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US slams inaction on people trafficking in Tanzania Full Report Business with 'Life and Organs' Kerala's renal trade under fire Dr.K.M.Seethi Until recently, Kerala was considered to be somewhat safe in human organ trade even while other states in India like Tamil Nadu, Karnataka, Maharashtra and Delhi have been very much in the news, most often associated with kidney racket. However, the starling reports about the renal business in Kerala have brought to the fore many throbbing cross-undercurrents in the health sector where the concerns of the state government seem to be sustaining the interest of the private sector. This has thrown open a flood-gate of private super- speciality/multi-speciality hospitals in the state, accompanied by a mushroom growth of diagnostic services/medical laboratories. This scenario has rendered the state-run medical colleges and hospitals meaningless (with poor or lack of facilities for conducting even emergency operations, leave alone the case of transplantations).
Health Industrial Complex
It is learnt that many multi-speciality and super-speciality hospitals make ready fortunes out of 'operation and transplantation trade' with the connivance of public authorities. In fact, the renal transplantation controversy surrounding a few hospitals in Kozhikode, Thrissur and Malappuram districts points to the gravity of the nexus between the health-industrial complex and middlemen, who could be from politicians to doctors and petty traders.
The renal controversy has assumed a sensitive character because most of the victims of the kidney 'deals' were tribals from the Idukki and Wayanad districts who were apparently cheated by middlemen or hospital authorities. According to reports, a good number of kidney transplantations were done in a few hospitals in Kozhikode, Malappuram and Thrissur districts, and as many as 150 cases got approval from the Authorisation Committee during 2001-02. Three hospitals in Kozhikode alone conducted nearly 297 transplants during the last few years, out of which as many as 211 were unrelated. The critical questions are; whether the hospitals under suspect had influenced the kidney donors in any manner; whether any financial transaction had taken place between the donor and the recipient with the knowledge of the hospitals/doctors; whether the tribals were subjected to exploitation in the kidney donation and; whether there was any violation of the provisions of the Human Organ Transplantation Act, 1994 by the hospitals/doctors involved in the controversy.
Illegal kidney racket target tribals
When the local media began to ring the tocsin, the government sought to offset it by instituting an enquiry under a DIG, Mohammed Yasin. The DIG submitted his report, which alludes to the shocking evidences of an illegal renal trade. Among the 23 transplants held in the recent past in three hospitals in Kozhikode and Thrissur, 18 cases were under an illegal trade, the report stated. It has also found evidences of a racket playing an important role in this human organ business. Even as the investigations were underway, some of the victims of the renal trade had come out in open to narrate their gruesome stories.
Victims -Rajani
For instance, a 27-year old woman from the Idukki district, Rajani, was subjected to inhuman torture by a kidney racket. Rajani was pregnant when she was forced to 'donate' her kidney. She was also lactating her son while undergoing the transplantation. Rajani had pleaded with the lady gynaecologist in the hospital not to kill her child, but the doctor said since all tests were conducted, there was no other option. Not only was her pregnancy terminated, but within a month itself her kidney was removed. A kidney racket which incidentally included her own family members had played an important role in coercing and threatening her to 'donate' her kidney for the benefit of a rich patient willing to pay for the organ. There was obviously money transaction in the 'deal' but Rajani was kept in the dark and she was ultimately cheated. Rajani's tale raises very serious questions about the medical ethics of the doctors who recommended her case and the hospital authorities who undertook the transplantation. The practice elsewhere is that a lactating woman would not be cleared for renal transplantation. In the case of Rajani, she was not only lactating but was also pregnant when the Authorisation Committee, which should finally recommend for transplantation for unrelated donors, cleared for removal of kidney.
Mohanan
The agony of Mohanan, a tribal from the Idukki district, also highlights the behind-the-scene activities in the renal trade. Mohan was lured into donating his kidney under financial pressure. The middlemen offered him Rs.2 lakhs and he was taken to a hospital in Kozhikode where a good number of illegal transplantations had taken place. According to Mohanan, he was cheated by middlemen there and he ultimately 'donated' his kidney under threat and persuasion without getting anything from them. Subsequently, he filed a petition before the High Court seeking CBI inquiry in the renal trade. Among the issues he has taken up, the woes of tribals should necessarily merit public attention. According to many sources, the tribals of a settlement in Adimaly have been inhumanly exploited. Kidneys of nine illiterate tribals had already been removed and as many as 30 tribals had been lured into donating their kidney who would be taken to those hospitals which had come under controversy for transplantation.
