Gurgaon no exception

The incident of organ trade is shocking but not surprising in a country where there is an annual demand for 150,000 kidneys, while the transplants remain only 3,500. It's time authorities streamlined organ transplant law

The kidney excavations at knife-point has been among the biggest stories during the last two weeks. The principal targets are three -- the police for conniving with and even facilitating the macabre organ digger, the health authorities for not doing enough to stop organ trade and medicos for hoodwinking and causing the poor to bleed (sometimes to death.)

The story revives memories of Robin Cook's novel and the film Coma (1978) which unraveled a grotesque story of how young men and women visiting a particular hospital for a simple procedure, were deliberately rendered comatose; to be strung up brain dead until their livers and kidneys were harvested by ruthless auctioneers operating a bizarre global organ trade.

The Gurgaon kidney scam is no less wacky. The difference is that in the novel, the victims were young, educated, independent and able-bodied. The Gurgaon outfit sounded rudimentary and the victims were poor, illiterate and defenceless. The only reason why it made so much news was because at long last at least one racketeer had been nabbed. Otherwise, accounts about South Indian fisherfolk ravaged by the tsunami selling off a kidney each for Rs 50,000 and 50 per cent of village populations in Pakistan living on one kidney have been recounted for years; as have been reports about thousands of organs purloined from Chinese prisoners fated for execution.

But the exposé and the notoriety that surrounds the Gurgaon scam demand wider thinking about the issue. Kidneys are the most frequently transplanted organs (around the world). In a country where poverty is ubiquitous, life is cheap and demand outstrips the supply, strategies have to be practical. Several countries have a solution whereby the donor has to explicitly dissent to organ donation during his lifetime.

In the US, the regulation of organ donation is left to individual States within the limitations of the Federal National Organ Transplant Act, 1968. Many States in the US have encouraged organ donation by allowing the donor's consent to be entered on the driver's licence. Thereafter, state regulations lay down the systems and processes to be followed.

In the early 1990s when I was the Secretary for Medical and Public Health in Delhi, doctors and policemen made several suggestions. Pass a law, they suggested, that in case an accident victim's body is not claimed on the spot, the organs may be harvested at a designated facility and used according to the registry of needy recipients. Looking at the number of accident cases involving young people, it will be easy to operationalise this strategy, particularly if it were coupled with the consent given on the driving licence.

Efforts have been on for decades to persuade the public to donate just corneas -- far less threatening than retrieving kidneys, but to little avail. Aishwarya Rai has fluttered her gorgeous lashes on countless television commercials encouraging people to pledge their eyes (like her), but the supply remains woefully short. The Economic and Political Weekly writing editorially has referred to an annual demand for 1,50,000 kidneys while the transplants remain only 3,500. The well-intentioned 1994 Organ Transplant Act has clearly failed to prevent the illegal trade of kidneys because criminals would hardly present themselves before the authorisation committee to humbly seek permission.

The recent comments by the Chief Justice of the Supreme Court that the problem is with the implementation and not the law appear to address the enforcement angle. However, no less important is the fact that in a country where poverty drives people to sell their land, house, livestock, jewellery and even children, what is the value of a kidney for the love of money? Especially when it is possible to live perfectly well on its pair?

There is also the whole question of the emotiveness that surrounds death. Whether Indians exhibit their feelings more or less is not the point. In the Indian context, when funeral rites are given such enormous importance, few families would be willing to face the additional trauma of waiting for organ removal in a hospital setting. It is not that the idea of harvesting organs or the establishment of organ banks should not be pursued. The point only is that it will take a long time to convince families overwrought with grief to take decisions and get embroiled with hospitals and operation theatres for one minute longer than necessary. The consent on the driving licence is perhaps a good way of giving freedom to the individual, but also to the police to whisk away deceased accident victims for organ retrieval while preserving the body for the last rites.

Second, it is the fundamental duty of every local Government to build awareness among poor people that they might be compromising their lives by agreeing to donate a kidney. For starters, all construction and building contractors should be enjoined under municipal regulations to display a film about the harmful effects of kidney removal, for all hired labour. The message may yet percolate to a wider group of poor people -- particularly those living in urban areas where nursing hospitals, homes and kidney seekers abound.