The Delhi police recently busted a kidney transplantation racket that targeted poor, homeless people, with the surgeries being carried out at a two-story house in a city not far from Delhi, allegedly by a class X dropout operation theatre technician. Several such others have been unearthed across the country over the years. The police found that the main accused held several seminars and events at hotels in Delhi’s Lutyens’ zone to lure doctors from private hospitals into joining them. Police also found that the gang often posed as members of a healthcare group.
The kingpin, a technician Kuldeep Ray (46), had worked with a Rajasthan-based gang earlier that transplanted kidneys. He observed that doctors and technicians who were part of that gang would get into trouble for a minor issue or mistake. As he wanted his gang to have a ‘good record’, he tried to get more doctors to come on board so he could get the right guidance,” said a police officer involved with the probe. The aim (of the seminars) was to show doctors that he leads a good life and has a lot of money. He was offering Rs 2.5 lakh-Rs 3.5 lakh to doctors for each surgery according to the papers.Among the arrested men are two doctors, Sourabh Mittal (37) and Priyansh (34), who have been working at private hospitals in South Delhi and Dwarka for years. During the investigation, police also found several “motivational” videos on mobile phones, many of which were uploaded and shared on WhatsApp groups.
Each year, more than 2,00,000 people need new kidneys but only 8,000 get them. The demand-supply mismatch creates a space for organ rackets where fake doctors carry out surgeries and forge documents to show donors and recipients as family. Three major kidney trafficking rackets spanning several states and neighbouring Nepal have been in India since June 2016. Two of them involved staff of important private hospitals in Delhi, and the third was a fake doctor and his family who operated India’s biggest and longest such racket. The law is partly to blame. In a bid to curb organ trafficking, the current law is so stringent that it is near impossible for anyone to get a kidney transplant unless samples of a blood relative match.
Diabetes and hypertension are the biggest cause of kidney failure in the country, accounting for 40-60% of chronic kidney diseases. With life expectancy increasing and lifestyle diseases affecting people at younger ages, the prevalence of chronic kidney disease is steadily rising. The average age of a person needing transplantation is less than 50 years. In order to prevent trafficking, India has severe restrictions on who can be a kidney donor. The Transplantation of Human Organs (Amendment) Act 2011 allows only a “near relative”— parents, children, siblings, spouse, grandparents, and grandchildren — to be a living donor. It also allows “swap’ donations, where a pair of incompatible donor-recipient pairs can swap with another incompatible pair so that each donor gives a kidney to the other person’s intended recipient.
The law also permits donation from “affection or attachment towards the recipient or for any other special reason”, but such donations are closely screened for commercial motives by the hospital ethics committee and the state authorisation committee. The checks are meant to ensure donations are not made under duress or for money. The black market flourishes despite these safeguards since it is often a matter of life and death. Swapping organs between incompatible donor-recipient pairs and ABO-incompatible renal transplantation to cross the blood group barrier has somewhat widened the donor pool, but cases are rare and not enough to meet the acute shortage. According to the Global Observatory on Donation and Transplantation, India performed the third-highest number of transplants in the world in 2019. At the same time, India reported a dismal organ donation rate of 0.65 per million population.
Living donation in India is often driven by gender, with the odds stacked against women. “Less than 20% recipients are women, while 55-60% donors are women from the family — sisters, wife or mother. And if the son wants to donate, parents almost always refuse as the sons are seen as breadwinners. Also, with families getting smaller and many siblings ineligible to donate because they have the same lifestyle diseases (diabetes, hypertension) as the patient, the donor pool is shrinking rapidly. To cite an example, According to estimates of the Lucknow-based premier nephrology hospital, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, around 31,000 people in Uttar Pradesh needed kidney transplants in 2019. However, only 150 transplants could be completed due to the unavailability of donors.
India’s position as being the leader in road accident fatalities presents an opportunity to widen the organ pool. More than 146,000 people die annually, of them close to 65% are from severe head injuries leading. This translates to around 90,000 people in hospitals with “brain death” each year. Given that two kidneys can be retrieved from each, the potential of lives saved is massive. The reality though is that a vast majority of potential deceased donors are poor motor vehicle accident victims who present for care in government hospitals without the necessary infrastructure or expertise to support deceased donation. In contrast, transplant infrastructure and expertise are concentrated in private hospitals and are only accessible to those with the ability to pay. Given these realities, the potential of deceased donor transplantation can only be recognized if Indians who are likely to donate organs are also provided access to transplantation.
A dialysis is an option, but it’s expensive: costing anywhere upwards of Rs 20,000 a month with medicines. It’s expensive and time-consuming. Besides, patients spend half or a full day in hospital — which makes people unemployable. People begin dialysis late and don’t go regularly because of inconvenience or expense, which damages kidneys and brings down survival rates. Also, dialysis is really a stop-gap solution as with time, its effectiveness of it reduces and a transplant generally becomes inevitable.
In 2021, the Indian government implemented the National Organ Transplant Programme to promote organ donation by the deceased, to reduce the existing gap between demand and supply. Even though such efforts are appreciable, they don’t suffice to address the complex issues attending to organ transplantation in India. They just tweak things a bit. When the transplant act was brought in by the Central Government of India, the number of centers performing organ transplants and the number of patients undergoing transplants were much lesser compared to the present-day statistics. Knowing that the shortage of organs is the driving force behind illegal organ trade, strategies for legal and ethical expansion of the donor pool should be framed.
Although the Transplantation of Human Organs Act (Amended 2011 and Transplantation of Human Organs and Tissues Act Rules 2014) included swap transplantation and laid down certain rules for the empowerment of deceased donor organ transplantation, certain changes are the need of the hour to expand the donor pool. Safeguarding the physicians’ security and the recipient and donor rights is of prime concern in the process of organ transplantation. The present Act needs certain changes which clearly define the legal definition of brain death, legal issues involved in brain death, ethical and legal means of expansion of donor pool, and objective assessment of altruism. Meanwhile, as in any supply-demand mismatch conundrum, extra-legal markets will establish themselves and flourish. A few of them, now and then will get caught and make a splash. But for the most part, life will go on…..