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 mastermind,
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 reportedly 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.