India’s dire need for organs still fuels a deadly trade

Traffickers exploit widespread ignorance and poverty to fill the gap created by shortage of donors.

Nagamma, a victim of organ traffickers, with two of her three sons in front of her shack in the Korukkupet area of Chennai, India. Shaikh Azizur Rahman for The National

MUMBAI // India is rightly proud of its status as one of the world’s fastest-growing economies. But there is another, less admirable label that refuses to go away. Despite the country’s best efforts to eradicate the black market trade in human organs, India retains a reputation as an easy place to buy a kidney.

Laws forbidding organ-trafficking have been in place since 1994, yet the heinous commercial trade goes on, as was highlighted by the case of the Apollo Hospital in New Delhi, one of the best hospitals in India. Doctors there admitted that they were duped into removed kidneys for transplant which ended up being sold for cash to organ traffickers. The doctors were deceived by fake documents which purported to show that the organ donors was undergoing surgery to help sick relatives. In fact, the organ was removed so that the donor could sell it for cash.

The hospital declared it had been the victim of “a well-orchestrated operation to cheat patients and the hospital.” Five people have been arrested, including two hospital workers.

It is an unedifying story but it also highlights another inconvenient truth: India’s need for donated organs is far greater than the supply.

There are many reasons for this, both practical and cultural. The very concept of organ donation is relatively new in India, and the western notion of removing organs primarily from people who have been declared brain-dead is even more unfamiliar, says Rakesh Rai, a senior consultant and transplant surgeon at Fortis Hospital in Mulund, a suburb of Mumbai.

“India is a huge country with 60 per cent of people still living in villages, so not everyone is so educated that they understand about organ donation. The second problem is not all doctors know how to identify the people who can donate their organs and they’re not geared towards organ donations. Also you need to have good connectivity. Imagine that the donor is somewhere in the rural part of India – how do you take out the organ and bring it to a major centre?”

Lack of understanding coupled with real or perceived religious restrictions have further kept the organ supply far below demand.

Rajendra Patankar, the chief operating officer at the Nanavati Super Speciality Hospital in Mumbai, says, “It’s basically due to the lack of awareness among the general population. There are certain people who feel that it is restricted as per their religion. That is not the case in reality – none of the religions in India is against organ donation.”

And then there are the horror stories which are a powerful deterrent. “Earlier transplants were misused by some and [the procedure] got a bad name so people are scared as well,” says Dr Patankar. He even knows of cases where patients were admitted to hospital for a quite different procedure only to wake up and find their organs had been removed.

Diabetes is rife in India. Untreated diabetes leads to organ failure, necessitating a transplant. But there are simply not enough donated organs to go around. India also receives many requests for organs from abroad. And so the underground trade persists. It has undoubtedly decreased but it is still there.

Recently reports surfaced from Pandoli, a small community in the western state of Gujarat where a number of impoverished villagers were allegedly pressured or manipulated into selling their kidneys to solve their financial problems.

“There are still a few small pockets where you have some kind of buying and selling of kidneys going on,” says Sunil Shroff, a transplant surgeon and managing trustee of the Mohan Foundation, an NGO which promotes organ donation in India.

“Today, a little bit of organ trade is thriving because of social media. India is considered to be the diabetes capital of the world, so there is a gap between the demand for organs and supply.”

The transplantation of human organs act, forbidding commercial trade in organs, came into being in 1994 and has proved effective.

“With time it has definitely come down,” says Dr Shroff. “The government has been very strict and a lot of people have been prosecuted. The middleman have been put behind bars and some of the doctors have been prosecuted.”

To promote organ donation as a positive thing, the authorities have enlisted the help of celebrities such as Bollywood actor Aamir Khan, who has pledged to donate his organs

However, the crackdown on illegal practice and all the awareness-raising might simply have helped shift the problem elsewhere. According to Dr Shroff, the current hot spot for the illegal transplant trade is Sri Lanka. Earlier this year Sri Lanka suspended all kidney transplants for foreigners after Indian police linked a kidney racket in India to doctors based in Sri Lanka, allegedly operating on Indian donors and recipients.