Sunday, 3 February 2008

Kidney racket: Change of heart will end illegal bazaar

February 3, 2008
Hyderabad: A change of heart among the general populace on organ donation is what is needed if the illegal sales of kidneys are to be curbed, medical experts feel. The racket thrives on the taboos which people entertain on transplanting organs of their dear and near ones who die.
"Every day we come across several brain-dead cases and if the relatives agree to donate the organs we can save several precious lives," says the eminent nephrologist, Dr T. Ravi Raju, superintendent of King George Hospital in Visakhapatnam. "We will also be delivering a major blow to the illegal organ market."
As such, it is mostly the poor who sell their kidneys for a pittance and it is mostly the rich who get them. Once in a while, some persons involved in the racket and caught and there is a big hullabaloo. After a while the noise subsides and things go on as before. A massive illegal kidney sale racket was busted in Guntur district of Andhra Pradesh during 1997-99. After nearly a decade, the Union health ministry has once more expressed "concern" over the issue after the exposure of a similar racket in Gurgaon.
However, in the interregnum, more than 1,500 people are estimated to have sold off their kidneys after being lured by touts and unscrupulous doctors. The occasional arrest of an agent or a doctor does not change the scenario at all.
For one, the victims rarely lodge a complaint with the police since they had voluntarily sold their organs. The poor people sometimes use this money to clear their debts or marry off their daughters. It is in this context that many health experts have suggested the need for an "attitude change". This may be the panacea to this particular menace.
"A well-run cadaver donation programme will bring down the illegal sale of kidneys," says eminent surgeon Dr J. Harsh. "There won't be any shortage of organs then."
Though Union health minister A. Ramadoss has suggested amendments to the Transplantation of Human Organs Act, 1994, medical experts and health planners say there is no need for any drastic change.
What is needed is creation of awareness among people about the nobleness involved in donating the organs of relatives who are declared brain dead.
They also want the bureaucracy to clear applications for organ transplants in the shortest possible time. At present, the government takes at least a year to clear the application, giving a fillip to the illegal organ market.
"We do not understand why officials take 12 to 18 months to clear applications on organ transplantation," observes senior endocrinologist, Dr C. Padmavathi. "Those patients who cannot wait too long often approach agents to purchase kidneys from poor and illiterate villagers."
Since there's no fixed price for kidneys, agents pay a paltry sum to the poor villager and pocket the rest of the money.
The government says it is difficult to trace illegal kidney rackets, but medical experts say that all sleuths have to do is keep track of specific medicines used for such transplants.
"Only a couple of companies manufacture such drugs and if you keep a watch on medical stores and drug dealers, you can find out where and when a kidney transplant has been done," points out senior nephrologist Dr M. Ammanna of Vijayawada.
Dr N. Kishore, president of Indian Medical Association in Guntur, says that the government should increase the jail term for those who promote illegal kidney sales.
He adds that after the Andhra Pradesh government tightened rules touts were taking poor people of Guntur to places such as Delhi for transplantation.
"Poverty is also a major cause," he points out. "Unless that is addressed, poor farmers in drought-hit areas will continue to sell their kidneys and livers."
Way back in 2004, the National Human Rights Commission dashed off letters to the Prime Minister and chief ministers pointing out that the "compassionate donor" provision in the Human Organ Transplantation Act was being abused. "In many cases, the donor is an unrelated and unacquainted person who is lured into donating an organ…by financial offers made by or on behalf of the prospective recipient," said the NHRC. "The practice of organ purchase has acquired the dubious dimensions of organ trade with touts operating as middlemen."
Ironically, what the country needs urgently is the use of the "compassionate donor" clause, in its genuine sense.
NHRC Guidelines that were never followed
1. State Medical Councils should screen the records of hospitals performing organ transplants and estimate the proportion of transplants which have been made through a "compassionate donor" mechanism.
In case of kidney transplants, wherever the proportion has exceeded five per cent of the cases performed in any of the past five years, the State Medical Council should initiate a full fledged enquiry into the background of the donors and the recipients, as well as a careful documentation of the follow-up health status of the donor and the nature of after-care provided by the hospital concerned.
2. Wherever police enquiries are needed for such background checks, the help of the State Human Rights Commission may be sought for providing appropriate directions to the State agencies.
3. Cadaver transplant programmes should be promoted to reduce the demand for live donors.
4. Facilities for chronic renal dialysis should be increased and improved in hospitals, to provide alternatives to kidney transplantation.
5. Better facilities should be provided for transparent and effective counselling of prospective donors.
6. Wherever possible, a mechanism should be established for independent verification of the veracity of "compassionate donation" by a group of experts which is external to the hospital wherein the transplant procedure is proposed to be performed.

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