'Dr Kidney' arrest exposes Indian
organ traffic By Sandhya
Srinivasan
MUMBAI - The arrest of "Doctor
Kidney" Amit Kumar for running a sizeable racket
in live kidneys has highlighted the role that
South Asia plays as the hub of an international
trade in human organs.
A sophisticated but
unregulated healthcare industry, a "donor pool" of
desperately poor people ready to sell a kidney,
and a corrupt monitoring system have combined to
create a special brand of "medical tourism" in the
region, especially in India and neighboring
Pakistan.
While India's 1994
Transplantation of Human Organs Act (THOA) is
observed mostly in the breach, the impact of
Pakistan's Transplantation of Human Organs and
Tissues Ordinance passed in 2007 is yet to be
gauged. Until last year, the organ trade was
legal
and flourished openly in that country.
Top
transplant surgeons are collaborating with
criminal organ trafficking networks to target the
desperate, noted Nancy Scheper-Hughes, founding
director of Organs Watch, an academic research
project at the University of California, Berkeley,
while speaking at the Vienna Forum to Fight Human
Trafficking this month.
"The latest
arrests reveal a global network larger in scale
than any other one," said Dr Samiran Nundy,
gastroenterological surgeon at the prestigious Sir
Gangaram Hospital in New Delhi. Nundy was one of
the architects of India's transplantation laws
that should have put an end to paid transplants in
this country. The THOA was the result of activism
by a small group of conscientious medical
professionals appalled by the trade.
Kumar
is accused of luring poor laborers to his
"hospital" in the New Delhi suburb of Gurgaon with
promises of job offers or large sums of money.
Typically, they were promised 300,000 rupees
(US$7,500) but paid only 30,000 ($750) after the
surgery, police said.
He is alleged to
have conducted more than 500 transplants over an
unspecified period, charging up to $50,000 dollars
for each operation. Investigators say his patients
came from Britain, the United States, Turkey,
Nepal, Dubai, Syria and Saudi Arabia.
The
racket first came to light on January 24 when
police raided Kumar's hospital following a
complaint by a "donor" who had been paid less than
the amount promised. At his hospital police found
recipients recovering from surgery and arrested a
number of doctors, nurses and support staff.
"Under the THOA, the powers to investigate
and take action lie with the authorization
committee," says Chennai-based surgeon Dr George
Thomas, editor of the Indian Journal of Medical
Ethics, who has campaigned against the kidney
trade. "However, this usually consists of
government doctors without the infrastructure to
investigate infringements. Many hospitals where
these transplants take place are linked to
politicians. And members of the authorization
committee never complain to the police."
A
series of investigations by the newsmagazine
Frontline has documented the extent of kidney
trade in various states of India, with "donors"
drawn from the poorest parts of the country. State
authorization committees have approved almost all
the hundreds of applications for donations by
non-relatives for "reasons of affection", despite
clear evidence that money had changed hands.
"But Amit Kumar did not even use the legal
loophole of pretending that the donors were
donating out of affection for the patient," says
Thomas. "He did not even bother to seek permission
from the authorization committee to perform these
unrelated transplants as required by THOA."
The kidney trade requires the collusion of
highly trained surgeons. Kumar was the organizer
of the enterprise and seems to have either hired
or partnered with surgeons and other medical
personnel. He had contacts all over the world who
directed patients needing transplants to him, and
a network of brokers all over India who ensnared
poor people into parting with a kidney with
promises of large rewards.
THOA was meant
to stop kidney trading, and is "one of the most
important pieces of medical legislation in India",
said Nundy. But "to a certain extent it has been a
failure though trading is much less than it was
before the law".
Pakistan's law, passed
last year, has been criticized as inadequate. "The
ordinance came about after a struggle by
professionals, civil society and the media for
almost two decades against a strong pro-organ
trade lobby," Dr Farhat Moazam, professor and
chairperson of the Center of Biomedical Ethics and
Culture at the Sind Institute for Urology and
Transplantation (SIUT), Karachi, told IPS by
telephone.
Moazam was part of the campaign
to get the law passed against what she prefers to
call organ "trafficking" rather than the more
neutral "trade".
"I believe it is a step
in the right direction. But it needs to be
strengthened in some areas and also implemented
honestly and transparently if it is to work." She
notes that the Indian law was a moral victory, an
important statement by [Indian] society, and it
has given the teeth to go after those involved in
this racket. Of course, no law completely
eliminates the practice.”
In 2003, SIUT
estimated that around 2,000 kidney transplants
were done in Pakistan every year, said Moazam.
Eighty percent were from unrelated donors, and, of
these, almost two-thirds were done on patients
from outside Pakistan.
The 2007 ordinance
makes it mandatory for institutions doing
transplants to register and be monitored,
prohibits and provides punishments for commercial
dealings in human organs as well as donation by
Pakistani citizens to "citizens of other
countries".
However, "donation" by
non-related individuals is permitted if it is
"voluntary", a term Moazam views as "vague" and
prone to abuse. She also notes that since spouses
may donate, "sham marriages are inevitable in an
androcentric society". Finally, the same problems
of corruption in giving permission for non-related
"donations" exist as in the Indian law.
Although India's THOA permitted the
transplant of organs from cadavers by recognizing
brain death, doctors estimated that fewer than 600
organ transplants between 1994 and 2003 were
cadaver-based. On average, 2,000 transplants are
recorded in India annually.
One reason
that the cadaver transplant program has not
developed in India is that the lucrative trade in
live "donations" has not been checked. Other
reasons are a lack of infrastructure and public
awareness. "We need the infrastructure and
regulations to harvest organs from smaller
hospitals, we need more publicity about cadaver
donation, people don't know what brain death is,
and that organs can be harvested from the brain
dead," says Nundy.
"There is a poor
understanding of brain death even among medical
professionals," says Thomas. "We also need a
system to seek and obtain consent from relatives
of brain dead people. What is needed is a social
movement for organ donation."
One option
to increase the number of cadaver organs is the
"presumed consent" policy followed by Spain, which
has 31.5 donors per million population (compared
to 21.2 in the US, 16.9 in France and 16.7 in
Portugal). Every citizen is considered a donor
unless he or she specifically opts out. "I would
prefer the 'opt in' policy in India at present
because the poor and less literate will not know
that they can opt out," says Thomas.
"Development of deceased donor programs at
least in some of the major institutions to
supplement living organ donation is absolutely
essential to address the needs in Pakistan," said
Moazam. "But this will require raising public and
professional awareness, and education."
In
Pakistan, only the SIUT has carried out deceased
kidney transplants, and of the 20 such transplants
only six were from deceased people.
In
2007 the World Health Organization estimated that
10% of all transplants involved patients from
developed countries travelling to poor countries
to buy organs. They depended on local agents who
"sourced" kidneys and arranged the transplant. At
least 15,000 kidneys are believed to be trafficked
in this way each year. While there is evidence of
people being forcibly deprived of a kidney,
clearly most "donors" are people in desperate need
for money.
"In my opinion, organ
trafficking involves societal and global issues
that must be discussed within the broader paradigm
of global injustices," said Moazam. "It must be a
debate about communities of one kind of people
being systematically exploited by communities of
other kinds, both internationally and
intranationally."
"This is exploitation of
the worst kind, where you want to remove a body
part of the poor to help a rich man survive," said
Nundy.
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