Organ-transplant black market thrives in India

Organ-transplant black market thrives in India

Anuj Chopra, Chronicle Foreign Service

Saturday, February 9, 2008

Chennai, India -- Tears well up in P. Guna's eyes as he stares at a long scar running down his side. A year ago, he attempted to stave off mounting debt by swapping one of his healthy kidneys for quick cash.

"Humans don't need two kidneys, I was made to believe," he said. "I can sell my extra kidney and become rich, I thought."

At the time, an organ trader promised Guna, 38, a motorized-rickshaw driver with a fourth-grade education, $2,500 for the kidney, of which he eventually received only half. Since then, he has experienced excruciating pain in his hip that has kept him from working full time and pushed him deeper in debt.

In recent years, many Indian cities - like Chennai in southern India - have become hubs of a murky business in kidney transplants, despite a 1994 nationwide ban on human organ sales (the Transplant of Human Organ Act states only relatives of patients can donate kidneys).

An influx of patients, mainly foreigners, seeking the transplants, has made the illicit market a lucrative business. Some analysts say the business thrives for the same reasons that have made India a top destination for medical tourism: low cost and qualified doctors. In fact, medical tourism is expected to reach $2.2 billion by 2012, according to government estimates.

Not surprisingly, an organized group of organ traders in cahoots with unscrupulous doctors is constantly on the prowl for donors like Guna.

In Gurgaon, a posh New Delhi suburb, police last month busted an illegal organ racket, which included doctors, nurses, pathology clinics and hospitals. In the past 14 years, the participants allegedly removed kidneys from about 500 day laborers, the majority of them abducted or conned, before selling the organs to wealthy clients.

Police say the doctor believed to be the mastermind behind the operation, Amit Kumar, searched for donors by cruising in luxury cars outfitted with medical testing machines, and kept sophisticated surgical equipment in a residential apartment. In his office, police found letters and e-mail messages from 48 people from nine countries inquiring about transplants.

On Thursday, police arrested Kumar in Chitwan, a Nepalese jungle resort. Local news reports said he was identified by a hotel employee who recognized him from Indian television broadcasts seen in Nepal. "I have not duped anybody," Kumar later told reporters in Kathmandu, according to the Associated Press.

Nepalese authorities say they won't extradite Kumar until they finish an investigation on whether he violated currency laws by not declaring $230,000 in cash and a check for $24,000 that he was carrying when arrested. He is scheduled to appear in a Nepalese court Sunday.

In another high-profile arrest, a renowned Chennai surgeon, Palani Ravichandran, was arrested in October in Mumbai for involvement in a kidney racket. He admitted to arranging organ transplants for wealthy foreigners - mainly from Persian Gulf states and Malaysia, whom he charged up to $25,000. Mumbai police say Ravichandran had performed between 40 and 100 illegal transplants since 2002.

Police say kidney donors can earn between $1,250 and $2,500, while recipients pay as much as $25,000, according to ActionAid India, an anti-poverty organization that has worked with kidney trade victims in the southern state of Tamil Nadu.

The same procedure can cost as much as $70,000 in China and $85,000 in the United States.

"These middlemen act more like cut-and-grab men whose only interest is to hack out the organ," said Annie Thomas, a field co-coordinator for ActionAid in Chennai, formerly known as Madras. "This is a reprehensible abuse of the poor, and this practice needs to be curbed."

Thomas says many middlemen typically masquerade the donors as relatives to circumvent the law while many foreigners in need of a kidney arrive on tourist visas rather than the required medical visas; some resort to false documents.

In Korkkupet, a teeming slum, the trade is prevalent, local activists say. Although they offer no specific estimates, the activists say it's difficult to find a family that doesn't have a relative who has sold a kidney.

Two years ago, A. Muttama, 39, a fisherwoman, received just $1,250 for a kidney after being promised $3,750 from a man known only as Kurrupiah. Residents say he is a Korkkupet resident who goes from house to house searching for donors.

"He told me, 'Follow my example. I was a very poor man. Now, look at me. I became rich after I sold my kidney,' " Muttama recalled.

Kurrupiah's three-story mansion is reached through a labyrinth of garbage-choked lanes, which meander through an endless sprawl of dilapidated shacks.

His wife, who, residents allege, also sold a kidney to her middleman husband, stood at the entrance, festooned with gold bangles, gold earrings and a glittering necklace.

A bevy of burly guards stood by. Kurrupiah, a middle-aged man, denied that he had anything to do with the kidney trade, and he refused to explain his source of income.

Chennai physicians say a scarcity of organ donors is the main factor behind the illicit trade.

Sunil Shroff, a well-known renal transplant surgeon, says the best practice to prevent the thriving commerce in living donors would use donors who are declared brain dead. "If the government is keen on ending the kidney trade, it should encourage cadaver-based transplants in a big way," he said.

But some doctors say even a campaign to use deceased-donor organs would only reduce the trade in living donors, and benefit just those who can afford the expensive operation. Patients receiving cadaver-harvested organs have to be on immunosuppressant drugs for life, which cost hundreds of dollars monthly, according to R. Ravichandran, the director of the Madras Institute of Nephrology.

"What is needed is a regulated system for legal live related organ donation," he said, which protects the interests of both donors and recipients.

"The choice before us in not between buying or not buying organs. This is happening regardless of the law. The choice is whether transplant operations and the sale of organs will be regulated or not."

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