Chronic corruption and lack of affordable access to treatments for serious diseases in the public health system stand exposed in the kidney commerce scandal in Tamil Nadu’s Dharmapuri district. Nothing can be a greater irony than the existence of such thriving sale of organs in a State that also has perhaps the best-run programme for donation of kidneys, livers, hearts and lungs by deceased donors. It is no small achievement that Tamil Nadu’s cadaveric donation rate for organs was reported last year to be nearly ten times the rate for India as a whole. With no ethics complaints on the distribution of organs by a government-appointed administrator, the programme is now globally acknowledged; its contribution in less than five years has been an impressive 1036 major organs, 641 of them kidneys. Yet, the vast gap in demand and supply to treat people with end-stage disease leaves plenty of room for unscrupulous medical professionals, corrupt bureaucrats and middlemen to trade in organs. In a country with an incidence of 232 people per million developing end-stage kidney disease, and a growing burden of diabetes and hypertension contributing to renal failure, States serious about closing organ bazaars should be looking not just at shady hospitals, but at their public health policies.

There is a compelling case for the Tamil Nadu government to institute an enquiry into the working of the Authorisation Committees, which, under the Transplantation of Human Organs Act, 1994 have been sanctioning transplants from living donors as in Dharmapuri. It would raise public confidence in the process if the in camera system of functioning is replaced with independent oversight, monitoring by civil society observers, videography of proceedings and publication of data in the public domain. Sunlight is the best disinfectant, and the mould of corruption can be quickly removed. Even so, a systemic clean-up cannot augment the supply of organs — the volume of patients requiring therapy is simply unmanageable, and more are added to the list constantly. To reduce the demand for organs, States have to, perforce, build capacity in district hospitals to offer free or nearly-free haemodialysis for patients with kidney failure. A second priority should be to heavily subsidise home-based peritoneal dialysis. This eminently feasible intervention in a fast-growing country will prolong life, and reduce the impoverishment of patient families. It is equally vital that official policies help prevent organ failure in the first place: by encouraging blood sugar control, legally curbing salt levels in packaged food, and making blood testing facilities widely accessible and affordable.

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