Between Selling Your Kidney and Prostitution, What Would You Pick?

For many donors, the cash-for-kidney model is a better alternative than say, prostitution, to climb out of poverty.

Consider this: At the moment, in Mumbai, more than 3,000 families are awaiting a kidney donation for loved ones suffering from End State Renal Disease (ESRD). Yet, more than half of 2016 later, only 52 patients have received cadaveric donations.

In a small village in Gujarat, 700 kilometres away, filling this demand-supply gap is a no-brainer for daily wage labourers and farmers. With an average income of Rs 50-100 per day and an average family size of three, offers to get paid in lakhs in exchange for an organ they can spare speaks to their survival instincts.

So, when Shobhana Thakur, a domestic helper in Piplav, Gujarat with four children and an alcoholic husband was lying in the operating room in Powai’s Hiranandani hospital, ready to exchange her kidney with cash enough to repay a crushing debt and pull her kids out of poverty, she was only doing what needed to be done.

“Two lakhs is a huge amount for us. I thought I would be able to send my children to a good school and pull them out of poverty. I was only selling the kidney for the sake of my children,” she told a reporter from Mumbai Mirror, speaking from Byculla jail.  

In the another village, 32 kilometres away from Piplav, 11 residents of Pandoli have sold their kidneys to a nexus of touts, doctors and hospitals from Maharashtra, West Bengal and even Sri Lanka, in the past year alone. It’s almost as if the great kidney racket of the early 90’s is back.

The Human Organs Transplant Act (HOTA) was enforced in 1995, largely in response to a collective public outcry to a thriving kidney black market in the early 90s. The streamlining act laid down guidelines for transplants from cadavers, as well as rules for organ transplants by willing donors.

A quick look at the numbers, however, paints a dismal picture. Less than 5,000 kidney transplants are carried out annually against a required number of 1,75,000. This wide gap between demand and supply creates a thriving black market for the bean-shaped organ, made worse when coupled with crippling poverty and unemployment.

This begs the question: if this pressing need for kidneys can be met by the millions of non-related willing donors, potentially saving the lives of thousands and reducing state costs of dialysis in the crores, what is the harm?

Turns out, with the recent kidney racket bust in the prestigious Powai hospital in Mumbai, this is an argument few doctors are willing to lend their name to.

A doctor belonging to the Mumbai Urological Society, on the condition of anonymity, admits: “There is a social element to kidney transplants that the government is quick to dismiss,” he says, narrating an incident of a father selling off his kidney to marry off his daughter.

The argument that opening the door for non-related donors will lead to the exploitation of poor people is simply ignorant. They are already suffering because of the system. What about that?

Anonymous Doctor, Mumbai Urological Society

The link between the conditions which push the poor to donate and the rise of recent kidney rackets is clear. Take, for instance, Gujarat: the state from where middlemen in the Hiranandani racket poached desperate villagers for kidneys. According to the Planning Commission’s report (2012-13), 44.6% of children under the age of five in the state suffer from malnutrition. A report by NSSO on poverty in the state for 2012-13 reveals the increase in poverty from 32% in 2001 to 39.5% in 2011. Growth in employment for the period 1993-94 to 2004-05 was 2.69% per annum, which fell to zero between 2004-05 and 2009-10.

“I needed money to pay off my family’s debt after my husband died. I had three kids. I didn’t even know this is illegal. For me, it was better than prostitution. You tell me, isn’t it?”, asks a frail 49-year-old kidney donor in Mumbai. She had heard about the recent arrests and kept asking if the police can pick her up for something she did more than a year ago.

It is no surprise, then, that the poorest districts of western Uttar Pradesh, Gujarat, West Bengal, north Bihar and Maharashtra are the recent favourites of touts lurking in the outpatient galleries of hospitals. Punjab is a surprising addition to this list; with it’s politically propped-up facade of being the face of successful green revolution, rampant unemployment is aggressively played-down.

The current system of hospital authorisation committees authenticating precesses to determine the legality of a transplant leaves too many loopholes for greed of the quick buck to take advantage of. Transplants, then, are best-case scenarios for people like Shobhana to clear a debt, get their daughters married, send their children to school and survive.

However, as a country, we’re far from accepting the cash-for-kidney model. Administrative processes need to organised and made stringent to prevent exploitation or worse, extortion for transplants. Going back to the model of state-authorisation committees might help, but what is more crucial is spreading awareness.

Doctors put the demand-supply gap down to ignorance, not selfishness or any religiousness injunction. The ratio of voluntary donors to patients in need of a kidney in India stands at 1:1 million – a poor figure when compared to 20:1 million in France, Spain and the US. People are simply unaware of the pressing need to donate, and about the facts around donation.

Seen in the above context, the linear approach of the government in curbing the illegal trade of kidneys is flawed. There is more to it than just criminal doctors and touts, and naive donors. Unemployment, poverty, illiteracy and lack of awareness are the forces that set the process of a black market kidney trade in motion; to continue to pretend these rackets are isolated incidents of greed and malice which can be solved with a few arrests and a prolonged trial is akin to insanity – trying the same thing repeatedly, expecting different results.