Saturday, February 9, 2008

Indian kidney
GLobal trade

The recent multi-crore kidney scandal, exploiting the poor for trading in their organs, exposes a number of glaring loopholes in the law and raises questions about the role of the authorities,
says Aarti Kapur

A policeman inspects the well-equipped operation theatre at Amit Kumarís clinic in Gurgaon
A policeman inspects the well-equipped operation theatre at Amit Kumarís clinic in Gurgaon

THE Rs 100-crore kidney racket unearthed at Gurgaon recently has shocked one and all for its sheer magnitude and the highly organised way in which it was being run by Ďdoctorsí for the last eight years. The incident has brought to light the growing Asian organ bazaar that sources kidneys from the poor and possibly ignorant donors to recipients in the Middle East, Europe, North America and South Asia.

The kingpin of the racket, ĎDrí Amit Kumar, a graduate of ayurvedic medicine, used his three-storeyed house in Gurgaon to carry out his nefarious activities in connivance with over two dozen doctors, touts and possibly even the local police. Interestingly, even eight years back Amit Kumar was booked in connection with an organ trafficking case and his Gurgaon house, with state-of-the-art surgical facilities, was sealed by the Delhi police. Surprisingly, the local police neither paid any attention nor took any action when the house was reopened and brazenly misused yet again.

This kingpinís involvement with the kidney trade surfaced even in the 1980s, when he was booked by the Mumbai police for similar charges. Each time, however, he succeeded in getting bail. The Transplantation of Human Organs Act came into force only in 1994. Earlier such offenders were booked for "cheating" under the Indian Penal Code.

With the recent racket some glaring legal loopholes were brought to light. The current Act is also expected to undergo amendments. Minister of Health Anbumani Ramadoss recently announced that besides asking the CBI to probe the racket, the ministry was determined to amend the existing organs transplant Act to plug the loopholes and make it more transparent.

This time round the lid was blown off the multi-crore racket, spanning six states, when a complaint was lodged with the Moradabad police about a labourer who was duped into parting with one of his kidneys. The local police along with its counterparts in Gurgaon swung into action and carried out raids on properties of Amit Kumar to discover the massive operation that thrived on exploiting the poor and fleecing rich recipients. Five labourers were rescued from the premises. Of them, Sakil of Ghaziabad, Vasim of Ahmedabad, Salim of Kotwali had already had their kidneys removed, while Ajay and Sanjay Kumar of Meerut were due for surgery in a day or two. Also found at the clinic during the raid were four Greek nationals and a NRI couple from the UK. They were detained by the police and are being questioned. All of them are suspected to be buyers of the kidneys being sold at the clinic illegally.

It is suspected that in the past eight years more than 500 kidneys were transplanted by the racketeers. The victims were brought from Uttar Pradesh, Maharashtra, Andhra Pradesh, Gujarat, Haryana, Rajasthan and even Nepal. The culprits (doctors involved) were never short of donors or margins in this clandestine operation that continued for years without any checks. Since the number of donors never matches up to the global requirements of kidneys, the whole trade flourished despite occasional reports of organ selling in countries like India, Pakistan and China. The industry was well fed by poor and needy donors who were lured with money and at times even coerced to live with a single kidney.

The Gurgaon scandal reveals that the organ bazaar of India was mainly driven by foreign clients (patients) who could afford to pay a hefty sum to get the prized product. More than 50 per cent of the patients operated for kidney transplantation by Amit Kumar were from the US, UK, Sudan, Saudi Arabia, Greece, England and Canada. His e-mail account shows 48 requests for kidney transplantation from foreigners and NRIs from different countries across the globe.

The racketeers sold one kidney for Rs 18 lakh or even more, while the donor was paid only between Rs 50,000 and Rs 1 lakh. Police sources say over the years, Amit Kumar had attained expertise in finding people who were in desperate need of the organ and those who had capacity to shell out a large amount of money.

Medical experts say Asian countries with a large population living in extreme poverty are a haven for such a thriving trade as there is no dearth of donors. Despite the Transplantation of Human Organs Act in the country and paucity of voluntary donors, the organs market continued to meet the demands of foreign clients from affluent countries.

As per Indian Medical Association (IMA) figures, the requirement of kidneys in India is around 1.8 lakh per year, but the number of patients who are operated for kidney transplantation is just 10,000 to 12,000 per year. Eighty per cent of the patients in India survive on dialysis for about two years and thereafter die due to non-availability of kidney donors. The life of only about 20 per cent of the patients is saved by donors, who are generally paid a handsome sum.

While talking to The Tribune, Dr S P Yadav, Senior Urologist, Gurgaon Pushpanjali Hopital, stated that the recent kidney racket had exposed how the organ market was being run in the name of medical tourism for foreigners. This illegal trafficking had raised a tricky situation for a country like India where on the one side kidney patients are dying each year due to non-availability of organs while on the other quacks had opened up a whole new market for selling organs to foreigners.

Ironically, Dr Yadav, whose hospital got the approval for organ transplantation in October last year, failed to perform even a single transplantation due to non-availability of donors in Gurgaon. The urologist says such a situation is the result of two reasons: firstly, it is usually seen that blood relatives of patients are not ready to donate their organs and, secondly, the procedure of voluntary donation is so complicated that donors prefer to avoid it. Even surgeons who conduct kidney transplantations fear the law as a number of legal complications can arise even if they have the consent of the voluntary donor.

The Gurgaon IMA Secretary, Dr Subrat Saxena, stated that the situation could improve if the government would liberalise the organs Act. He said that due to legal complications even the medical fraternity sometimes avoided transplantations in their hospitals. This was adversely affecting needy patients who were unable to get timely medical help.

Chinks in the law

Sakil, a resident of Ghaziabad, was rescued by the police from Kumarís residence
ONE OF THE VICTIMS: Sakil, a resident of Ghaziabad, was rescued by the police from Kumarís residence

The Transplantation of the Human Organs Act 1994 says close relatives of recipient like parents, children, brothers, sisters and spouse can donate the organ without government clearance.

  • All other relatives who wish to donate the organ need to appear before the Authorisation Committee for clearance and, only after its approval and clearance, can get the organ transplanted. The Authorisation Committee set up for the purpose ensures all the documents required under the Act have been supplied.

  • The Act does not allow exchange of money between the donor and the recipient.

  • Organ sales are banned by the Act. Therefore, no foreigner can get a local donor. If it is found money has been exchanged in the process then both the recipient as well as the donor is considered as prime offenders under the law.


According to sub-clause (3), Clause 9, of Chapter II in the Act: "If any donor authorises the removal of any of his human organs before his death for transplantation into the body of such recipient not being a near relative as is specified by the donor, by reason of affection and attachment towards the recipient or for any other special reasons, such human organ shall not be removed and transplanted without the prior approval of the Authorisation Committee."

Experts say this clause in the law that permits unrelated donors to donate live kidneys for reasons of "affection and attachment" has been misused by unscrupulous persons. It is not necessarily difficult to find an unrelated donor who suddenly develops an "affection or attachment" for the recipient provided he or she is properly rewarded.

In addition, the Authorisation Committee set up by the respective state governments only ensures that all documents needed under the Act have been supplied. The Committee has neither the means nor the authority to verify the facts stated in an affidavit before a magistrate. If unscrupulous hands exchange money in getting the donors then the recipients as well as the donors are prime offenders under the present law. Medical bodies have been demanding suitable amendments in this law to enable a person to donate a kidney for a consideration.