HEALTH-INDIA: Whose Kidney is it Anyway?

By IPS Correspondents Reprint | | Print |

Dev Raj

NEW DELHI, May 24 1998 (IPS) - When Ashok Gupta bought himself a kidney earlier this year, he thought the purchase would give him a reprieve on life. He never reckoned on his doctor getting arrested or the possibility that he would wind up in jail.

Because no other doctor will give him post-operative treatment – as that would be illegal – Gupta (not his real name) now believes getting arrested might not be such a bad idea. “At least I may get to consult my doctor there,” he says.

Like the 200-odd patients who received kidneys from live donors at the Noida Medical Centre (NMC) a large private hospital situated across the border in neighbouring Uttar Pradesh state, Gupta is on immuno-suppressant drugs which prevent his body from rejecting the kidney. But immuno-suppressants make Gupta wide open to infections. He needs powerful antibiotics and regular shots of Interferon, a drug which helps prevent the development of cancer. And he also needs re-dialysis to lessen the load on his new kidney.

A fairly well-to-do businessman, Gupta says he can afford the 400 dollars worth of treatment he needs every month to stay alive, “but I desperately need to consult Dr. Sanjay Wadhwan, my doctor.”

Gupta’s troubles began after the police raided the private hospital earlier this month and arrested Dr. Wadhwan and the surgeon who performed the operation, Dr. Harish Johri. Police also took into custody eight other people, including the directors of the hospital after a donor complained that he had been duped into parting with one of his kidneys.

Ever since the Human Organ Transplantation Act (HOTA) came into force four years ago, trading in kidneys became illegal and stiff penalties were prescribed for doctors and surgeons found involved in organ transfers from live donors.

There are gaping loopholes in HOTA. For one thing it is a federal law which, to be effective, has to be extended to individual states. It is still inapplicable in Uttar Pradesh, India’s largest state, where the NMC is situated. Police cracked down on the NMC because one of the ‘donors’, Shaukat Ali, formally complained that his kidney was “stolen” by NMC doctors after he was lured there by touts and the doctors rendered him unconscious.

The Indian Medical Association (IMA) has been quick to defend the arrested doctors. Its secretary general, Dr. Prem Aggarwal, says it is scientifically impossible to ‘steal’ anybody’s kidney. “It is more likely that the seller did not receive adequate compensation for the deal,” he says.

Dr. Aggarwal says it is an open secret that commercial transactions take place between patients suffering end-stage kidney failure and desperately poor people who are willing to sell one for a price.

According to official estimates, in a country like India, some 100,000 people end up with kidney failure every year and are put on dialysis if they can afford it. Barely a thousand of them can expect to find a suitable kidney harvested from a cadaver donor as prescribed by HOTA.

Theoretically, with an average of 100 accidental deaths occurring every day in Delhi alone, something like 200 harvestable kidneys should be available, says Dr. Ramesh Kumar a nephrologist. “But because of poor infrastructure and lack of public awareness the organs are wasted.”

According to Dr. Kumar, the retrieval of two kidneys from a single cadaver could mean sparing the lives of three. “While two patients can get a kidney each the dialysis machine becomes available for a third.”

It is now becoming painfully apparent that HOTA is more suitable to developed countries than to India, which does not have a computerised national roster of patients needing kidneys and other organs which can be retrieved from cadavers.

Apart from serious infrastructural problems starting with a shortage of ambulances, few doctors dare ask relatives of people who have died in accidents if they can remove a kidney or other organ. “The government never mounted a campaign to make organ donation popular,” Kumar says.

What HOTA succeeded in doing was to drive the kidney trade underground and make the cost of a live donor transplant more expensive because touts simply factored in the legal risks to doctors, hospital owners and to themselves. On the other hand, HOTA came into being because India was fast turning into a kidney bazaar with renal failure patients flying in from developed countries like Japan, Germany and the Middle East looking for cheap kidney transplants.

Sandeep Guleria, a leading transplant surgeon at the All-India Institute of Medical Sciences (AIIMS) says “at the rate at which kidneys were being removed, a substantial number of India’s poor was in danger ending up functioning on one kidney.”

Guleria is not exaggerating. A suburb of the southern Indian city of Chennai has been renamed Kidneyvakkam (Kidney Town) because most of its able-bodied men and women have sold away one kidney to collect 1,000 dollars that the bean-shaped organ fetches the donor. The touts, nursing homes and doctors, however, skim away large fees.

The going rate charged a foreigner for a package which includes the organ, its transplant, and medical charges, works out to around 50,000 dollars. Nursing homes are even known to insist on offshore payments from foreigners in hard currency.

With a cadaver-based transplant programme yet to take off in this country, doctors’ associations like the IMA have begun pleading for a more ‘realistic’ approach to kidney transplants on behalf of patients who would otherwise die.

“What is required is a gradual phasing out of commercial donations and better compensation for the donor,” declares one IMA member.