All South Asians must be shocked at the ghoulish kidney transplantation racket unearthed near Delhi, with ramifications across several nations. Dr Amit Kumar alias Santosh Raut’s operation involved 3 hospitals, 5 diagnostic centres and 10 laboratories, and more than 50 accomplices, including doctors and nurses, “spotters” and touts who would lure potential donors with the promise of jobs, and thugs who would force them to part with their kidneys. The 600-odd recipients included nationals of half-a-dozen countries The racket was unearthed at the initiative of an earnest young female police officer, Manzil Saini. But it couldn’t have been conducted for years without collusion on the part of the police. Raut was repeatedly arrested since 1993, including in 2000 in Delhi. Raut escaped because he was tipped off. Two Greek nationals in contact with his set-up were also allowed to leave India. What demarcates Raut’s racket from the illicit kidney trade which flourishes in many South Asian cities is muscle power. Typically, it’s extreme economic distress that compels poor people to sell their body parts. But Raut’s goons would abduct their victims and dope or beat them into agreeing to excision of their kidneys. This highlights the gravity of the comprehensive police failure in enforcing the law, India’s Transplantation of Human Organs Act (THOA) 1994, which illegalises the sale of human organs, both direct and masked in “rewards”. The Act allows organ donations by close relatives without government clearance. All other relatives who wish to donate must be cleared by an Authorisation Committee. THOA however has a big loophole. It dispenses with the Committee’s approval if the donor feels “affection” or “attachment towards the recipient”. This is licence for abuse. The Raut racket follows a pattern that’s familiar to Pakistanis as well as Indians. Rich clients suffering from end-stage renal disease, many of them foreigners are contacted by an international organ trade network at the centre of which are unscrupulous doctors who prey upon the poor, who are often in deep debt. They’re misled into believing they’ll get jobs and induced into selling a kidney for as little as Rs 40,000 to Rs 1 lakh. The international kidney bazaar is highly evolved, with extensive cross-border transactions and a hierarchy of preferences and prices. Thus, kidneys from India, Pakistan, Bangladesh or the Philippines sell for as little as $1,000 to 2,000. A Romanian kidney goes for $3,000-plus a kidney from Turkey costs $10,000 or more. Mexico, Brazil and South Africa fall in between. The donor’s consent is typically secured through coercion or under exploitative and unequal conditions. It cannot be remotely termed free or informed. The donors are usually quickly discharged without being warned of the risks from their surgery. There’s no follow-up treatment nor an attempt to monitor if they might need dialysis in case their remaining kidney malfunctions. Many donors end up ill and destitute — as soon as they have partially repaid their debt. Many poor countries have no laws to regulate organ trading. In India, the law came years after kidney transplantation had already become an established business. In Pakistan, the law came only last year. Common everywhere is police failure to enforce THOA. A major reason for this, apart from large bribes, is the belief that the victims got a modicum of “justice” because they were “compensated” to the extent of Rs 40,000 to 100,000 for kidney removal, and that they can, after all, survive with just one kidney. The only “injustice”, many of our law-enforcers probably believe, is that of disproportion: racketeering doctors, middlemen and brokers make much larger sums, totalling Rs 15-20 lakhs, than donors. This belief, probably shared by a section of our elite — which, for instance, finds nothing wrong with child labour — betrays utter contempt for life and the principle of inviolability of the human body, which is foundational to any civilised society. It justifies robbery of the vital organs of flesh-and-blood people. Organs like kidneys don’t regenerate. Donating them is different from blood or sperm donation. This belief places an abysmally low value on the bodies of poor and vulnerable people. This should be repugnant to anyone with the slightest conscience or elementary faith in human solidarity or an essential bond or social compact among people, regardless of their social rank. The idea that you can cannibalise the bodies of the underprivileged is totally unacceptable. The injustice of disproportion is secondary in character. Even if all middlemen and brokers were eliminated, it would still be unconscionable for medical science to be used to harvest the organs of the poor for the rich. Ethically, treating human organs like inanimate commodities remains extremely troubling, especially when there’s huge disproportion between the power of recipient and donor. Those who advocate “market-based solutions” to the kidney failure problem are profoundly mistaken. In India, there’s a big gap between the numbers affected by end-stage renal disease, estimated at 1.5 lakh, and the number of kidneys transplanted (under 4,000). Another 6,000 get dialysis. The rest just perish. But that gap can’t be filled by sacrificing the poor. Rather, what we need is more and cheaper dialysis facilities, cadaver-based transplants (from the brain dead), and encouragement to patients’ relatives to donate kidneys. Kidney donation has few adverse effects if properly managed with follow-up, etc. The public must be educated to make kidney donation pledges along the lines of the successful cornea donation campaign. Cadaver-based transplants are ethically least problematic. More than 10 brain deaths occur in each of our major cities every day. Yet, there have been only 500 cadaver-based kidney transplants in India since THOA came into being. To promote these, we need to simplify and speed up cumbersome medico-legal procedures for organ donation, create transplant registries, and permit round-the-clock post-mortem examinations. Unfortunately, our governments are coming under pressure to “ease” transplant norms through “incentives” and “organ-swapping”. This is open to abuse. Meanwhile, the problem of preventing Raut-style rackets cannot be ducked. The inhuman practice of violating the bodies of ultra-vulnerable people must be put down and severely punished. This must provoke serious critical reflection on the neoliberal economic policies we are pursuing, under which growth aggravates destitution. It must also trigger police reform. Equally important, we need to re-educate doctors on medical ethics and social responsibility. Our medical profession has been complicit in all kinds of malpractices. The phenomenon of India’s “27 million missing women” caused by female foeticide wouldn’t have occurred without its active involvement in sex determination and abortion. It’s a shame that the state too is indulgent towards the perpetrators of this ghastly and shameful gendered violence. So a laughable 66 cases have been registered against doctors for sex selection in all these years. Yet, there’s a smart way of zeroing on clandestine organ transplants. All their recipients are given immuno-suppressant drugs to prevent rejection, such as cyclosporin, tacrolimus and mycophenolate. These are only made by a handful of companies like Novartis and Roche, which know exactly which hospitals/clinics order them. They must be made to part with the information. But will our governments muster the will to do this?

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Praful Bidwai, a fellow of the Transnational Institute, is a senior Indian journalist, political activist and widely published commentator. He is a co-author (with Achin Vanaik) of ‘New Nukes: India, Pakistan and Global Nuclear Disarmament’.