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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on February 22, 2008, 08:59:28 AM
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chicagotribune.com
Gruesome harvest in India
In a country where organ pirates made $1 billion, officials fight back with education, other efforts to boost legal donation
By Laurie Goering
TRIBUNE CORRESPONDENT
February 21, 2008
NEW DELHI
For the past seven years, Rajesh Gupta has spent 12 hours a week in a hospital bed, hooked up to a hemodialysis machine. He would prefer to undergo a transplant to replace his failed kidneys. But India has no national organ waiting list, few registered organ donors and a legal system that bars transplants from most living donors except for close family members.
That means Gupta, with no donor matches in his family, must pay about $900 a month for dialysis treatments for life. Still, he counts himself lucky: In a nation where about 150,000 people suffer kidney failure each year and the average monthly per capita income is $63, options are limited. Only about 14,500 Indian patients undergo dialysis each year and another 3,500 manage transplants. Many of the rest simply die.
"Those who can afford treatment, live. The others die. They have no other option," said Gupta, 37, whose family runs an electrical cable factory in New Delhi.
India's acute shortage of legal kidneys for transplant is the key reason police regularly break up horrific illegal organ-transplant rings. Earlier this month, authorities in Nepal nabbed Amit Kumar, the absconding kingpin of a ring based in the New Delhi satellite city of Gurgaon. Indian police say he ran a flourishing organ-transplant business that netted $1 billion in less than a decade and carried out at least 500 illegal kidney transplants. On Sunday, Kumar's brother Jeevan Raut also was arrested.
In many cases, the organs harvested for transplant into rich Indian and foreign clients, including visiting Americans, came from poverty-stricken Indian laborers willing to sell a kidney for anywhere from $1,280 to $2,500, police said. But at least some organs were regularly carved from day laborers who were kidnapped, blood-typed, then held under guard for days or weeks until they were wheeled, terrified, into an operating room. On release, they were warned they would be killed if they informed.
Indian police say the ring had links to at least three private hospitals, 10 pathology laboratories and 40 dialysis centers in New Delhi.
In a nation where end-stage kidney patients face bitter choices, Kumar's transplant business elicits horror -- but also some level of quiet support among families confronted with hard decisions.
"Who has driven him to this? We are the culprits," Gupta said.
What Kumar did "was illegal but not wrong," the businessman said. "It's just that you can't become some kind of Robin Hood."
Policies faulted
India's failure to harvest more legal organs for transplant -- from the recently deceased or from brain-dead patients -- is largely a problem of lack of education and government policy. In the U.S., many people are routinely asked whether they want to become organ donors when they get a driver's license or are admitted to a hospital.
Years of public education campaigns about the need for organ donations, and a waiting list system for recipients that is seen as reasonably fair and efficient have helped popularize organ donation. In 2006, 17,000 of the 74,000 people waiting for kidney transplants in the United States got them.
In India, 160,000 people die in road accidents each year -- "a potentially huge pool of donors," says Dr. Sunil Shroff, a transplant surgeon and proponent of organ donation. But only 1 in 20 million people becomes an organ donor each year, compared with 1 in 50,000 Americans. That's largely because few Indians have been educated about the need and because most are presumed to not want to donate.
India's famed red tape is also a problem. Doctors hoping to harvest organs for transplant from a brain-dead patient need to carry out a complicated and repeated series of tests with at least four doctors present each time to prove brain death. Bereaved families often object to the removal of organs from brain-dead family members, holding out hope they might somehow recover.
What is needed is a strong government and public education campaign in favor of donation, said Shroff, who runs the Multi Organ Harvesting Aid Network, a charitable, Chennai-based organization promoting legal organ donations.
Points of success
He points to a campaign a few years ago to boost badly needed cornea donations; it produced a spike in donations after a top national cricket player and a Bollywood star noted for her beautiful eyes signed up to donate.
India's army similarly has been able to boost organ donations at army hospitals with an education campaign that includes posters that read, "Don't take your organs to heaven. For God knows we need them here."
"A little bit of awareness will do the trick," Shroff predicted. And "if we meet the demand, there will be less pressure for these [illegal harvests] taking place in the country."
India's government, spurred by the most recent organ transplant scandal, has said it will announce changes to the national organ transplant policy early next month, including approval for kidney swaps -- families joining together to donate to each other when matches within one family aren't possible. Also possible are incentives for those who legally donate a kidney to a random recipient, including free medical care, a life insurance policy and discounted rail tickets for life.
Such changes, however, are still unlikely to produce enough kidneys for transplants in a nation with one of the highest number of people with uncontrolled diabetes in the world -- a key risk for kidney failure -- and a reputation among rich foreigners as the place for cheap transplants.
That suggests India may not have seen its last illegal organ-harvesting ring.
Even Gupta, who has long rejected the idea of seeking an illegal transplant on ethical grounds, says he couldn't rule out that option if dialysis stops working for him.
"If my need for an illegal kidney was much more serous, I might succumb," he admitted. "When I don't have any other options, I might."
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lgoering@tribune.com
http://www.chicagotribune.com/features/lifestyle/health/chi-kidneys_goeringfeb21,1,1644600,print.story