Kidney trade arrest exposes loopholes in India's transplant laws

Police have arrested a senior surgeon in Mumbai (Bombay) for his alleged role in facilitating trade in human kidneys.


The arrest has exposed a loophole in India’s decade old organ transplantation act. Doctors say that the act is not strict enough to stop unrelated living donors pretending that they are a friend or relative of the recipient and are giving a kidney for emotional rather than financial reasons.


Detectives arrested Dr Suresh Trivedi, a nephrologist at the Bombay Hospital and Medical Research Centre, last week after claiming to have established links between him and agents who recruited kidney donors for his patients.


Police said that Trivedi would pass requests for kidneys to agents who would find poor donors and fabricate documents to show that the donors were distant relatives or close friends of the patients. Each donor would receive 30 000-50 000 rupees (£360-£610, $660-$1100), but a recipient would be charged up to 200 000 rupees (£2420) for a kidney.


Trivedi and the agents had allegedly been running the illegal kidney trade for nearly three years, and investigators are trying to determine the exact number of transplants made.


India’s Human Organ Transplantation Act of 1994 allows a father, mother, brother, or sister to donate organs. Other live donors are screened by a state transplantation authorisation committee to ascertain that they are donating organs exclusively because of emotional attachment to patients and not for monetary or material gain. “This clause has [produced] a loophole for unrelated transplants with state sanction,” said Dr Sanjay Nagral, a gastrointestinal surgeon at the Jaslok Hospital, Mumbai.


Nagral said sections of the kidney transplantation community are, at best, turning a blind eye and, at worst, colluding with agents in organ trade. “It should be obvious to the committee about what’s going on. There is probably collusion between the committee and transplant surgeons, but they rationalise it, believing they’re helping save lives,” he said.


“Unrelated organ donation in India has always been one way traffic—the poor donating to the rich,” said Dr Sunil Shroff, a urologist and transplant surgeon at the Sri Ramachandra Medical College, Madras, who heads the Multi Organ Harvesting Aid Network Foundation, a non-governmental organisation campaigning for more cadaveric transplants. Last year, police in the northern Indian state of Punjab exposed a live kidney transplant racket in which labourers served as donors (BMJ 2003;326:180).


The number of kidneys from live donors in India far exceeds the number of cadaveric kidneys. Doctors estimate that less than 600 cadaveric transplants have been performed in India since trade in human organs was outlawed 10 years ago, but the annual number of kidney transplants is over 2000.


“The pity is that there doesn’t have to be a shortage of cadaver organs in India,” said Shroff. “Most relatives of brain dead persons are willing to donate, but there is no system in place in most hospitals to counsel relatives and harvest organs.”


The Multi Organ Harvesting Aid Network Foundation has written to the health ministry asking for government steps to promote cadaveric transplantation, including stricter scrutiny of live, unrelated donors. “We haven’t got any response yet,” said Shroff.


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