How Poverty Fuels Black Market Of Human Organs

In May this year, Delhi police received a tip-off about an illegal kidney transplant racket operating from a private laboratory in Hauz Khas, an upscale residential and commercial area in the south of the city.

Sources said the gang that operated the racket offered Rs 1-3 lakh to homeless people to donate one of their kidneys. By the time the police set a trap and nabbed suspects on May 26, the gang had allegedly already performed 20 such illegal donations.

Illegal transplantations of organs, especially kidneys, are a nationwide phenomenon. Sources in the police said the Hauz Khas case was the third suspected racket they had busted within the past 15 years.

Mumbai Police in 2016 busted a similar racket at Dr L H Hiranandani Hospital in Powai, an upscale residential area in the centre of the city, and took into custody several doctors suspected to be involved in this racket.

“These rackets prey on poor people reeling from debt and desperation,” said Dr Sukrat Jain, a medical officer in Tikamgarh, a small town in Madhya Pradesh, about 250 km northeast of state capital Bhopal.

“A few cases in which doctors have been found facilitating these rackets gives a bad name to the medical profession,” he added.

Academic researchers, however, have found that it is often influential people who start and run these rackets.
Anthropologist Lawrence Cohen in a paper titled Where it Hurts: Indian Material for an Ethics of Organ Transplantation, published in 2003, claimed that donors in India often do so to pay off existing debts. The involvement of influential people like doctors, politicians, and bureaucrats in these rackets makes it difficult to collect evidence around it.

The kidney warehouse

Since the emergence of renal transplantation in India in the 1970s, the country has emerged as a notorious black market for organs.

Saradamoyee Chatterjee, a Lucy Cavendish College Associate at the University of Cambridge, in her paper The Illegal Kidney Trade: Who Benefits? writes: “The availability of low-cost, commercial organ donors was no challenge in a country where a vast section of the population lived below the poverty line.”

While India became the fifth-largest economy in the world recently, mass poverty continues to haunt it. A 2017 report by World Bank showed that about 20 per cent of India’s population lived below the poverty line — a situation that has probably been aggravated by Covid 19-related job losses and impoverishment.

Chatterjee provides a chilling picture of the modus operandi of organ trading rackets: “(S)couting small towns and city slums and lure people in need of money. The touts particularly preferred the slums, a goldmine for the organ traders, where the underprivileged surviving in appalling living conditions hoped to uplift themselves by selling their kidneys.”
India, for a while, has been known as the kidney warehouse of the world, she added.

Penalty no deterrent   

The law, however, forbids such commercial organ donations.

The Transplantation of Human Organs and Tissues Act, 2011, recognises only three types of donations. First, donations by near relatives —parents, siblings, spouses— to the patients. Second, altruistic donations, but it has to be vetted by the authorities concerned. And third, swap donations, where two donors can be swapped for better matches with their recipients. This, too, has to be vetted by the authorities.

For illegal donations, there is a fine of Rs 20 lakh to Rs 1 crore, and possible jail time.

However, the paucity of organs available for necessary transplantation in the country allows the black market to flourish.

The Directorate of General of Health Services shows that 1.8 lakh kidney transplantations are needed in India every year, but its website has registered only 6,000 transplantations between 1971-2016.

There remains a huge gap between official donations and unofficial and illegal ones.

Ill effects on legal donations

Doctors claim that news about illegal rackets deters people from volunteering as donors and convincing potential donors and their families can be an uphill task.

“The death of a person devastates their family and friends. Young and healthy people are the best donors, but a young person’s death is even more devastating for their family. There is a need for dedicated counselling of families,” said Dr Jain from Tikamgarh.

Dr Abhinav Anand, senior resident at All India Institute of Medical Sciences, Patna, said, “Hospitals lack dedicated teams to counsel patients.”

AIIMS, Patna, has the Organ Retrieval Banking Organisation to monitor donations and counsel family members. But few other hospitals do.

“The toughest task is when you break the news to the family. If there is a professional counselling team, the task becomes much easier,” added Dr Anand.

Rumours about organ thefts during the Covid 19 pandemic have only added to the challenges.

“Most people don’t know that a person suffering from a serious disease cannot be a donor. For instance, a person with hepatitis B cannot donate kidneys. There is a need to spread awareness,” said Dr Jain.