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The praful bi'dwai column

Stealing organs from the poor

Praful Bidwai writes from New Delhi
*-***Common everywhere is failure of enforcement. The reason, apart from bribes, is the belief that the victims got a modicum of "justice" because they were "compensated" with money; they can, after all, survive with one kidney. The only "injustice," many law-enforcers believe, is that of disproportion; racketeering doctors, middlemen and brokers make much larger sums, Rs 15-20 lakhs, than donors.***
THE ghoulish kidney transplantation racket unearthed near Delhi, with ramifications across the nation, has shocked the public. Amit Kumar alias Santosh Raut's operation involved 3 hospitals, 5 diagnostic centres and 10 laboratories, and more than 50 accomplices, including doctors and nurses, "spotters" and touts who would lure potential donors with the promise of jobs, and thugs who would force them to part with their kidneys.
The 600-odd recipients included nationals of half-a-dozen countries.
The racket couldn't have been conducted for years without collusion on the part of the police. Raut was a known offender with a history of repeated arrests since 1993. Raut escaped because he was tipped off. Two Greeks involved in his set-up were also let off.
What demarcates Raut's racket from the kidney trade, which flourishes in many South Asian cities is muscle power. Typically, extreme economic distress com-
pels poor people to sell their body parts. But Raut's goons would abduct their victims and beat them into agreeing to kidney excision.
This further highlights police failure in enforcing India's Transplantation of Human Organs Act (THOA) 1994, which illegalises the sale of human organs and allows transplants from brain-dead people. It allows organ donations by close relatives without government clearance. All other relatives must be cleared by an Authorisation Committee.
THOA however has a big loophole: No Committee approved is needed if the donor feels "affection" or "attachment towards the recipient." This is licence for abuse.
The Raut racket follows a familiar pattern. Rich people suffering from end-stage renal disease are contacted by an international organ trade network run by unscrupulous doctors who prey upon the very poor. The victims arc misled into believing they'll get jobs, and induced into selling a kidney for as little as Rs
40,000 to Rs 1 lakh.
The global kidney bazaar is highly evolved, with an hierarchy of preferences and prices. Kidneys from India or Pakistan sell for $1,000 to $2,000; a Romanian kidney for $3,000-plus. A kidney from Turkey costs $10,000.
The donor's consent is typically secured through coercion or under exploitative, unequal conditions. It's not remotely free or informed. Donors are quickly discharged without being warned of risks. There's no follow-up treatment or monitoring for possible kidney malfunction. Many end up ill and destitute.
Many poor countries have no laws to regulate organ trading. In India, the law came years after transplantation had already become established. In Pakistan, the law came only last year.
Common everywhere is failure of enforcement. The reason, apart from bribes, is the belief that the victims got a modicum of "justice" because they were "compensated" with money; they can, after all, survive with one kidney.
The only "injustice," many law-enforcers believe, is that of
disproportion; racketeering doctors, middlemen and brokers make much larger sums, Rs 15-20 lakhs, than donors.
This belief, shared by a section of the sub-continental elite --which also justifies child labour --betrays utter contempt for the principle of inviolability of the human body, which is foundational to any civilised society. It justifies the robbery of vital organs. Organs like kidneys don't regenerate. Donating them is different from donating blood.
This belief places an abysmally low value on the bodies of the poor. This should be repugnant to anyone with elementary faith in human solidarity, or an essential compact among people, regardless of their social rank. The idea that you can cannibalise the bodies of the underprivileged is totally unacceptable.
The injustice of disproportion is secondary. Even if all middlemen were eliminated, it would still be unconscionable for medical science to be used to transfer organs from the poor to the rich. Ethically, treating human organs like commodities remains extremely troubling, especially
when there's huge disproportion of power.
Advocates of "market-based solutions" to the kidney failure problem violate this criterion.
In India, there's a big gap between those affected by endstage renal disease, about 1.5 lakh, and the number of kidneys transplanted (under 4,000). Another 6,000 get dialysis.
But sacrificing the poor can't fill that gap. Rather, we need more and cheaper dialysis facilities, cadaver-based transplants (from the brain dead), and donations by patients' relatives. Kidney donation has few adverse effects if properly managed with followup, etc. Kidney donation pledges must be promoted along the lines of the successful cornea donation campaign
Cadaver-based transplants are ethically least problematic. More than 10 brain deaths occur in each of our major cities every day. Yet, there have been only 500 cadaver-based kidney transplants in India since 1994. To promote these, we need to simplify and speed up cumbersome medico-legal procedures for organ donation, create transplant registries, and permit round-the-clock post-mortem examinations.
Unfortunately, subcontinental governments are coming under pressure to "ease" transplant norms through "incentives" and "organ-swapping." This is open to abuse.
Meanwhile, the problem of preventing Raut-style rackets
cannot be ducked. The inhuman practice of violating the bodies of ultra-vulnerable people must be put down and severely punished. This must provoke serious critical reflection on the neo-liberal economic policies we are pursuing, under which growth aggravates destitution. It must also trigger police reform.
Equally important, we need to-re-educate doctors on medical ethics and social responsibility. Our medical profession has been complicit in all kinds of malpractices. The phenomenon of India's "27 million missing women," caused by female foeticide, wouldn't have occurred without its active involvement in sex determination and abortion.
It's a shame that the state, too, is indulgent towards the perpetrators of this ghastly and shameful gender violence. So, a laughable 66 cases have been registered against doctors for sex selection in all these years.
Yet, there's a smart way of zeroing in on clandestine organ transplants. Their recipients are given immuno-suppressant drugs to prevent rejection, such as cyclosporin, tacrolimus and mycophenolate. These are only made by a handful of companies like Novartis and Roche, which know exactly which hospi-tals/clinics order them. They must be made to part with the information.
But will our governments muster the will to do this?
Praful Bidwai is an eminent Indian columnist