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The Great Kidney Bazaar

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By TT Bureau
  • Published 13.11.11

Srikanta does not beat around the bush. After all, it’s a matter of life and death and spells big money for him. “Her kidney size is 10-11cm,” he says in a business-like way. “Normally, 9cm is considered a healthy organ. So she will give you a healthier kidney,” says the 30-something man dressed in a crisp white and blue striped shirt. Accompanying him is Meghna, a petite woman in her mid-twenties, who hails from Canning in West Bengal.

Srikanta is peddling kidneys. Meghna’s fresh young kidney, to be precise. He is meeting a prospective buyer in a snazzy mall on the southern fringes of the city. Srikanta is, in fact, a tout or middleman who finds organ donors for patients in need of kidney transplants, especially those who cannot — or will not — get a family member to donate a precious kidney. Kidney sale is banned by law in India and draws stringent punishment. But the likes of Srikanta and Meghna don’t seem to care about that.

The deal is finally struck at Rs 3 lakh for a kidney and some extra money for forging documents. While Srikanta doesn’t divulge his “cut” from the deal, Meghna says she needs the money to pay off her debts and make ends meet as her husband is out of work and she recently lost her job in a telesales company.

The interaction with Srikanta and Meghna gives one a glimpse into how organ trade is being carried out with impunity in West Bengal. At a time when all other states in India are refusing to allow non-related donation to curb organ trade in accordance with the rules laid down by the Transplantation of the Human Organ Act, the practice is flourishing in Bengal.

An unsuspecting Srikanta divulges some tricks of his trade to the person posing as a “buyer” acting on behalf of a sick relative. “I advertise in newspapers for donors,” he says. “I get countless applications and I can pick and choose. I came to know Meghna through an ad as well. Her blood group matches your patient’s. We’ll get the tests done.” He is referring to HLA (Human Leukocyte Antigen) testing that is required for a kidney transplant match between recipients and donors.

Srikanta rattles off the names of top private hospitals in Calcutta where he can facilitate non-related live kidney donation. He can also recommend doctors. And he seems to be fully conversant with all the medical steps leading to a successful kidney transplant.

He is also a Mr Fix-it. The “buyer” informs him that the patient, who is based in Mumbai, wants to get the transplant done in Calcutta as the authorities in Maharashtra have become extremely strict about allowing non-related live kidney transplants. He is also told that the health ministry in Maharashtra has refused to give the patient an NOC or a no-objection certificate (those who want to get a kidney transplant done in a state other than their own have to get NOCs from the health departments in their domiciles).

“No problem,” says Srikanta promptly. “We’ll have to establish that the patient is a resident of Calcutta. For an additional fee, I will arrange all the relevant documents — voter ID card, PAN card, ration card or even house deeds. Just bring some photographs!”

Srikanta is obviously a tip of the proverbial iceberg. Health activists and even medical practitioners allege that a nexus among touts, hospitals and doctors has led to West Bengal becoming a hub of kidney black marketing. So much so that people from other states and other countries have been flocking to Calcutta to get kidney transplants done here.

It’s a thriving kidney bazaar here,” asserts Abhijit Taraphder, a city-based nephrologist, who’s crusading against the practice. “It is being said that Calcutta and Singapore are the two kidney transplant tourism centres in this part of the world.”

“It’s an open secret,” admits Dr Rajendra Pandey, professor, department of nephrology, IPGMER at SSKM Hospital in Calcutta. “No other state is allowing non-related transplants.”

Though most health experts balk at going on record about the existence of organ trade in Bengal, Calcutta’s reputation as an unrelated kidney transplant and donor centre has travelled far and wide.

“It is well known that Calcutta is the hub of unrelated organ donation,” says Sandeep Guleria, senior consultant surgeon (general surgery, GI surgery and transplantation), Indraprastha Apollo Hospitals, Delhi, who’s also associated with the Indian Society of Organ Transplantation (ISOT), a body which disseminates information about transplantation and creates public awareness about organ donation.

Even international health experts are aware of Bengal’s reputation as the place where you can easily access a kidney donor — for a price. “I know of a woman from New York who went to Calcutta, put an advertisement in the newspaper and bought a kidney with no difficulty at all,” says Dr Francis Delmonico, professor of surgery, Harvard Medical School in Boston, Massachusetts, and president-elect of The Transplantation Society (TTS), an international non-profit organisation based in Montreal, Canada.

Although official statistics regarding the number of unrelated kidney transplants in Bengal are hard to come by, sources reveal that on an average 40-50 live transplants are carried out in the state every month and that 80 per cent of all kidney transplants in the state are non-related.

Doctors say that at a time when the number of live transplants is declining in the rest of India, Bengal is witnessing a surge, especially in non-related ones.

Consider the latest figures from the ISOT (covering a few hospitals across the country) registry. Between 2003 and 2008, the number of live kidney transplants in India has gone down from 1,024 to 569. For the same period, the number of cadaver transplants (transplants done with the help of organs from deceased persons) has gone up from 32 in 2003 to 125 in 2008. This data excludes figures from West Bengal because, apparently, hospitals in the state do not participate in the registry. Health activists say that this is because they have to divulge the names of unrelated donors and the number of unrelated kidney transplants they do.

