the officer, he was called to a forlorn garden in Ahmedabad in January last year by the agent whose number was on the paper.

Shah was asked to get a blood test done. A week later, however, he received a call from the agent asking him to come to Delhi for another test. “He said that along with him there were several people from Gujarat who had come to Delhi for the blood test,” says an officer. “After taking my blood test, the agent kept saying ‘kuch gadbad hain (something is wrong)’. When I enquired with him, he did not answer. After my blood test was done, I returned to Gujarat,” Shah is said to have told the police.

“If there are any medical issues with the donor, like high sugar, they are rejected and cannot donate kidney,” says the officer. Shah told the police that he kept calling the agent for nearly six months but was told every time they would call him once he found a “party”. In November 2015, the agent reportedly called him and informed him about a “Baroda party”. The “deal”, however, could not go through since Shah had high sugar. “Upset, I returned home and decided that if not me I would get my wife Rashida Bano to donate her kidney,” Shah has told the police.

In April last year, Shah approached Ghanshyam once again. This time round, Ghanshyam gave him the number of one ‘Sandeep’, which is suspected to be an alias for Bhijendra Bhisen who had been arrested by the Mumbai Police as the kingpin of the 2007 kidney racket. “I spoke to Sandeep on the phone. He told me to come to Mumbai Central station. This time, I also took my wife along and got a few tests done. Within 2-3 days, they called me up and said my wife could donate her kidney. They said my name would be ‘Bharatbhai’ and my wife’s ‘Rasilaben’. Documents showing our identity had been made. Finally, on May 2, I got my wife to Hiranandani hospital in Powai where her kidney was extracted for another woman. Sandeep later paid me Rs 3 lakh following which we returned to Gujarat,” Shah has said to the police.

According to an officer, while Shah returned home quietly as he was paid the money, kidney rackets are busted mostly because the donors are promised anywhere between Rs 3 and 5 lakh and given a few thousands only. “The normal practice is to pay around Rs 30,000 only,” says inspector Dinesh Kadam, who had probed a similar racket in Mumbai in 2007. It is these aggrieved donors, who after realising that they have been duped, approach the police. The agents believe most of these people will not approach the police fearing arrest, according to the police.

Two women who heard about Rashida having sold her kidney for Rs 3 lakh approached Shah who then became a middleman and informed Sandeep about them. Shobha, whose case unravelled the scam, was one of the two.

A native of Anand, Shobha was in debt and earned a meagre income through house chores. Her husband does little work. When she saw the prospect of paying off her loan and earn some extra bucks, she readily accepted the offer to give away one of her kidneys.

“This is how the network of donors operates: word of mouth. Be it anywhere in the country, the donors mostly come from particular pockets where donating kidney for money is an open secret,” says a senior police officer. He adds, “In this particular case, the Nadiad village from which Shah hails is one such hub. Once a person donates a kidney, it travels through the grapevine. Soon, those in financial crisis who find the offer too good to be ignored, approach this donor, who now becomes a middleman and links the prospective donor to the agent.”

While agents are always on the lookout for prospective kidney patients, sometimes it is also the patients who are looking out for such options. Jaiswal, who was slated to receive Shobha’s kidneys, says he has two sons, brothers and an ill wife and none was able to donate their kidney to him. He stopped working a year ago in Surat due to a failing kidney while his wife visited temples and babas for a cure.
“One day she was crying about my health in front of a lady in our building. The lady told us about an agent who could help,” says Jaiswal, speaking to The Indian Express.

He came in touch with two agents in Surat — Sandeep, who brought Shobha on board, and Mukund. They assured him a transplant “was possible in Mumbai”. Earlier this year, Jaiswal claims, he was first taken to a Mulund clinic to consult a doctor and later admitted to Hiranandani hospital for treatment. He had been on dialysis for over one and a half months before fake documents could be prepared to show Shobha as his wife ‘Rekha’ and his son Kisan as his brother-in-law.

***

For a live organ transplant to be approved, a set of 16 documents are listed as necessary under the Transplantation of Human Organs Act, 1994. These include a notarised letter and approval of the state government-appointed officer. Once the documents are approved by the hospital’s transplant coordinator, a local authorisation committee set up by the hospital interviews the donor, the recipient and a witness, which is video-recorded. The aim of this interview is to confirm the relationship between the donor and the recipient.
The probe in the Hiranandani case finds “negligence” on part of the six-member local authorisation committee in the Hiranandani case. The video-recording of Thakur, Jaiswal and Kisan shows a feeble question-answer round between them and the hospital’s four panel members.

“Where do you stay,” the doctor asks.

“Malabar Hills, Napean Sea Road,” Jaiswal replies.

When Shobha is called in separately and asked the same question, she says, “Malhar Hills.”

“Theek se batayiye (Say properly),” says a panel member, to which she laughs nervously and replies, “I am from a village, sir.”

All three were questioned for less than 15 minutes. Simple questions such as their age, if they knew the cost of the transplant procedure, medical care required, Jaiswal’s business, were asked.

Discussing the need to now lay down a lengthy format for the question-answer round to establish that the donor and the recipient are indeed related, Maharashtra state organ transplant in-charge Dr Gauri Rathod says, “The questions should be more difficult, like name of the wife’s mother or in which bank do they have their accounts in. Through the video, we could tell the donor and the recipient had been tutored well and they seemed to know what type of questions to expect.”

Rathod says duties of the transplant coordinator do not require extensive paperwork for donor and recipient. “It is a nephrologist’s job. Why was the coordinator doing it.”

In Delhi’s Apollo Hospital too, an advisory committee has been formed to look into the current matter. The hospital has invited eminent jurist Justice Shri Mukul Mudgal, former chief justice of the Punjab and Haryana High Court, to be part of the committee.

“The committee is reviewing the current transplant procedures closely and are going to give recommendations to further strengthen the approval process,” says a hospital spokesperson.

So far, the hospital states a personal staffer of the transplant doctor concerned has been arrested in the case.

While Apollo hospital did not face a suspension in performing organ transplants, Mumbai’s Hiranandani did. In a desperate attempt to enter the transplant scene again, it is now internally evaluating each kidney transplant to look for possible forgery.

“This episode will shake people’s belief in transplants,” says nephrologist Dr Rajesh Kumar, attached with Hiranandani hospital.

Preliminary examination of 32 kidney transplant cases done by Hiranandani Hospital shows how minor discrepancies were overlooked while approving transplants.

“In another transplant on July 14, we noticed varying accounts of the father, the son and the mother. One said son is on dialysis for six months, other said one year and third said two years,” Chatterjee had admitted weeks before his arrest. This particular kidney transplant, apart from two others, is now under the police scanner.

The Directorate of Health Services in Maharashtra has also been asked to participate in the probe. “We have asked the police to check the call record details of the urologists and the nephrologist to see if they are involved in the racket,” says a senior DHS official.

In Maharashtra, a new set of recommendations are under way, which suggest biometrics and Aadhar card linkages mandatory for confirming an individual’s identity.

“We will have to spoon-feed them about all protocols. Hospitals don’t even have a copy of the transplant Act,” rues organ transplant in-charge Rathod.