Antony- Hide and Seek?
Meanwhile, the government is trying to play hide and seek in the whole affair. In response to a petition filed in the High Court, the Additional Advocate General submitted that under Section 22 of the Transplantation of Human Organs Act 1994, it had been stipulated that no court shall take cognizance of an offence committed under this Act unless the authority appointed under the Act made a complaint. The authority appointed under the Section 13 of the Act is the Director of Medical Education (DME). However, the DME seems to be prolonging the issue on the pretext that he is studying the report submitted by the DIG. Speculations are rife that the DME is planning to file a case putting the entire blame on the middlemen who would have played a key role in the 'kidney deal', thereby absolving the hospitals and doctors who were responsible for the transplants.
Hospitals-Doctors given clean chit
This issue, in fact, had already created a credibility crisis within the IMA. Ostensibly, the Report of the Committee appointed by the Kerala Chapter of the IMA exonerated the medical community of its responsibility in the whole episode. In a press conference, the officials of the IMA told that the hospitals involved in the issue did adhere to the provisions of the Transplantation of the Human Organ Act and that there was no evidence to prove that the hospitals and doctors had done anything to influence the kidney donors. More importantly, they argued that "the Authorisation Committee failed to elicit the illegal money transactions between some of the donors and recipients." The ethics committee of the IMA also claimed that the report of the three-member committee was "strictly based on facts and not on any kind of assumptions".
However, the Chairman of the three-member inquiry committee of the IMA, Dr. Mohammed Ali, came down heavily against the IMA officials saying that the original report he submitted had been tampered with by some within the Association to absolve the real culprits. The manipulation was obviously done with a view to diluting the findings of the inquiry team and exonerating the doctors and hospitals guilty of abetting the crime of promoting the illegal renal trade. The original report made available to the press subsequently contains many shocking revelations which were not to be found in the report released by the IMA officials in a press conference on 25 October. A major item of deletion relates to the inhuman exploitation of a lactating woman who was also pregnant at the time of the removal of her kidney. The original report also specifically mentioned about the involvement of the staff and doctors in the transplants deal and what is shocking in the report is that the qualifications of the doctor who undertook the transplants were placed under question.
In an interesting turn, the Chairman of the North Zone Authorisation Committee for Organ Transplantation, Dr. Chandran, who is also the principal of the Kozhikode Medical College, called the IMA report as "inconclusive and conducted for a namesake." Meanwhile, five eminent doctors of the IMA, which included B. Ekbal, Vice-Chancellor of the University of Kerala, blamed the Association for damaging the reputation of the medical community by trying to absolve the real culprits. In a statement they said: "What is really shocking is that even the mildest criticisms against these grave lapses aired in the original report (of the committee appointed by the IMA to study the issue) is sought to be hushed up by the IMA bigwigs. It now seems that what they really wanted was a whitewash job." Interesting it may seem, these five eminent doctors and the chairman of the three-member committee of the IMA are currently facing disciplinary action in the IMA for their forthright criticism of the leadership of the Association.
India a Renal Storehouse for Arabs?
A cancer infected kidney
The kidney racket in Kerala is only the latest in the series of such incidents elsewhere in the country. India has been identified as a potential 'renal-storehouse' and it has already emerged as one of the largest health-industrial sites for renal transplantation in the world. The development of powerful immuno-suppressant drugs and the advances in the surgical techniques have accelerated the pace of renal transplants. The record of successful operations and the loopholes in the medical regulations in India pushed up the transplant boom and kidney rackets. Many foreigners, particularly from West Asia and other Third World countries, besides the rich in India, have capitalised the potential renal market in the country. What sustain their interests in India are the low costs, easily availability of kidneys and the possibilities of bargaining in the corridors of the health-industrial complex.
A few years back, customs officials in the capital unearthed a 'kidney' racket in which potential 'donors' were persuaded to go abroad for renal transplants. Reports indicated that hundreds of such potential 'donors' had gone on such 'renal excursions'. Besides, a large number of illegal renal transplants were reported from Chennai, Bangalore and Mumbai. In one instance, kidneys of as many as 1,000 people were removed in a leading hospital in Bangalore by eminent doctors. The potential 'donors' used to get offers of money and placements and the renal transplants had taken place under the pretext of changing blood.
