Archive for February 25th, 2008

Dire poverty fuels India’s lucrative trade in kidneys

Monday, February 25th, 2008

But sellers often lose organ only to find shame, depression after their finances fail to improve
THE TORONTO STAR, February 25, 2008
SONYA FATAH

CHENNAI, India–When Geetha Vijaya heard that a “kidney broker” was scoping out her neighbourhood looking for donors, she put her kidney up for sale. Her husband, an auto-rickshaw driver owed loan sharks about $800 and earned, at best, a little more than $100 monthly.

Burdened by daily visits from creditors, Geetha arranged for her kidney removal. On Jan. 4, 2006, after her kidney was removed at Aswene Soundra Hospital in Chennai, she collected $900 and paid off her husband’s debt.

“The money disappeared as soon as it came,” Geetha chuckled good-naturedly in her cramped one-room home in the city’s largest urban slum, Villivakkam.

Just two years after her surgery, the couple is in debt again. Suffering from dull but chronic back pain, the 31-year-old is frustrated that selling her kidney didn’t turn out to be the long-term investment she had imagined.

“At the time, I justified it to myself because of the money and because the person who got my kidney had been suffering for seven years. But now I feel sad, sometimes very low, thinking about it.”

Villivakkam, or “Kidney Vakkam,” as it has been known for decades, as Chennai’s central hub for the lucrative organ trade. Hundreds of its residents have had their kidneys removed over the years, the long scar along one side of the waistline a permanent reminder of that sale.

The kidney trade is illegal in India, but still thriving. Last month, police arrested alleged transplant kingpin Dr. Amit Kumar who had fled to Nepal after a kidney racket was broken up in New Delhi.

Kumar, whose wife and children live in Brampton, Ont., is accused of masterminding an illicit racket that transplanted more than 500 kidneys for his high-paying patients, most of whom come from overseas, including Canada.

Today, illegal kidney rings can be found across India, where 100,000 to 150,000 people suffer from renal failure every year and only 4,000 authorized transplants take place. Targeting inner-city slums and rural areas, middlemen and brokers seek out willing “donors,” offering India’s poor a quick way to escape financial debt or to bankroll a costly wedding for an eligible daughter.

Most kidney sellers approach brokers directly. But a few, like Mary Gurwadan, 35, head directly to a hospital. Gurwadan, who lives in a slum along the city’s railway line, made her way over to Pandalai Nursing Home in the centre of the city to collect the $750 she was promised. Virtually all of India’s kidney sellers live under the poverty line, eking out a living as construction workers, cycle-rickshaw drivers, fishermen and other low-paying jobs. When they fail to pay off their debts, loan sharks move in, often resorting to high pressure to get their money back.

Forced into finding quick financial solutions, thousands of India’s poor have gone under the knife happy to sacrifice a piece of themselves to resolve their financial crises. But as many have discovered, the money goes quickly. Later, there’s nothing left to sell.

“If I was given the chance again, I would never sell my kidney,” said Kalvati, 30, in Tsunami Nagar, an area in north Chennai where tsunami victims were resettled. Kalvati owed neighbours more than $250 four years ago. A broker offered her the princely sum of $2,500 but after she was operated upon at Meenaxi Mission Hospital in Madurai, he only gave her $1,000.

“Sometimes, I sit back and I think, `Why did I sell it?’” she said. “Sometimes I get palpitations thinking about it, about a decision I cannot reverse.”

Almost all of those who had sold one kidney and were interviewed for this article said they feel a deep loss, even shame, at having given up a body part to cover their debt. “Shame. Shame. Shame,” chanted one seller, chastising herself.

For those who study the underground organ trade, it’s clear that the biggest price paid by donors is the long-lasting psychological scars: Their perennial debtor status makes many of them despondent.

“What we’ve noticed is that if the true motive of donation is money, then eventually depression sets in because nothing has changed in the donor’s life and, in fact, their financial situation is worse,” said Dr. Sunil Shroff, who runs the Multi Organ Harvesting Aid Network, a Chennai-based organization that works on advocacy and on improving understanding around cadaver-based transplants.

Organ sale is illegal in India. The Transplantation of Human Organs Bill was passed into law in 1994 and strictly prohibits the sale of organs. Yet, a commercial underground industry has mushroomed because of the lack of legal kidneys.

“The problem in the kidney trade is poverty,” said Shroff.

