India’s health ministry, in the wake of a racket involving illegal kidney transplantations, has announced plans to promote donations from cadavers. It will allow more hospitals to harvest organs from brain stem dead patients and offer incentives to relatives of dead donors.
Police have arrested a doctor, Amit Kumar, and his associates, for allegedly performing hundreds of clandestine kidney transplantations in Gurgaon, an industrial town near New Delhi. Police claim that Dr Kumar used a network of touts to lure poor people into giving up their kidneys for payments of about 60 000 rupees (£770; €1030; $1510) and that the organs were transplanted into patients from India, Europe, and the United States.
India outlawed trade in human organs in 1994, but transplantation surgeons have said that organ sales have persisted because of a shortage of cadaver donors and collusion among donors, doctors, and patients waiting for a transplant.
But the scale of the operation in Gurgaon has surprised health officials and the medical community. Police have alleged that Dr Kumar transplanted kidneys into some 600 patients in a residential building turned into a transplantation clinic.
The health ministry will seek to introduce free health and medical insurance, free periodic medical check-ups, and a priority position on organ waiting lists for relatives of brain dead patients whose organs are used, a senior official said.
“A massive public education campaign is long overdue,” said Samiran Nundy, the head of surgical gastroenterology at the Sir Ganga Ram Hospital, New Delhi, who had helped draft India’s Human Organ Transplantation Act of 1994.
Doctors estimate that fewer than 1200 cadaver organs have been donated in India since the act banned the organ trade and defined brain death to facilitate cadaver transplantation. About 3000 kidney transplantations and some 150 liver transplantations are carried out each year, most of them involving organs from live, related donors. Transplantation surgeons are hoping that the Gurgaon scandal will accelerate plans to launch a national organ transplantation programme.
The health ministry is also assessing proposals to make it mandatory for hospital staff to ask for organs in the event of brain death, to educate the public on cadaver transplantation, and to ensure that hospitals where organs can be retrieved are not linked with hospitals where transplantations are performed.
“Such a delinking will dramatically increase the number of organs available,” said Sunil Shroff, managing trustee of the Multi Organ Harvesting Network Foundation, a non-government agency that has been promoting cadaver transplantations in southern India.
“India’s transplant scandals have themselves created an environment where doctors find it difficult to approach relatives of brain dead patients for organs,” said Subash Gupta, a liver transplantation surgeon at the Apollo Indraprastha Hospital, New Delhi.
Last year police in the southern state of Tamil Nadu investigated the sale of kidneys by women from a settlement for survivors of the 2004 south Asian tsunami. In two unrelated cases earlier, police had arrested doctors from Mumbai and Amritsar for facilitating trade in kidneys (BMJ 2004;328:246 doi: 10.1136/bmj.328.7434.246-c; BMJ 2003;326:180 doi: 10.1136/bmj.326.7382.180/b).
In most earlier scandals patients and doctors exploited a loophole in the act that allows donations from live, unrelated donors provided that the donors are giving up organs for reasons of altruism and not financial gain.
“A major public education initiative on cadaver donations would help meet India’s organ demands,” said Harsha Jauhari, chief of renal transplantation surgery at the Sir Ganga Ram Hospital. Doctors point out that not all among India’s tens of thousands of patients who have organ failure can afford transplants and the associated drugs.
India’s current cadaver organ donor rate is 0.05 per million people, in contrast to six per million in Greece, 22 per million in the US, and 32 per million in Spain. “If India improves this to two per million we would not need to do any live kidney transplantations, and we would take care of all liver and heart transplantations performed in India,” Dr Shroff said.
Doctors have long been arguing for a government programme to inform the public about brain death. “We can’t do this in an intensive care unit after a diagnosis of brain death. The public must learn about this option in their homes when all is well,” said Devinder Rana, president of the Indian Nephrology Society.
Delhi police claimed last week that Dr Kumar and his associates had paid a bribe of 1.98 million rupees to some police officers linked to the investigation. Police have arrested one officer on charges of extortion and are looking for absconding constables.