Cash for Kidneys: The ‘Industry’ That Preys on the Desperate

Illegal organ trade is a thriving industry; profitable for everyone involved except the impoverished donor.

(Image: The Quint/Hardeep Singh)

After Mumbai police bust yet another kidney racket, arresting 5 reputed doctors and the CEO of Hiranandani Hospital, questions are being raised about the effectiveness of existing laws, integrity of doctors as well as the role of police machinery. But what exactly is a kidney racket? What should a patient do when their kidneys fail? What does the law say? What is the government doing about illegal organ trade? We try to answer all these questions.

1. Buying Kidneys From the Desperate: A Thriving Trade

Although doctors in the West have been trying since the beginning of the 20th century, the first successful kidney transplant took place only in 1954 in Boston, USA. 17 years after the breakthrough in Boston, the first successful renal transplant took place in Indian at Vellore in 1971. In next two decades, over a 100 thriving kidney rackets forced India to finally pass the Transplantation of Human Organs Act, 1994. The act allows transfer of a kidney from a brain-dead patient or a “near-relative” or an authorised non-related donor. The act prohibits buying/selling of kidneys. Since it is often difficult to source kidneys legally, and is easier to buy it from someone who is poor and desperate, several rackets thrive in India even today.

2. Partners in Crime

A patient (who needs a kidney), kidney ‘brokers’, doctors, hospital management, hospital staff, government officers, police officers and donors can all be part of a racket. It is difficult to illegally transfer a kidney from a seller to a buyer without paying bribes at every stage.

It’s extremely difficult to live life on dialysis. I have to go for it twice a week. So, my life is tied to the hospital. I had to resign and sit at home. I don’t know when I will get a donor legally. I don’t know how long I can live. I have no choice but to receive a gkidney from an illegal donor.

Kidney Transplant Patient, speaking on conditions of anonymity

3. Modus Operandi

A patient with failed or ailing kidneys visits a hospital regularly for dialysis (clinical purification of blood, which is otherwise done by kidneys). This is where he is generally approached by a member of the hospital staff, who may act as an agent of a broker. The broker is the most important person in this chain; he’s the link between the patient, hospital, government and most importantly, the donor. The broker not only makes arrangements for a donor of a suitable blood group, but also makes a watertight ‘file’ by exploiting loopholes in the law.

If the donor is shown as a ‘near-relative’ of the patient, then the file only needs the approval of an internal committee in the hospital. If the donor is not related, then the file goes to a zonal committee in the government, which has to approve it.

(Image courtesy: Hiranandani Hospital)

4. An Illegal Kidney Can Set You Back by Rs 50 Lakhs

A ‘donor’ in a racket is usually a poor villager from Bihar, Gujarat or Vidarbha. The typical donor may have a loan to repay (as in the case of Akola kidney racket) or is in desperate need of the money. He generally receives between Rs 1 lakh and 2 lakhs. Donors with a rare blood group like AB negative generally demand more than that. Hospital charges on paper are around Rs 5 lakh. Agent, broker, doctors, staff and committee members take ‘cut.’ These ‘cuts’ vary, and can be anything from Rs 1 lakh to Rs 5 lakhs, depending on the case. In smaller towns, an illegal kidney transplant operation can cost around Rs 20 lakh. In cities like Mumbai or Delhi, the cost can be as high as Rs 50 lakhs.

In many cases, the donor doesn’t get the money promised. After removing a kidney, he cannot do any strenuous work. He cannot live on the 1 lakh rupees he gets from selling his kidney. His life is ruined. 

Suresh Gupta, Complainant in the Hiranandani case

5. Transplant Tourism: Delhi, Sri Lanka or Singapore?

Brokers in Delhi offer ‘package deals’. Once a patient pays around Rs 40 lakh, the broker arranges for everything from a suitable donor to a hospital; he puts together a fool-proof file and ‘manages’ doctors, police officers and committee members.

Earlier, Sri Lanka was the preferred location for Indian patients as it was less complicated to carry out the entire procedure there. But ever since Indian agencies began investigating the role of hospitals in Sri Lanka, some hospitals there have backed out and are refusing to be a part of the deal.

Singapore is another destination for the rich. If one is willing to shell out one crore rupees, brokers assure transplants in the finest hospitals in the developed island country. The concept is called ‘transplant tourism’.

Victims of kidney scams show surgery marks. (Photo Courtesy: megapoker88.blogspot.in)

6. Failed Mechanism

The existing law and the machinery that is supposed to implement it has clearly failed at several levels. Has the government learnt its lessons?

What can the committee do if forged papers are presented before it? Committee members should be given access to the database of Adhar cards and pan cards. Only then will members be in a position to find out if someone is posing as someone’s relative. In fact, I am going to request the government not to make the rules very strict (as a reaction to the discovery of these rackets). If rules are made stricter, it will delay surgeries in genuine cases. As I see it, it’s fine if one illegal case receives approval, if it means that 99 genuine cases don’t face trouble. 

Dr Pravin Shingare, Chairman, Organ Transplant Committee, Mumbai

7. What’s The Solution?

In developed countries, organs of more than 70 percent of all brain-dead patients are donated. While in India, Dr Shingare points out that relatives of only 10 percent of all brain-dead patients allow organ donation. If kidneys of more brain-dead patients are made available for transplant, it will bring down institutionalised, illegal organ trade in India to a large extent.