In India, organ donations involving monetary transactions are illegal. Yet, news about kidney black-marketeering is common, the outrage involving poor, illiterate patients duped of their organs for paltry sums of money, or cash-strapped donors parting with their kidneys in exchange for meagre compensation. Such largescale scandals highlight the economic disparity in the country. However, another widely prevalent skew in kidney donation — gender disparity — is just as shocking when the bald numbers are scanned.
Doctors at Narayana Health, a large Bangalore-headquartered hospital chain run by well-known cardiac surgeon Devi Shetty, found that an overwhelming 65 per cent of kidney donors in its hospitals are women, whereas 70 per cent of kidney recipients are male. Kidney donation is a medically proven safe process that has no bearing on a person’s lifespan. Yet, a combination of economic, social and cultural factors, as well as coercion, tilts these statistics against women.
The pressure on the woman to donate her organ is so extreme that, in order to rescue the reluctant woman, nephrologists like Vincent Lloyd, head of department and senior consultant, Nephrology, of Narayana Hospitals, are sometimes impelled to summon the family and state that the woman is “medically unfit” to make the kidney donation. When a woman confides in the social worker or doctor that she is being forced to donate her organ against her will, doctors have learned to come up with reasons on the unsuitability of the particular donor.
Both men and women are equally susceptible to renal disease but of every 100 kidney transplants that Narayana conducts, 65 to 70 donors are women and 70 recipients are men, says a recent study released by its nephrologists. Voluntary kidney donations are classified “altruistic” but are neither voluntary nor altruistic in some cases. The numerical pattern weighing against the female gender predictably repeats in other hospitals, including in corporate hospital chains catering to the well-heeled, not just in Bangalore but in cities across the country. The predominant donor is the wife of the recipient but other female relatives, such as sister, mother and grandmother, and even mother-in-law, are called into the equation to give a new lease of life to their male relatives.
“The pressure is much more when the women are uneducated, financially dependent, living with their in-laws and having no financial or other support from their parents’ side,” says Lloyd. If the woman is young, employed and has the support of her parents, she could stand up and refuse the organ donation, but such cases are rare, he said.
The social and familial pressure on women to donate is immense. The pressure stems from women feeling more responsible for the welfare of the family. Mothers and sisters counted for the most frequent donors after the wives. Role compulsions such as “My husband/ brother/ son is more important than me” create pressure, and cultural stereotyping of the sacrificial role played by the wife/ mother/ sister plays an important role in the woman’s “altruism”, says Usha Bapat, a psychiatric social worker who has worked for decades in the field of renal transplants at St John’s Hospital and is now a consultant at Jain Hospital. “It is culturally ingrained in Indian women that they have to sacrifice,” says Bapat. She knows of divorced, widowed or otherwise financially dependent women feeling obliged to repay their families by donating their kidneys.
It all boils down to the social complexities that Indian women have to live with, says Narayana’s Lloyd, which felicitated five kidney donors this week, all women. In some renal transplant programmes in India, women outnumber men as kidney donors by a ratio of 6:1, he said.
Narayana wants to raise awareness on this by collating and disseminating the numbers. In general, gender inequity is widely prevalent in India when it comes to access to medical care. In complicated diseases like renal failure, men are much more likely to arrive at hospitals to receive medical attention than women. Even if diagnosed, women fail to show up for treatment because kidney haemodialysis is an expensive process. That also makes women less likely to receive dialysis treatments, and gives them even slimmer chances of receiving renal transplants. For instance, studies in neighbouring Andhra Pradesh show worse trends for women in both dialysis and transplants.The only exceptions are in the case of the kidney sale scandals. Here, a majority of the donors are men and a majority of the recipients too are men.
Women who confide their circumstances to social workers during personal interviews fear lifelong repercussions for refusing to donate their organ. “We have to deal with this very delicately,” says Bapat. So that she does not get blamed and shamed for the rest of her life, the woman declares in front of the family, “Oh, I wish I could have given my kidney.”