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The great Indian kidney bazaar

Over the last two decades, scandals involving kidney commerce have broken out with depressing regularity in various Indian cities such as Mumbai, Noida, Amritsar, Bangalore, and Chennai. What sets the Gurgaon venture apart is the scale of the operation and hard-core criminality in the modes of procuring kidneys for profit. Networking at least three hospitals, five diagnostic centres, four doctors, 20 paramedics, and an unknown number of middlemen, Amit Kumar, the mastermin d, oversaw a cottage industry-sized operation that performed approximately 500 illegal transplants over the last few years. Not content with luring innocent poor folk with offers of cash, he and his henchman used naked threats and force — sometimes at gunpoint — to coerce ‘donors’ on to the operating table. The Central Bureau of Investigation, which is taking charge of the case, has its job cut out. Dr. Kumar has been arrested in Nepal but the investigators might have to go after a ring suspected to be active in at least five States and also in other countries, since a fair number of the clients are foreigners.

Kidney commerce began to flourish in India in the 1980s. The adoption of the Transplantation of Human Organs Act in 1994 — it prohibited commercial dealings in all human organs, recognised brain death in law, and also introduced provisions to regulate the “removal, storage and transplantation of human organs” — has done little to check the kidney trade, which is not only illegal but also goes against all canons of medical ethics. Sadly, the Indian medical profession and its ethics bodies have failed to come out effectively against the racket. Shaken by recurrent scandals, the Central government has proposed to notify new rules under the Act. Any new set of regulations must focus on the unethical and exploitative nature of organ commerce (as underlined by the World Medical Association) and on rooting it out. At the same time, it needs to encourage cadaver organ donations in innovative ways. The new rules must stay uncompromisingly with voluntary, altruistic, unpaid giving, the model developed by Richard Titmuss in his classic work, The Gift Relationship: From Human Blood to Social Policy (1970), which argued powerfully that blood donation must be founded on a sense of spontaneous generosity, not on the commodification of human tissue. Kidney commerce exploits human morbidity and thrives on the enormous gap between demand and supply. If the gap is to be narrowed, a serious debate needs to be initiated on adopting a law of presumed consent — the system of organ procurement that assumes that individuals have agreed to donate their organs upon certified brain death unless they have expressly opted out. Countries that have introduced this system — notably Austria, Columbia, Norway, Italy, and Singapore — have witnessed a marked increase in the rate of organ recovery.

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