ORGAN DONATION. Rampant black market at one end, procedures steeped in legalities at another

In 2014, more than 4.5 lakh people met with death due to accidents. On the other hand, it is estimated that annually more than 2 lakh people lie in wait for corneas — an organ easily taken from a recently deceased person. Only 50,000 corneas are, however, donated in India.

Different sources place the number of people in need of kidney transplant at 1.5-2.2 2.2 lakh annually. However, less than 3 per cent, or between 3,000 and 3,500 patients, land one.

More than 95 per cent of these organs come from live donors, though the same could be taken from recently deceased or brain-dead patients, if their relatives agree to donate the organs. The country’s donor rate, at about 0.2 donors per 1 million people, is among the worst in the world.

The Transplantation of Human Organ Act, passed in 1994, makes ‘unrelated transplants’criminal and to only be allowed through a rigorous process.

However, while official records are hard to come by, it is estimated by doctors that more than 80 per cent of kidney transplants in India are unrelated.

While the law was aimed to eliminate illegal organ trade, it, along with the huge supply-demand gap, very few registered donors, low rates of donation from brain dead or deceased patients, and extreme poverty, have pushed illegal organ trade in the country deeper into the shadows, making regulation hard.

The Act states that approval from an authorisation committee is required before an unrelated organ donation can take place. The committee can be based at the State/regional level for small hospitals and, for a large hospital conducting more than 25 transplants in a year, the committee can be internal.

However, with little to no action against internal committees of hospitals where illegal organ trade has been exposed, such as in the recent case at Apollo Hospital in Delhi, the burden of criminal charges fall on the victims of such a racket.

Amar Jesani, Researcher and founder of Forum for Medical Ethics Society said: “The approving committee needs to be investigated…Besides the committee, the hospital is also supposed to appoint trained transplant coordinators that take a look at all aspects of such procedures, besides counselling relatives of brain dead patients to donate organs. Were they appointed?

“Such private hospitals don’t reveal minutes of their meetings, because they aren’t required to do so by law. But the lack of transparency and accountability has resulted in this kind of corruption.”

He was referring to the Apollo case, in which donors were arrested first and the hospital slapped a ₹10-lakh fine.

Ruing the lack of a movement for cadaver donations, Jesani agreed that the shortage of legally available organs is driving the black market based on a skewed market mechanism. It is estimated that in India over 2,000 kidneys are sold every year.

While the law has been able to curb the influx of foreign patients looking for organs, the domestic trade is still a concern. People from neighbouring countries are also reportedly brought into India on the pretext of monetary benefits.

While the recipients of illegally procured organs reside the world over, China, India, the Philippines, Turkey, Egypt, Moldova, Romania, Brazil, Bolivia and Peru are some of the biggest donor nations, according to the Transnational Crime in the Developing World report by Global Financial Integrity.

While several developed countries have restrictions on unrelated living donors and do not allow sale of organs, flexibility in rules allow two willing donors to donate organs to each other’s patients and or find matches in the organ waiting lists or even completely unrelated donors.

Amit Sengupta of the Public Health Foundation of India said: “There are several problems with organ donation in India. There are too few donors and even willing donors find it difficult (because of the system); then there are social issues such as lack of awareness, and cultural and social prejudices.

“What has not helped is the law criminalises organ donation that is not from a relative. The more you criminalise something (which is already in short) the more it goes underground.”

COMMENT NOW