The police crackdown on the illegal trade in kidneys in Ramanagaram district merely scratches the surface of what appears to be a thriving racket that involves agents, sub-agents, multi-speciality hospitals and top doctors, who together form an intricate and exploitative network facilitating the sale of kidneys by impoverished donors to affluent patients suffering from end-stage renal disease.

This racket flourishes unchecked in neighbouring Mandya district, despite the police crackdown in 2002 that identified the district as a hotbed for kidney trade. Little seems to have changed since then, it would appear, as women such as Sujatha (39), Thimakka (45) and Asha (36) have managed to circumvent the law with relative ease, and earned themselves what they see as a ticket out of poverty, and more specifically, indebtedness.

In their village, Halebudunuru -- comprising 1,300 households -- there are at least 10 women who have sold their kidneys in the past three years, residents say. The two women, who fleshed out the contours of this racket, told The Hindu the standard procedure involved being "chosen" by a tout, making weekly trips to Bangalore for medical tests, short meetings with the donors, and a string of false testimonies before the police and court committees where they attest to having “close relations” with the recipient, and finally, payment before surgery. The cost of a kidney ranged between Rs. 70,000 and Rs. 3 lakh.

Sujata, a daily-wage labourer at the diary co-operative here, ‘donated’ her kidney in January 2011. She says she thought this would tide her over her debts, which spun out of control after her daughter’s wedding and dowry, which cost her Rs. 2 lakh, a spate of illnesses in the family and educational expenses for the children. To escape her insurmountable burden, she sold her kidney for Rs. 1.5 lakh to a senior judicial officer, whom she met for the first time at a leading multi-speciality hospital in Bangalore. “I was taken to court where I had to say that I had worked as his domestic help for 20 years,” she said, fully aware that the entire transaction was illegal. “But what else could I have done?” she asked, pointing out that being landless, they had no option but to “sell all that they owned”. Two years later, she says her health has deteriorated; she suffers from acidity and breathlessness, and severe back pain.

Tragically, this transaction did not rid her of her debts. The post-operative pain prevented her returning to work for a year. “In retrospect, I am back where I started.”

Like many women in this village, Sujata has borrowed heavily from microfinance institutions (MFI). Two years after she paid off a chunk of her loans, her credit situation is no better. Her current equate weekly microcredit payments (from four MFIs) total Rs. 1,670. A quick calculation reveals that the interest rates for all these micro loans range between 40 and 60 per cent. Her husband has also many outstanding loans from private moneylenders.

For Ms. Thimakka (45), selling her kidney did bring her respite from a large chunk of her debts. Thimakka sold her kidney to a Mandya businessman, posing as his brother, for Rs. 3 lakh. The transplant was done in a leading multi-speciality hospital in Bangalore, where she says many similar cases were taken. Thimakka too was part of two microcredit groups and had borrowed heavily from private moneylenders. Ask her why she decided to take such an extreme step, and she snaps: “With recovery agents at your doorstep every day, offending you and threatening you, what else do you do? Who do we turn to for help?” She claims it has not impacted her health, and quickly adds, that even if it did she would have no remorse. "My life with all those loans was worse than death. I was scared to get out of my house, and go to work at the dairy. I was trapped," she says.

But, residents here allege, that since then she has encouraged others too to do what she did, and put them on to touts.

The loophole

The sale of organs is prohibited under the Transplantation of Human Organs Act 1994, which was amended in 2011 to expand the definition of “near relatives”, include harsher punishments for unauthorised removal of human organs and for receiving and making payments for human organs. However, even the new law retains the loophole that permits unrelated persons to donate organs after deposing before an authorisation committee.

(The names of the women have been changed to protect their identities)