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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