The Hindu : KIDNEY COMMERCE

Online edition of India's National Newspaper
Saturday, Jan 24, 2004

Opinion

Opinion - Editorials

KIDNEY COMMERCE

NINE YEARS AFTER trade in human organs was banned in the country, there is fresh evidence to show that kidney commerce is thriving in some States. Rather than isolate and stop the trade, the Transplantation of Human Organs Act 1994 has ironically become a handy tool for several hospitals involved in the racket. The Centre for Sustainable Development (India) of the Indian Institute of Technology (IIT), Chennai, has reported that there is evidence of a rise in kidney trade since the passing of the Act. Donation of a kidney by a living person not related to the recipient was made possible by the Act under Section 9(3) on the ground that the donor has "affection or attachment towards the recipient or for any other special reason." Such donation requires the permission of an Authorisation Committee set up by the State. The IIT report confirms that this loosely worded provision is the escape clause that enables the trade in kidneys.

Demand for kidneys in India greatly outstrips availability. An estimated two lakh patients with renal failure die each year, while one lakh fresh cases are added to the number of those already afflicted. More people could face renal failure because the incidence of diabetes and hypertension, major contributory factors for kidney failure, is also on the increase. Kidney disease gets scant attention in health policy in the country and the majority of patients receive little or no treatment. For those able to pay for a transplant, the first point of contact at some private hospitals is a broker offering to procure kidneys from unrelated donors. Studies show that almost all unrelated donors sell a kidney in an attempt to escape debt or deep poverty but in reality get sucked into a far more debilitating cycle of ill-health and greater poverty because they suffer neglect after donation and lose the confidence to work. This pattern has been documented in countries as diverse as Iran, where organ sale is legal, and India, where it is illegal and done clandestinely. Countries such as South Africa, Brazil and Mexico have reported organ trade facilitated by medical tourism.

With incontrovertible evidence available on the unethical and exploitative nature of kidney commerce, the focus must be on rooting it out without compromise. The first priority is vigorous prosecution of those operating organ sale rackets, as Karnataka has done. Equally important, the law has to be tightened, restricting unrelated donation to those with a demonstrable closeness to the patient. All donors must have their addresses independently verified to eliminate fraudulent transactions and the working of the Authorisation Committee and the Appropriate Authority, which scrutinises hospitals under the Act, has to become transparent. Tamil Nadu's recent move to ask patients from other States to get clearance from the Committee of the respective States to be eligible for a transplant has unsettled doctors. Many patients come from States that have not adopted the Act and have no Authorisation Committee. The measure might therefore curb some of the trade but makes no exception for genuine cases. Part of the solution lies in a comprehensive cadaver programme for donation of solid organs, building on the successful eye donation campaign. Efforts by non-governmental organisations to create an organ registry must receive wholehearted official support. Government hospitals need to be made aware that their reluctance to certify brain death even where international protocols are honoured wastes precious organs and indirectly aids kidney commerce. State Governments must treat renal failure as a public health priority and fund low cost dialysis. Customs duties and taxes on kits for dialysis must go.

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