To me, there is nothing more special than the gift of life. Knowing Nicole saved so many lives through her gifts, I feel such peace and calmness in my heart. Did you know there are nearly 2, people waiting for a lifesaving transplant in our region? One single donor can save up to eight lives through organ donation and save or heal more than 75 lives through tissue donation. Organ and tissue donation is a generous and selfless gift. Since , approximately three of every four kidneys for transplantation have come from deceased donors, the rest from living donors who give one of their kidneys to a relative, loved one or even a stranger.
In the United States, live donation seems quite safe. A recent study found that kidney donors have only a slightly higher absolute risk of developing end-stage kidney disease than healthy non-donors. What might we do to alleviate the shortage of kidneys in the U. One positive step would be to adopt an opt-out system of deceased organ donation like one now in place in Spain , where the rate of organ donation is highest of any country.
The default in this system is donation at death when organs are viable, but everyone has well-publicized opportunities to opt out of donation. As it stands, U. The rate of donation in the U.
Unfortunately, changes in deceased donation practices are unlikely to eliminate shortages. Surely a lot more people will be willing to sell a kidney, assuming the price is right, than to donate one, their argument goes. Yet purchasing kidneys is not only prohibited by international norms , it violates U. The only country where a legally approved market in kidneys exists is Iran.
But market proponents insist that legal prohibition of commerce in kidneys is a grave mistake. Are the proponents right? The answer depends in part on moral argument.
In conducting this argument, it is important to steer clear of two implausible absolute positions. Perhaps the best known philosophical proponent of this view is the 18th-century philosopher Immanuel Kant. We are obligated always to act in a way that expresses respect for the dignity of humanity, Kant held. The action always sends a false message, Kant seems to have believed: that the seller himself has a mere price.
An increase in transplantations from unrelated living donors after the discovery of cyclosporine opened the door of a huge transplantation industry, a global traffic in organs. It is considered a relatively easy way to trade organs.
The patients i. The international movement of potential recipients is often arranged or facilitated by intermediaries and health-care providers who arrange the travel and recruit donors Shimazono, Despite efforts to boost altruistic donation and resolutions to curb transplant tourism, the implementation is not effective Jafar, As the demand for kidney transplantations increased, a few needy patients chose to explore the possibility of transplantation in a foreign country.
The risks of this practice is assessed in a single centre study in the United States. Although, the patient survival rate was not significantly inferior, the rate of acute rejection in the first year after transplantation, and incidence of severe infections among them were higher in comparison to local patients Gill et al.
Similar infectious complications such as Hepatitis B or C and pulmonary tuberculosis were present in 69 Canadian commercial transplant recipients Prasad et al. Different countries have varying infectious diseases profiles and the medical history of organ vendors are often not examined properly. These factors, in addition to country-specific limitations in the whole transplantation process, make these patients unintended bearers of different infections post-transplantation Gill et al.
Irrespective of general advantage of transplant tourism i. This illicit trafficking of organs brings strangers from different ethnic groups, classes, regions, religious backgrounds, political affiliations and nations into intimate contact for the procurement and transfer of tissues and organs.
The popular trajectory of this traffic is from South to North, from East to West, from poor, low-status men to more affluent men. The trade has led to the identification of a source of organs in the bodies of the poor, the medically illiterate, the displaced and the desperate.
These transactions might range from consensual contracts formal and informal , to coerced deals, to criminal trafficking verging on transnational kidnapping by local and international brokers involved in a multi-million-dollar business. The difference in economy, health care and regulatory policies have created organ donor vs organ recipient nations SchepherHughes, For several years, organized programs carried affluent patients from Israel, Saudi Arabia, Oman and Kuwait initially to India for transplant.
Later these patients went to Turkey, Iran and Iraq, Russia, Romania, Moldova and Georgia and more recently to Brazil and South Africa, where kidney sellers were recruited from army barracks, jails and prisons, unemployment offices, flea markets, shopping malls and bars Schepher-Hughes, Recently, Syrian refugees were found to be regular commercial donors of organs in absence of sustained livelihood options and mounting debt BBC news, April The trade also exists in Bangladesh Islam and Gasper, In this section, the emergence, proliferation and sustained existence of the organ trade in India are discussed in below, proceeding to the ethical aspects thereafter.