Experts say that in a state like Tamil Nadu, the rise in kidney transplants from cadaveric donors has stamped out organ trade. Dr N. Gopalakrishnan, head of nephrology, Madras Medical College, says, “In the past Tamil Nadu had the dubious distinction of being a hub of illegal kidney donor trade in India. The government curtailed it in 2008 when it removed the bottlenecks in the Cadaver Transplant Programme (CTP). Kidney transplants in Tamil Nadu now largely take place through living related donors.”

Adds J. Amalorpavanathan, head of the CTP, “Between October 2008 and October 2011, 399 kidneys have been donated by cadavers. Yearly, cadaveric donations account for about 80 kidneys, and we hope to take this number to 150. If we are able to do that, and if 100 kidneys come through close relatives, we will be able to meet the kidney transplant requirement in the state.”

As opposed to this, in Bengal the state authorisation committee received around 400 applications for unrelated kidney transplants between January and October 2011. (As per the law, the authorisation committee screens applications only for unrelated organ transplants. Organ donation from family members do not need its approval).

Yet, despite the fact that kidney touts like Srikanta are making a healthy living, the committee hardly rejects any application. “During my tenure I haven’t rejected any application from unrelated donors,” says S.K. Bandyopadhyay, director of medical education (DME), government of West Bengal, who heads the authorisation committee. “Unlike other states which reject applications, we are very lenient here,” he admits.

Doctors in other parts of India know this all too well. Take Dr D. Chopra, an orthopaedist based in Delhi, who has brought his relative, Ritwika, 27, to Calcutta for a kidney transplant. Several members of Ritwika’s extended family have done their non-related kidney transplants at a private hospital in Calcutta. “We’ve heard the hospital is quite good at facilitating transplantation,” says Dr Chopra. “We have found a donor in Calcutta and put in a word with the hospital to send our papers to the authorisation committee as quickly as possible.”

Dr Mohan Seal, transplant surgeon and owner of Remedy Hospital in Calcutta, says he gets two to three patients from Delhi and other places daily. Besides, patients come to him from the US, Canada, Switzerland and even Israel, he claims. In fact, Remedy — a 25-bed hospital near Moulali — is one of the busiest centres of kidney transplant in the city. “I have done 500 transplants since 1988,” informs Dr Seal.

Even a Delhi High Court judgment mentions Remedy’s role in kidney transplants. While deciding on a case where a patient was denied an NOC from Delhi’s health department for a transplant in Calcutta, the court noted, “The respondent (the department of health and family welfare) was issuing NOCs; however… the practice has now been discontinued, finding commercial trade in human organs being involved and further finding that residents of Delhi were flocking to Remedy Hospital, Calcutta, for such transplant.” Ultimately, the court did direct Delhi’s department of health and family welfare to issue the NOC to the patient.

It’s not just the ease of getting the paperwork processed that draws kidney transplant patients to Calcutta. It’s also because donors are easily available and they come from all over Bengal and even from Bangladesh. “My donor came from a very poor family near the Indo-Bangla border. They are a family of professional kidney donors,” says Partha Pratim Chaudhury (name changed), 46, who underwent a kidney transplantation recently in Calcutta. Chaudhury paid Rs 3 lakh for the kidney, which is supposed to be the “standard rate”.

However, the official refrain from all hospitals in Calcutta is that there are checks and balances to ascertain the authenticity of donors. “We always encourage live and related donor transplants in all our hospitals,” says Dr Rupali Basu, CEO, Apollo Gleneagles, Calcutta, and CEO, Apollo Group, Eastern Region. “But we do carry out unrelated transplants, and only after all the legal formalities are completed and we get approval from the authorities concerned.”

Dr Seal echoes her assertion. “People come to Remedy because of our transplantation facilities. Our donors constitute a combination of related and non-related persons who give their kidneys for emotional reasons. We take extreme care in selecting donors keeping in mind the state of their health and we also confirm their identities and check their papers thoroughly.”

But the state authorities say they simply do not have the infrastructure to ensure that financial deals are not taking place in cases of non-related kidney donations. “We have a team of experts who scrutinise papers and grill the donors. But we don’t have the machinery to check whether financial transactions are occurring on the sly,” says DME, S.K. Bandyopadhyay.

Some doctors actually feel that kidney sale cannot be condemned outright and that it has a “social angle”. “A father has donated a kidney to marry off his daughter,” says Dr Seal. “In our country, we have no social security to help the poor. So first develop infrastructure for the poor and then blame doctors.” Meghna, kidney tout Srikanta’s find, also does not believe she is doing anything wrong by selling one of her kidneys, illegal though it may be. “It’s better than prostitution, right,” she asks.

These arguments are specious, counters Dr Guleria of ISOT, “There is no excuse for breaking the law. Any kind of money exchange in organ transplantation is condemned by us and global organisations like WHO,” he says. “Calcutta has brilliant expertise, but that shouldn’t be used to fuel organ trade,” adds Dr Sunil Shroff, managing trustee, MOHAN Foundation, Chennai, which works to implement cadaver donation in Tamil Nadu, Andhra Pradesh and Kerala.

Indeed, the fact that West Bengal lacks any kind of cadaver organ programme is one of the main reasons for the continued practice of non-related organ donation in the state. “It’s high time Bengal wakes up to the possibilities of deceased donation programmes that can stop unrelated transplant altogether,” says Dr Shroff, citing the progress that states like Tamil Nadu have made in this regard.

Until that happens kidney touts like Srikanta will have a field day.