“Kidney scams, prostitution, child labour, these are all persistent problems in India and are a response to a larger community problem. This is the larger problem of a social evil.”

The kidney trade is hardly new to India. The financial desperation that motivates most kidney sales was the theme of a popular 1980s Bollywood movie, Saheb, starring one of India’s most popular stars, Anil Kapoor. Kapoor’s character was forced to abandon his dream of playing professional soccer after he sold his kidney so his parents could afford his sister’s wedding, highlighting the tragic consequences of his sacrifice.

All of the kidney sellers interviewed for this story said they had lost part of their earning capability because of health problems.

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An extensive network makes buying kidneys `very simple’

Monday, February 25th, 2008

Although commercial sale banned, loophole in law enables `donations’ for `special reasons’
The Toronto Star, February 25, 2008
SONYA FATAH

CHENNAI, India–The transplant business is built on the nexus of doctors, government officials, hospital staff, patients, kidney sellers, brokers and lab technicians.

Together, they create the conditions under which kidneys bought from the country’s desperately poor are transplanted into the bodies of wealthier Indians and foreign patients.

A 1994 organs act strictly prohibits commercial peddling of organs. But one loophole is repeatedly exploited. Living, unrelated people can “donate” their kidney “by reason of affection or attachment towards the recipient or for any other special reasons.”

Middlemen, many of whom once sold their own kidney, fabricate tales of relationships between seller and patient to get approval from a government-mandated authorization committee. The network is so extensive that it is relatively simple for a patient with renal failure to get connected with a seller.

Rajesh Gupta, 37, a resident of New Delhi, began receiving dialysis treatment in 1997. As the prosperous owner of a company manufacturing electrical wires and cables, Gupta coughs up $600 monthly to get treatment at Delhi’s Apollo Hospital.

Still, buying a kidney is hardly difficult, he said.

“The process is very simple, actually,” Gupta explained. “The (nursing) attendants of patients in dialysis rooms have all the details. They give you a number and connect you with a donor.”

India’s medical elite have been debating the kidney business for years with two decided camps arguing their positions in medical journals, newspapers and talk shows.

In the pro-kidney selling camp are a bevy of senior nephrologists, surgeons and urologists, who argue that India’s poor benefit economically from selling their kidneys. Yet, almost all kidney sellers interviewed for this article were all in debt again.

“Look, in this country we’ve been trying for cadaver transplants for 15 years,” said Dr. K.C. Reddy, the doctor who removed seller Mary Gurwadan’s kidney, and who is one of the biggest proponents of kidneys for sale.

“The simple fact is that people here want to receive their bodies intact for cremation. They don’t accept removal of organs.”

In the absence of alternatives, a ready pool of willing sellers ought to be embraced, he said.

“We’re talking about saving lives here.” Reddy said.

“Preventing a man from selling the only thing he has of value just isn’t right.”

Indeed, the names of senior doctors and their hospitals repeatedly appear on medical documents obtained by the Star detailing the kidney donations.

Thirty-nine-year-old Anjalai Subramanium, a resident of a North Chennai slum, went under the knife for $800 in 1994. At Chennai’s Willingdon Hospital, she was operated upon by one of Chennai’s best-known doctors.

It’s unlikely that foreign nationals, who fly into India to get a kidney transplant, are ignorant of how kidneys are sourced.

With India quickly growing into a major destination for medical tourism, many come here after being stuck on waiting lists for years.

“When someone’s life is at stake, especially when the solution is just a matter of money, people are willing to compromise on a lot of things, including integrity,” said Amanda Gallagher, an American tour operator who is looking to set up her own medical tour operation, though not for illegal kidney transplants.

Government authorities mandated to prevent the commercial trade in kidneys appear complacent about the practice.

“One of the problems is that the crime status is fairly low in comparison to other crimes,” said Dr. Sunil Shroff who runs the Multi Organ Harvesting Aid Network in Chennai.

“It isn’t a murder, so when there is a sting or a media bust then the authorities do something quickly just to appease the media and temporarily silence things.”

The penalty for selling kidneys is hardly a deterrent. If convicted, a judge can sentence the accused to two to seven years or a fine of between $250 and $500.

Documentary evidence, found in countless files kept by sellers in their slum dwellings across Chennai, reflects that doctors, hospital administrators and government officials take a very casual view of the kidney trade.

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