The first section is a commentary on the emergence of a legal market in organs, the subsequent prohibition by the Government of India on the organ market and the re-emergence of the trade illegally. The commentary is based on secondary data from newspaper reports and available studies on the organ trade in India and an empirical study undertaken by the author on the illegal trade in organs in India. Renal transplantation started in India in the s. The country progressed from one stage to the next to become the leading country in renal transplantation in the Asian subcontinent Shroff, The number of renal transplantations increased phenomenally when the anti-rejection drug cyclosporine was introduced in and transplantations from unrelated donors became a feasible option.
Thus, a combination of factors i. 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. A class of touts and middlemen grew to dupe innocent people to be exploited for kidney donation Acharya, The modus operandi of the trade involved scouting 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 Schmitt, A centre of supply was typically a pocket of concentrated poverty and indebtedness, from where an initial few desperate people would have sold their kidneys. Some of the initial donors acted as collection agents for city brokers and doctors in renal transplant centres, and brought many others with similar interests to the centre Frontline, The pockets of kidney supply and sales grew in various parts of India.
Many people between the late s and , travelled to and within India to receive kidney transplants from living donors who were in most of cases compensated financially, although rarely receiving the actual money they were promised for the donated kidney.
The countries from where people requiring kidney transplants most typically came to India for surgery were Middle Eastern countries such as Oman, Saudi Arabia, Bahrain, Kuwait, and the United Arab Emirates. This unscrupulous trading continued unabated until developing a successful legal market in organ trading in India. A number of complaints from the donors such as unpaid compensations, uninformed kidney transplantations in which people were unaware that a kidney transplant procedure had taken place, prompted the Government of India in to enact the Transplantation of Human Organs THO Act which prohibited commercial dealings in human organs Shroff, Immediately after the THO Act was enforced, fear of the law drove brokers out of the business and forced many hospitals to withdraw from active involvement in the trade.
However, the prohibition did not cease the demand of organs. To keep up with the pace of demand, the country witnessed the emergence of an illegal market of organs. Consequently, there were reports of reactivation of the trade in some areas as soon as For example, since the late s, two places in the southern part of India grew into virtual kidney farms. Kidney sales in these towns were associated with the fortunes of the power loom industry, for it is from the power loom workforce that kidney sales were prolific.
Indebtedness was very high among this poorly paid workforce and they sold their kidneys to clear debt. After the enforcement of the Act, the brokers remained inactive for some time, then resumed the trade activity again, this time illegally, once they became conversant of taking advantage of the loopholes in the law Frontline, The loopholes in the THO Act, are discussed below.
There is one major loophole in the law which indirectly encouraged the illegal trade in organs in India. The Section 9 3 of the Act permits an unrelated person to donate an organ out of affection or attachment. There has been a gross misuse of this section as there are large number of unrelated transplantations in India claiming to be out of affection.
Mani , a nephrologist in India argued that it is inconceivable that hundreds of slum dwellers would have sufficient affection or attachment to millionaires they had not met two weeks earlier to donate a vital organ to them. Therefore, the act restricted the scope of live related transplantation encouraging needy patients to seek an organ commercially.
The low level of punishment in the Act for the perpetrators was another limiting factor. The nature of the offence i. The Act was also not successful in establishing an active deceased donation programme in India which could have reduced demand on live organ donors.
The Act was amended in to plug these loopholes, which is discussed later. The illegal black market of organs thrived and took a substantially firm hold over the years, in a scenario of unfulfilled demand of kidneys and active operation of organised crime networks driving the trade.
In absence of a proper renal registry in India, it is not possible to estimate the actual demand of kidneys in recent years. Approximately, there was a demand for , kidneys in the country in , but only 5, patients received kidneys to undergo transplant Sinha, Due to the persistent increase in end-stage renal disease, the demand has increased annually, and the supply of organs has trailed far behind. The rate of organ donation has been dismally low in the country at 0.
Public apathy and a lack of public awareness, an absence of proper infrastructure across the country to retrieve organs, and myths and misconceptions surrounding organ donation, restrict optimum organ donation in India. That the THO Act, was unable to give a boost to organ donation and was unsuccessful in restricting the illegal organ trade, is evident from the fact that even a decade after the enactment of the Act, the Indian media frequently reported incidences of kidney trade being dismantled by the police, which are primarily run by the organised crime networks.
