6 months after a national registry for organ and tissue donation was launched to make donations transparent, last week’s revelations about a kidney racket in Delhi showed that clean-ups were unlikely to work while the market for out-of-turn allotments remained alive. ABANTIKA GHOSH looks at the rules of kidney transplant, and how and why they are repeatedly subverted.
Who is legally allowed to donate an organ in India?
Organs and tissue transplants are governed by the Transplantation of Human Organs and Tissues Act, 2011. Organs can either be retrieved from cadavers or from brain dead patients with family consent, or may be donated by living donors. The law recognises three types of living donors: near relatives like parents, siblings, grandparents, grandchildren or spouses; others who can donate for “affection and attachment” or for a special reason but not for financial considerations; and swap donors where near relative donors are swapped between patients whose own family members are incompatible. (For example, if a husband is willing to donate a kidney to his wife but is not compatible, he can do so to another patient, provided a near relative of that patient is compatible with his wife and can donate a kidney to her.)
Who monitors the kidney donation process?
An elaborate set of documentation is required, apart from the usual compatibility test, psychiatric evaluation, etc. The documents include affidavits with photographs of both the donor and the recipient, verified by a magistrate. There are in-camera interviews. Two separate committees for related and unrelated donors evaluate and clear cases. The committee that looks at procedures involving related donors comprises hospital staff, but people who are not part of the treating team. For unrelated donors, there are, in addition, two nominees of the government who evaluate the cases. In November last year, a national registry for organs and tissue donations — currently limited to hospitals in Delhi and NCR — was launched to make the process transparent. Patients need to register there and would be given an organ depending on availability regardless of their financial or social status.
How was the donations registry bypassed in the alleged kidney racket at Delhi’s Apollo Hospital?
The police are still investigating, but it appears that two assistants of the transplant surgeon in the hospital drew up elaborate fake documentation and got donors for patients who were willing to pay for the organs. “We are doctors, not an investigating agency. We have to go by the documents that have been placed before us. We do not have the wherewithal to check their veracity,” says a senior transplant surgeon. While that may be a valid argument, what nobody seem to be talking about right now is that for something like this to have happened in one of Delhi’s — and India’s — best known private hospitals, the institution too would need to answer a few questions at some point.
So, what are the loopholes in the organ transplant law?
For a long time, kidney racketeers have exploited the provision that allows an unrelated person to donate out of love and affection. Enterprising and unscrupulous elements have managed to bypass norms, all of which, experts say come from the one basic problem: the perpetual shortage of organs. The huge demand-supply gap has fuelled a murky black market in organs.
But why is there a shortage of organs?
The cadaver donation programme has been a virtual non-starter. The large numbers of road accident victims can, for example, provide a steady supply of organs — but that does not happen because of the lack of a consolidated programme and lack of awareness. Families of brain dead patients are reluctant to give organs. According to data available with the Indian Transplant Registry, a non-government effort supported by the Indian Society of Organ Transplantation, of the 21,395 kidney transplants that have happened in the country since 1971, only 783 came from cadaver donors. According to figures available with the Ministry of Health, the annual requirement of kidneys could be in the range of 1-2 lakh, while the number of transplants that happen every year is just about 5,000.
Have there been kidney rackets in the past too?
Yes, several, the best known being the Gurgaon kidney racket of 2008, whose alleged kingpin Amit Kumar was arrested from Nepal. Kidneys from poor people from western Uttar Pradesh were transplanted into rich patients from the United States, United Kingdom, etc. for large sums of money. In the early 2000s, there was the Amritsar kidney scandal said to be worth Rs 150 crore, in which poor people were lured into donating their organs, with fake documentation covering the trail. Last year, Hyderabad Police busted a kidney racket by arresting a Shirdi-based doctor for selling a “kidney package” for Rs 30 lakh, arranging donors, and taking patients abroad for surgery. In Jalandhar, a terror alert led to the unravelling of a kidney racket last year.