India’s kidney transplant crisis

NEW DELHI —  For the last seven years, Rajesh Gupta has spent 12 hours a week in a hospital bed, hooked up to a hemodialysis machine. He would prefer a kidney transplant. 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 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 get 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. Recently, authorities in Nepal nabbed Amit Kumar, the absconding alleged 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. 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. Some organs were taken from day laborers who were kidnapped, blood-typed and 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 police.

Indian police say the ring had links to at least three private hospitals, 10 pathology laboratories and 40 dialysis centers in New Delhi, and probably couldn’t have operated so long without assistance from New Delhi’s legal medical community.

In a nation where end-stage kidney patients face bitter choices, arrested transplant kingpin Kumar’s 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, gesturing around his dialysis treatment room crowded with patients.

What Kumar did “was illegal but not wrong,” the businessman said. “He was helping patients. It’s just that you can’t become some kind of Robin Hood.”

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 United States, 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 for recipients that is seen as reasonably fair and efficient, have helped popularize organ donation. In 2006 alone, 17,000 of the 74,000 people waiting for kidney transplants in the United States got them, many from newly deceased donors.

In India, where 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 -- only one in 20 million people becomes an organ donor each year, compared with one in 50,000 Americans. That’s largely because few Indians know about the need for organ donation.

India’s infamous bureaucratic 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 that 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 organization based in the city of Chennai, formerly Madras, that promotes legal organ donations.

Shroff 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 as donors.

India’s army similarly has been able to boost organ donations at army hospitals with an education campaign that includes posters reading, “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.”