Some of the cases year onwards, are briefly described in Table 1 to provide an insight into the nature and extent of the illegal trade prevalent in India. The nature of the trade being clandestine, it is hard to find detailed reports of the incidences of trade. The cases listed below are result of an electronic search on the newspaper reports and journal articles. The list is not exhaustive. Cases from different states are selected to show that the trade is active in all the regions of the country.
It is evident from the above table that the illicit organ trade is prevalent in all regions of the country. The organised trade networks involving middlemen and allegedly surgeons run the trade and the donors are usually those who are deeply entrenched in poverty. A few earlier research studies conducted among the commercial kidney donors in India, looked at the modus operandi of the trade and the factors, which compelled the poor to sell an organ, discussed below.
He conducted a study in Chennai on kidney donors and found that most people sold their kidneys to get out of severe debt, but they were back in debt within a very short period of time. A study few years later by Goyal et al. During a month, they were able identify and interview more than commercial kidney donors in Chennai alone.
Three-fourths of the participants who sold their kidneys were still in debt at the time of the survey. The sale of kidneys by these poor people did not benefit them either socially or economically.
The donors often received less money than promised and that nephrectomy was associated with a decline in both health and income status. Haagen in his case study on the trade in kidneys in the South Indian state Karnataka found that due to the existence of a high rate of poverty and inequality, selling a kidney becomes a necessity.
However, he also argued that in India, poverty may be the primary reason behind people selling their organs, but selling an organ is the last, not the preferred option, for earning money. He argues that it happens only in an emergency—it is a reflection of the limited possibilities that these people have.
Similar factors such as poverty, debt and weak enforcement policies encouraged the illegal trade in kidneys in Bangladesh and Pakistan, the two countries which are geographically and socio-economically closer to India. Pakistan has been a hub of kidney trade for long time. Poverty, ineffective enforcement policies, and the limited supply of organs encouraged the affluent to routinely exploit its millions of poor with the help of organ trade mafias.
Kidneys can be bought so cheaply in Pakistan that overseas buyers largely from the Gulf, Africa and the United Kingdom visit the country The Express Tribune, A study among the commercial kidney sellers of Bangladesh reiterated the theory of poverty and debt behind kidney sale, as discussed in the studies above.
The existence of the trade in organs in India for decades is an irrefutable reality. The media reports on the illegal trade in organs from different parts of the country show a widespread existence of the trade since the s Frontline report on pg. The enforcement of the THO Act , was not able to control the trade. The first section of the study aimed at seeking opinion of the medical community i. Due permission was obtained from the ethical committee of the VHI for interviewing the participants of the study.
The study did not endeavour to study a large group of commercial donors as other research studies in India, such as by Cohen and Goyal et al. The scope of this study was limited to four cities in India. One metropolitan city from each geographical region of India viz. Delhi, Mumbai, Kolkata and Chennai were selected for the study. These cities have well-established transplantation services. The first section of the study was primarily quantitative; a self-devised structured interview schedule was used to collect the data.
The questions were both closed and openended. During the interview, after the personal details, the question related to the major cause and the factors which fuel the illegal trade was discussed. The question was a multiple-response one. Therefore, the respondents could express their opinion on more than one factor. At the end of the interview, the opinion of the transplant professionals was sought on measures to control the illegal trade including a possible existence of a legalised market in organs in India.
The data was analysed using SPSS. The second section of the study is qualitative. Two commercial organ donors and two buyers of organs were interviewed with the help of an interview guide.
A review of the literature revealed that the nephrologists and renal transplant surgeons are the medical professionals responsible for the treatment of patients with renal failure and they closely encounter issues related to organ scarcity during the course of treatment. In addition, they also play an important role in policy level recommendations on organ donation and countering the organ trade.
Therefore, it was considered appropriate to seek the view of these professionals on the perpetual existence of the kidney trade in India and explore means to counter it. At first, a list of 70 transplant professionals from prominent hospitals of the above mentioned four cities was prepared. Subsequently, they were contacted by email and telephone to explain the purpose of the research and seek permission for interviewing.
It was emphasised that the study was purely academic and complete anonymity will be maintained on their response. A personal interview was preferred rather than sending questionnaires to elicit better and more authentic response. The renal transplant surgeons and nephrologists with more than five years of experience in the field were included in the study.
Five years of experience was thought essential to discuss the subject of the study. Liver, pancreas or heart transplant surgeons are excluded from the study. The rest were either not available or were not interested in participating in the study. The two commercial kidney donors and receivers were selected with the help of snowball sampling. The two donors were from the same village in Chennai.
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