A racket in Karnataka

This time the racket has been unearthed in Mandya, but the trade is evidently widespread.

SEVEN years after the Bangalore police cracked down on an organised trade in human kidneys, seemingly an even bigger racket involving the illegal sale of kidneys has been unearthed in Karnataka by the Mandya district police. The players in both rounds are the same - impoverished donors willing to sell their organs for a reprieve from the burden of indebtedness, generally well-to-do patients facing end stage renal failure (ESRF) only too willing to buy a kidney in contravention of the law, a network of agents and sub-agents who have their contacts in both these camps and in the Bangalore hospitals where renal transplants are performed, laboratory technicians, doctors and hospitals.

The emerging contours of the racket that the police stumbled on, and are yet in the process of investigating, point to a flourishing trade involving ESRF patients from all parts of the country and even abroad, and a network of agents. Employing fraud and coercion, including the forging of verification documents issued by the police, the agents have been sourcing kidneys from poor donors. While a majority of the donors are from Karnataka, they have also come to hospitals in Bangalore from Tamil Nadu, West Bengal, Kerala, Bihar and Maharashtra.

Between January 1996 and now, over 1,000 applications for 'unrelated renal transplants' (transplant from a donor to a recipient unrelated to him or her) went up before the Authorisation Committee set up by the Karnataka government under the Transplantation of Human Organs Act, 1994. Unrelated transplants are disallowed by the Act except in very special circumstances, when it can be proved before the Committee that the donor is gifting a kidney purely on altruistic grounds. Of the 1,000-plus applications, those rejected by the Committee can be counted on the fingers of one hand. A preliminary survey of these applications indicates that nearly 80 per cent of them carry supporting documentation that could well be forged, an angle that the police are now investigating.

"No role has been envisaged for the police in the relevant Act, and we only entered the picture to investigate a case of forgery that was brought to our notice," Amar Kumar Pandey, Superintendent of Police, Mandya, told Frontline. The police got on the kidney trail when they found that a residence certificate of a person living in Holalu village, purported to have been signed by a Sub-Inspector, was a forged one. The document was sent to them by the Authorisation Commit-tee for verification. The S.P. said: "It is apparent from the sheer size of the racket that Section 19 of the Act has been grossly misused. It appears that the Act has been sabotaged by those involved in the fraud. However, it is for the Appropriate Authority to take a decision on whether to institute an inquiry." The police have arrested 19 suspected agents. A number of them were picked up from the premises of Bangalore hospitals such as Lakeside Hospital and M.S. Ramaiah Hospital.

Holalu village in Mandya district has been a hub of donors, agents and sub-agents. Forty-seven residents of this village, which has a population of around 10,000, have sold their kidneys, and enquiries revealed that there were at least 100 people in the queue when the lid was blown. Most of the donors were unlettered, all of them poor and deeply in debt. The main reason for the high concentration of donors from the village was the presence of a particularly resourceful agent from the village who became rich from the commissions that he reaped by means of putting donors in touch with recipients. To the poor and vulnerable of the village, which is about 100 km from Bangalore, he dangled the prospect of a monetary windfall that the sale of a kidney could get them, and there were many who fell into his trap. According to the police, he was responsible for forging police documentation. When news that the police were on his trail reached him, he committed suicide.

Lakshmamma, an agricultural worker from Holalu, decided to sell her kidney to clear a part of her debt of Rs.70,000. "My fear was not in selling a kidney but over how I could lessen my debt and get my daughter married," she said. Deserted by her husband, she had to fend for herself and her two growing daughters. She contacted the agent, who arranged for her to sell her kidney to a person from Mysore suffering from ESRF. The transplant was done at Lakeside Hospital and she was paid Rs.40,000 by the agent. She stated before the Authorisation Committee that she had lived for many years in the house of the person who was to receive the kidney. Lakshmamma feels weak periodically and cannot go to work every day; her debts have been rising again. She has taken her 13-year-old daughter out of school as she cannot afford the cost of books.

The whistle was blown by Doddamadayya Setty, an agricultural worker, also from Holalu. "I did not know what a kidney was, nor how many my body had until an agent from Mysore told me about it," Setty confessed. When told of the money that would be his if he donated a kidney, he agreed and was taken to M.S. Ramaiah Hospital, where he was put through the routine medical checks. He then met the prospective buyer of his kidney. Bewildered and frightened by the fast-moving events, Setty gave himself away before the Authorisation Committee. "I was shaking like a leaf, and although I had been told to say that I had stayed in the recipient's home for eight years, I could not tell them what work I did there. After all, I am a brick layer and know nothing else," Setty said. His application rejected by the Committee, he returned to the village. The Authorisation Committee sent his resident verification papers to the Mandya police. When called to the police station, Setty told the police all that had happened.

