Shantanu Dutta, 19 September 2007, Wednesday
The number of people succumbing to kidney failure in India often goes unnoticed. To make matters worse, renal therapy is costly. Legislation on the subject is fraught with practical difficulties. This is where the kidney-selling racket kicks in.
ONE OF THE lesser known stories in India’s health sector is the number of people dying of kidney failure every year. In over 90 per cent of the people developing kidney failure in India, the outcome is death. In 2004-05, it is estimated that over 1,00,000 people died because of kidney failure. Renal disease remains a major, though largely unrecognized, public health issue in India. An estimated 1,00,000 people develop end-stage-renal-disease or chronic renal failure every year. This is in addition to a pre-existing pool of about 20,00,000 sufferers. A person with chronic renal failure requires renal replacement therapy in the form of either dialysis on a continuing basis or a renal transplant. Both are expensive options that require recurring expenditure over the person’s lifetime. Further, treatment for renal disease is still largely in the private healthcare sector, where costs are high.
This is where the kidney-selling racket kicks in. The relevant legislation in India, viz., the ’Transplantation of Human Organ Act’, 1994 (THO, 1994) deals with organ donation in the country. It has since been possible to undertake multi-organ transplant activity from brain-dead donors.
The purpose of the law is:
1. To define brain death also as death
2. To stop commercial dealing in organs
3. To define the first relative (father, mother, brother, sister, son, daughter and wife) who could donate organs without permission from the government. In the event of the donor not being a first relative, an approval has to be obtained from a government-appointed Authorization Committee in each State of the country.
Such a racket thrives in India in spite of the regulatory framework because cadaver organ donation has never really caught on in India, either in terms of response from prospective donors or in terms of the requisite hospital infrastructure. 60,000 accident cases are reported in India every year.
While many of these victims are brought to the hospital in a brain-dead state, their organs are not efficiently harvested for the following reasons:
• Many of these victims are not even attended to in hospitals, as they are expected to be shifted to referral or government hospitals. While this happens, the victims die.
• Brain-death certification is to be given by an approved neurologist. There are not many of them around. They must be available when the accident victim is brought in. They must have the infrastructure to conduct the tests before declaring that the patient is brain-dead. After this is done, an organ bank has to be coordinated with. In many places the trauma / neuro unit is not located close to the organ bank. Hence the effort is quite often not made and sometimes it is made too late.
• Most people inherently fear donating organs, post-death.
How does one respond to the kidney racket? Typically the response should come from the police; they should use a piecemeal approach and enforce the law with an iron hand; they should arrest some of the guilty medical professionals and some donors who have sold their kidney since sale of human organs is an offence. Somehow I don’t think that the legal and police response will really work in India. There will always be poor people in the country and there will always be people willing to pay for the organ the poor people sell.
I think other ways will work better than this coercive way. In a country of a billion plus where people sell their daughters for Rs.10.00, why would a man not sell his kidney for a significantly higher sum of money? He would and no law can stop that practice because he has his own compulsions which outweigh all other considerations. So what would work?
Firstly, simplify the law, especially for cadaver organ donations. The present system which lays down that organs can be harvested only from brain-dead cadavers and brain-death has to be certified by a neurologist is rather utopian. Where on earth will we find all this manpower? Also in a country where people do not exactly line up to donate their organs and the mourning relatives want to complete the last rites, the requirement of certification will only kill whatever little inclination exists to donate kidneys as well as other organs. The law needs to be humane in other ways too. In case the donor of a kidney is a non-relative, he or she has to prove that he or she has a special affection for the recipient which has motivated the donation. Genuine benefactors might be hard put to demonstrate the reasons for their affection, but this is where the racketeer has his script ready.
Secondly, organ donation has to become a mass movement like blood donation has become in many parts of the country. There was a time when mobilising blood for a patient was something of a nightmare because there were myths and stories associated with the after-effects of blood donation and what it might do to a person. But once those myths were unravelled and revealed for the old wives’ tale that it was, the fear attaching to blood donation vanished and today on occasions like Republic Day and Independence Day, blood donation camps are effortlessly arranged. NCC cadets and NSS students also participate in such camps.
The same game needs to be played out in respect of organ donation too by invoking religious texts and roping in the services of teachers, if need be. The teachings of the various religions need to be explained and interpreted in a manner that will put to rest the fears and apprehensions of the people, somewhat akin to the way in which the services of the Maulavis are being sought to dispel fears about the polio vaccine among Muslims with at least some degree of success.
Let us remember that it is estimated that every year over 100,000 people are diagnosed as having kidney failure in India. Due to various reasons, including the non-availability of organs, only about 2,500 kidney transplants are done. In a country of our size, it is a very, very small number indeed.
Other Article(s) by Shantanu Dutta
Social responsibility - Not just corporate responsibility
The school that Anna built
Healthcare: How the Church can stay relevant
The World of Global Conversations
Battle for the ‘third space’