Why it is difficult to cut out organ black-marketers

Catch them young India requires about two lakh kidneys but only 2 per cent of this demand gets met

Sophisticated fraudsters continue to sell body-parts, despite stringent laws. Can the Israel or Singapore models work?



It was during a visit to a Chennai colony over 20 years ago that one became painfully aware of the disturbing practice of organ trade. The vulnerable residents there, largely living with leprosy, were targeted by middle-men to sell their kidney to individuals who desperately needed one.

Soon enough, the government stepped in and put in place stringent laws to stop the commercial trade of organs. After all, the reputation of doctors, the state and eventually the country itself was at stake here.

It is for this very same reason that the kidney racket reported from Delhi’s Indraprastha Apollo Hospital last month needs to ring alarm bells. The incident did not happen in a back alley in a remote part of the country, but in the national capital, seat of both the Delhi State and Union Governments.

As investigating agencies unravel how deep the rot may have spread in the Delhi case, doctors complain that it is becoming increasingly difficult to call the bluff of scamsters. Despite approval committees at State and hospital levels that assess every organ donor and “related” recipient, frauds seem to happen. And it’s not always because there are black sheep in the medical fraternity, says a doctor unwilling to be named.

In some cases, the donors and recipients are able to furnish fake Aadhaar cards and documents to prove they are related, there is no way even a committee of doctors can spot the fraud here, says the doctor. Future committees may need to include forensic experts and interrogators to sniff out such frauds, he says. Sunil Shroff, Managing Trustee with Chennai’s Mohan Foundation, echoes these views. “Doctors cannot police each case,” he says, adding that passports and ration cards are fabricated to prove that the organ donor and the recipient are related (as mandated by law).

As a kidney surgeon himself, Shroff says, despite having stringent procedures to weed out fraudsters, “later we (have) realised we were duped”. The case involved a woman and a person who was supposedly her son.

Such incidents can take place even in the best of institutions, he says, admitting that in some cases it could involve bad eggs in the profession.

The Transplantation of Human Organs Act, 1994 and subsequent amendments have brought in checks, punishment and penalties on frauds. A huge deterrent is the fact that the doctor’s image can get tarnished if he or she is linked to such frauds, he says.

Go public

Amar Jesani, Editor with the Indian Journal of Medical Ethics, observes that a hospital cannot absolve itself from an incident of fraud happening in its portals, as every organ transplant is overseen by a committee of doctors including those not involved with the surgery, such as psychiatrists.

The Apollo incident provides a unique opportunity to bring in greater regulatory governance, says Jesani. The system needs to be made more transparent and the process, transplant decisions, minutes, etc., need to be in public domain, he says, even as patient names are kept confidential.

Donor initiatives

Shroff says that frauds can be plugged if the donor-recipient shortage is addressed, and the number of voluntary organ donations increases substantially. At any given point in time, India reportedly requires about two lakh kidneys but only 2 per cent of this demand gets met.

Israel and Singapore encourage people to become donors by promising to prioritise their case if they ever need an organ later. Those not interested in volunteering can opt out. Another more debatable initiative exists in Iran, where a donor is legally paid, but under the government’s watch. But Iran is set to review it, says Shroff.

As the demand increases for organs (kidney, liver, heart, other tissues), a key method to outlaw the commercial trade of organs is by increasing voluntary supplies. And for that much greater awareness is needed. Last year, Prime Minister Narendra Modi’s Mann ki Baat spoke of voluntary organ donation.

And earlier this week, Apple said that iPhone users would be able to sign up for organ donation though an app. Its initiative was a recognition of the “excruciating” wait no less than Steve Jobs had to go through for a liver transplant in 2009.

Published on July 08, 2016
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