Beyond Holalu, donors have come from across a surprisingly large area. They are from Bangalore City (Peenya, Ulsoor, Tamil Colony, Jeevan Bheema Nagar), Bangalore Rural (Magadi, Ramnagar, Channapatna), Mandya (Srirangapatnam, Pand-avpura and Mandya town besides Holalu) and Mysore (Nagenahalli and Mysore City). While around 80 per cent of the donors are from Karnataka, the rest are from West Bengal, Tamil Nadu, Kerala, Andhra Pradesh, Bihar and Maharashtra. They get between Rs.35,000 and Rs.40,000 for a kidney (The rates have evidently not changed since Frontline did an independent investigation into the kidney trade in 1997 (Frontline, December 26, 1997).

Bangalore retains the dubious distinction of being a leading centre of unrelated kidney transplants. Data collected by the Health and Family Welfare Department and the Appropriate Authority show that in 1998-99 and 1999-2000, the following hospitals conducted unrelated transplants - Lakeside Medical Centre and Hospital (86), M.S.Ramaiah Institute of Nephrology (58), Bangalore Hospital (47), Mallya Hospital (12), Manipal Hospital (28), Basappa Memorial Hospital (1) and St. John's Hospital (7). These cases were all approved by the Authoris-ation Committee.

The critical difference between 1994 and now lies in the status of the law. The unethical and exploitative trade in kidneys that the police uncovered in 1994 (Frontline, March 10, 1995) happened when there was no law in place to regulate renal transplants. Since then, not only was the Transplantation of Human Organs Act, 1994, adopted by various States, but the institutional structures mandated under the Act were set up, and have now been in operation for several years. It is clear that the trade did not stop. Driven underground for a few years after the law was passed, the trade surfaced again and flourished with impunity, unchecked by those structures that were supposed to curb it. The compassion clause in the Act has been widely misused and the Authorisation Committee has clearly been willing to be convinced of the genuineness of each case.

"The main purpose of the Act is to prevent organ trading," Dr. H. Sudarshan, chairman, Task Force on Health and Family Welfare, told Frontline. "When the donor makes a statement that he is donating his kidney on compassionate grounds, every Commit-tee member is surely aware that money has changed hands. Second-ly, the relationship of the donor with the patient is at most times not well established. I feel that the Committee must err on the side of strictness. If there is an iota of doubt over the genuineness of an application, permission should not be sanctioned. On the contrary, they are approving most of the applications."

Dr. Sudarshan brought the issue of organ trading before the members of the Authorisation Committee and the Appropriate Authority in March 2001, and requested that both bodies be reconstituted. The Authorisation Committee was reconstituted in December 2001 to include the Commissioner of Police or his nominee, and the Commissioner, Health and Family Welfare. Indeed, the State government's lack of seriousness on this issue is evident from the fact that the Authorisation Committee for a short period had Dr. K.S. Siddaraju, Head, Department of Nephrology, Government Victoria Hospital, as a member. Dr. Siddaraju was one of the main accused in the 1994 kidney scam. He was arrested on January 28, 1995 on charges that included extortion and cheating. He was alleged to have found poor donors for patients whom he would direct to private hospitals in which he was a consultant. As recently as September 29, 2000, a senior government officer lodged a complaint with the Principal Secretary, Health and Family Welfare, citing proof that Dr. Siddaraju had offered to procure a kidney through an agent for a patient from West Bengal. The Principal Secretary, Health, called for a departmental inquiry.

If and when an inquiry is instituted into the recent round of cases that have been unearthed, the Authorisation Committee may have much to explain. Frontline's independent investigations in 1997 revealed a flourishing trade in kidneys, one that was carried out in defiance of the law. A Frontline team found that the structures set up by several State governments to stop unrelated transplants were in fact responsible for promoting them. As long as unrelated transplants are not stopped, a cadaver-based transplantation programme cannot develop. Little appears to have changed since then. The lack of teeth in the Transplantation of Human Organs Act, 1994 - the selling and buying of kidneys is not a cognisable offence under the Act - is one of the reasons for the huge commercial racket in kidneys. Unless the Act is strengthened, there is little hope of change.