Ineffective Control Mechanism
It was under the circumstance of innumerable reports about the illegal organs trade that the Government of India passed the Transplantation of Human Organs Act in 1994 in order to prevent the trade in human organs. The Act prohibits all commercial trading and allows organs to be removed only for therapeutic purposes. It bans all organ transplants, except those donated by relatives (specified as spouse, son, daughter, father, mother, brother or sister) and states explicitly that organs can only be removed from brain-stem dead people. Thus, the Act makes it illegal to donate a body organ to anyone outside one's immediate family and requires that proof of familial relationship be shown when donating an organ.
The effectiveness this Act is put under question by many for a variety of reasons. The punishment for selling an organ is seven years' imprisonment and a fine of Rs. 10,000. Many consider that this punishment is inconsequential, considering the colossal amount that change hands in every illegal transplant. The Transplantation of Human Organs Act, 1994 was envisaged to stop the organs trade and to facilitate a cadaver-based human organ donation programme to get underway. However, the Act has been found quite insufficient to put an end to the illegal organs trade. Many argue that the Act itself has been misused. For example, Article 9(3) of the Act permits a person to donate his or her kidney out of love or emotional attachment to the recipient. But one finds that in almost all cases of unrelated transplants that had taken place in the country, including in the recent experience of Kerala, money transaction had taken place. Evidently, Section 9(3) of the Act defeats its very purpose, for it provides a convenient escape route which helps grow human organs trade in utter disregard to ethics and humanitarian considerations.
Growing Business of Kidney Transplants
Some studies say that nearly 2,000 people sell their organs for money every year in India. According to the UN Human Rights Commission, more kidneys were sold in India than anywhere else to buyers from developed countries. It is estimated that almost one lakh Indians suffer from renal failure and an average of 80 new cases per million population are reported every year. Costs of kidneys range from Rs.30, 000 to Rs. 2, 00000 and the share of brokers and middlemen could be anywhere between Rs. 20000 -50000. Reports say that as many as 3,000 transplants are performed in India every year. This constitutes only a small percentage of the total number of kidney patients who actually require transplants.
The renal trade in India raises many moral and ethical questions. Undoubtedly, the procurement and sale of kidneys from poor and the destitute would become a violation of the fundamental rights, particularly when they are enticed to sell their body organs to meet the transplant needs of high-paying customers, largely from the developed countries. The World Health Assembly, the supreme governing body of the WHO, has addressed some of the ethical and moral issues raised by organ transplantation which declared that "trade for profit in human organs among living human beings is inconsistent with the most basic human values and in contravention of the Universal Declaration of Human Rights." The WHO has set forth guiding principles to provide an orderly, ethical, and acceptable framework for regulating the procurement and transplantation of human organs - preferably from the bodies of deceased persons - for transplantation purposes.
Likewise, the World Medical Association (WMA) held in October 2000 stressed the fact that the primary obligation of physicians is to their individual patients, whether they are potential donors or recipients of transplanted organs or tissues. This obligation is not absolute; for example, the physician's responsibility for the well-being of a patient who needs a transplant does not justify unethical or illegal procurement of organs or tissues. The WMA categorically states that transplant surgeons "should ensure that the organs and tissues they transplant have been obtained in accordance with the provisions of this policy." In all cases the physician has an independent responsibility "to ensure that organs to be used for transplantation have been procured in a legal and ethical manner." It further pointed out that in the case of living donors, special efforts should be made to ensure that the choice about donation is free of coercion. Financial incentives for providing or obtaining organs and tissues for transplantation can be coercive and should be prohibited. Way back in 1991, the World Health Assembly set out in detail the parameters under which organ transplantation should take place.
With regard to trading in organs, it is stated, among other things, that "The human body and it's parts cannot be the subject of commercial transactions. Accordingly, giving or receiving payment (including any other compensation or reward) for organs should be prohibited." It specifically declares: "In the light of the principles of distributive justice and equity, donated organs should be made available to patients on the basis of medical need and not on the basis on financial or other considerations." Ethical guidelines and legal stipulations notwithstanding, renal trade is growing apace in India and the Kerala experience underlines the inevitability of people's initiatives to resist 'business with human organs'--(keralamonitor.com )
Dr. K.M.Seethi is a Reader in the School of International Studies, Mahatma Gandhi University. He writes on various socio-economic development issues and international politics.(c) copyright.
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