The Body Shop

The Gurgaon organ trade scandal, where hundreds of poor labourers were tricked into selling their kidneys, is only the latest example of a sordid practice that continues to plague India. Up to the early nineties, India was the organs bazaar of the world. Despite the poor medical outcomes, affluent citizens, mostly from the Gulf countries, would shop for kidneys in the urban shanty towns of Mumbai, Kolkata and Chennai, before the Transplantation of Human Organs Act in 1994 criminalised the practice, creating an even larger black market. The fact remains that lakhs of people suffer from end-stage renal disease every year, and have to get either highly expensive dialysis treatment or get a kidney transplant. The vast gap between demand and legal supply donations from family membersforces many patients to rely on the kind of racket plied by 8216;Liberty Healthcare Pvt Ltd8217; in Gurgaon.

Now, the health ministry is considering a policy U-turn. Realising that regulation is a more viable solution than outright banning, they want to modify the Act, to simplify transplantation and help fill the gap between demand and supply. They will concentrate on harvesting healthy organs from brain-dead patients and educate the poor on organ trade. While there is no question that these cadaver-based organ donations are the humane option, the government has not managed to get its act together on this so far. We don8217;t even have registries on organ transplants, and people do not know that this is an option. The Spanish model, for instance, presumes consent for transplant, unless the family officially objects. They also have transplant infrastructure and procedures solidly in place. But like eye transplant campaigns have managed to make an emotional appeal, cadaver organ donation also needs a sustained awareness campaign.

This said, the underlying question about medical and mercantile uses of the body remains open. While blood, sperm and ova are available on the market, internal organs like kidneys that do not replace themselves, present a bioethical dilemma. Some feel that setting a market price for these is almost like cannibalising the poor, whose bodies have least value. Treating organs like spare parts to be bought and sold on the market is an ethically fraught issue; and no matter how 8216;educated8217; the poor are, their choices are not free or autonomous. What8217;s more, after selling their kidney, can they afford dialysis or transplants themselves if their remaining kidney fails? Either way, this transaction between desperately ill buyers and desperately poor sellers should not be ghoulishly exploited by middlemen and brokers, and policy reform is the first step.