Ashraf Engineer
September 21, 2024
EPISODE TRANSCRIPT
Hello and welcome to All Indians Matter. I am Ashraf Engineer.
A recent CNN investigation showed that desperately poor people in Myanmar have been selling their organs in India. The initial matching of seller to buyer is done through Facebook groups and then taken forward by agents. The sellers make their way to India, often on the pretext of tourism, where the illegal transplants happen.
This isn’t unique to Myanmar. Such donors – and often they don’t even know their organs are being harvested – are increasingly coming from Nepal too. Other media reports have highlighted that the poor there are targeted by agents who promise them jobs in Delhi. The unsuspecting victims are transported into India over a border that is virtually open and taken to hospitals where doctors conduct illegal surgeries, removing a kidney to be sold to a buyer.
Once the victims revive, they are given some money and sent back to Nepal. The kidneys are usually sold to rich buyers who are desperate to skip the queue for organ transplants. When they return home, the victims once again find themselves jobless, the money they were paid lasting only a short while, and now without a kidney.
As the list of organ seekers far outpaces that of willing donors, such practices are spreading fast. What can be done to curb the illegal organ trade in India and how can we meet the high demand?
SIGNATURE TUNE
Let’s return to Myanmar. It’s been three years since the military coup in this very poor country. More than half of its 54 million people live below the poverty line, a number that has doubled since 2017, according to the United Nations Development Programme.
This is a very troubled, violence-riddled country. Unemployment is rampant and prices are skyrocketing. It’s a situation ripe for the illegal organ trade.
The kidney black market in India is large and it preys on the poor in neighbouring countries. Both, buyers and sellers, work with middlemen who match donors with recipients and forge the documents needed.
In India, the sale of organs is illegal and only relatives can donate organs, so the agents even forge family records with the help of lawyers and notaries. These documents are reviewed by the Myanmar embassy and the case is cleared for the state or hospital authorisation committee.
The authorisation committee’s job is to catch those trying to cheat the system. The documents are reviewed and interviews conducted for good measure but it’s not easy to spot fakes. The committees tend to look at the case sympathetically because they have before them a person for whom it’s a matter of life and death.
For the committee, once the embassy signs off on the documents, it’s a formality for it to follow suit. It does not have the capability to authenticate documents from another country.
What follows is a long chain of illegality in which hospitals, doctors, other medical professionals and government officials are all complicit.
All this is in sharp contrast to the internationally accepted processes for kidney transplants. Written consent is sought from the donor, and in most cases he or she is related to the recipient. It is ascertained that the donor is not under any pressure and is not getting paid. The responsibility is spread across the government, the medical professionals involved as well as the hospitals.
Organ transplants have been taking place in India since the 1970s. Once the scope for commercial sale of organs came to light, Parliament passed the Transplantation of Human Organ and Tissues Act (1994), which was amended in 2011 and came into force in 2014. The law banned the sale of organs and only allowed them to be given to close family members.
As medical science progressed and organ donation became more common, some cities became hubs for transplants of organs such as the kidneys, heart and liver. The deceased donor programme, through which organs are harvested from brain-dead donors, has also become popular.
As of 2022, India was performing 13,300 living transplants and 2,700 deceased donor transplants. Yet, it had more than 3 lakh patients on the waiting list for organs and 20 people dying each day for want of an organ.
Government data shows that the number of transplants grew from 6,916 in 2014 to 16,041 in 2022. From 2014 to 2022, the number of liver donors increased from 1,327 to 3,911; kidney donors increased from 5,512 to 11,705, heart donors from 53 to 243 and lung donors from 15 to 144. It is estimated that one person is added every 10 minutes to the waiting list for organ transplants.
Over the years, several steps have been taken to promote organ donation: doing away with the domicile rule; removal of the age bar for recipients; removal of fee for registration for transplant; easing rules on withdrawal of life support; and facilitation of organ transport.
The government also implemented the National Organ Transplant Programme to promote donations from the deceased to bridge the gap between demand and supply of organs.
The major reason for people turning to illegal donations is the duration of the wait for an organ. Often, it’s years and usually it’s the poor who suffer the most. Often, the organ sellers are from urban slums or poor regions, and it’s very difficult to trace them.
The fear is that as the demand-supply gap widens, organ trafficking will increase too. Everyone, other than the donor, benefits. I’m referring to the agents, doctors, transplant centres and pharma companies. Often, the illegal surgeries happen in the so-called five-star hospitals.
The exploitation is such that it is now a human rights issue. Indeed, in April, the National Human Rights Commission took cognisance of a media report about an organ trafficking racket in Haryana and Rajasthan and asked for a thorough probe.
Researchers and doctors say that, so long as the demand-supply gap is not bridged, the racket will continue. They point out also that it is more prevalent in India because it’s easier to get away with it here. Sadly, corruption is common and often such profiteering is even celebrated.
As far back as 2007, a World Health Organisation bulletin described India as a “commonly known organ-exporting country”. Organs from local donors are regularly transplanted to foreigners for commercial considerations, it said.
According to a study conducted at the All India Institute of Medical Sciences in Delhi, roughly 1,500 in a million people in India have chronic kidney disease. Around 350 to 400 per million population have end-stage renal disease. Patients of chronic diseases are increasing, therefore demand is too.
The situation is worrisome, so many have suggested a system that allows commercial trade of organs. That would be disastrous because legitimising sale and purchase of organs in an unequal society will mean even greater disparities in healthcare. It is commonly believed that even with cadaver donations, the organs go to rich patients willing to pay bribes.
India must do away with the VIP culture in waiting lists and encourage more people to donate. If the poor are assured that donated organs are not just meant for the rich, more people across the social spectrum would come register, increasing the availability of organs from cadavers.
Here are some ways to increase voluntary organ donations.
- Awareness building: A largescale campaign funded by the government would lead to message impact and add credibility to the cause. It should educate about the need for organ donation, and tackle myths and misconceptions.
- Mandatory brain death declarations: This would increase instances of organ donation and also spark discussions between doctors and relatives of the brain dead. The appointment of transplant coordinators could be pivotal in establishing trust with the patient’s relatives. The coordinator would explain the need for donation and facilitate retrieval of the organ from the deceased or brain dead patient’s body.
- Better hospital infrastructure: Transplantation should be available in all government hospitals as the majority of patients cannot afford treatment at private hospitals. There is a need for better infrastructure at all public hospitals to store and transport organs and train staff for transplantation procedures.
- Sensitising police: Most brain death cases are accident cases. There is legality involved and therefore a sensitised police force could go a long way in facilitating donations.
These are only some of the ways the demand-supply gap can be bridged. Illegal organ donation is exploitative of the very poor, widens inequalities in society and is unsafe. India needs urgent action on this front.
Thank you all for listening. Please visit allindiansmatter.in for more columns and audio podcasts. You can follow me on Twitter at @AshrafEngineer and @AllIndiansCount. Search for the All Indians Matter page on Facebook. On Instagram, the handle is @AllIndiansMatter. Email me at editor@allindiansmatter.in. Catch you again soon.
