Busting illlicit organ trade is imperative. Equally important is creating awareness on donations, making processes transparent

Last week’s busting of a network of kidney traffickers in Delhi evokes a sense of déj vu. In the last week of May, a similar racket was unearthed in Pune. The latest scam in Delhi is the third such incident in the capital in less than 15 years. Like in most such cases, the web involved doctors and other healthcare personnel, hospital administrators and donors who have fallen on bad days — they cater to patients with end-stage kidney diseases who cannot be treated with medicines or dialysis and require a transplant. Reports and surveys suggest that more than 1.5 lakh people in the country require such a procedure every year. However, the number of organ donors is a small fraction of this requirement. In Delhi, for instance, barely 10 per cent of renal failure patients manage to get a transplant. Therefore, while the cleaning up of what medical anthropologists refer to as “kidney zones” is imperative, stopping the illicit trade would require plugging the vast gap between patients’ needs and the organs available for harvesting.

The Transplantation of Human Organs and Tissues Act, 2011 recognizes three kinds of donations by living organ donors. Those by near-relatives (parents, siblings, and spouses), altruistic donations and swap donations when a near relative is medically incompatible with the recipient, the pair is permitted a swap transplant with another related unmatched donor-recipient pair. The black market in organ trade flourishes by disguising illegal trafficking as “altruistic donation”. That in case after case — including the latest scam in Delhi — the desperately poor are lured into selling their organs speaks of the failure of the procedures that aim to establish the donor’s “altruism”. Suggestions to increase the transparency in the work of committees that scrutinise organ donations have been largely ignored by the country’s medical authorities.

In recent years, the “opt out” system — it assumes all citizens to be willing organ donors after death, unless they “opt-out” of doing so — has gained currency in several Western countries. However, medical ethicists caution that such a policy may not always be sensitive to the families of the deceased, especially in countries where awareness of organ donation related issues is low. India’s organ transplant law recognizes cadaver donations with family approval. However, declaring a person brain-dead in time for the organs to be harvested is a complicated procedure and most hospitals in the country would be hard put to summon the expertise and facilities required for this purpose. With the number of people suffering lifestyle diseases increasing exponentially in the past two decades, addressing such challenges, in an ethical manner, cannot be postponed for too long.

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