Data sources and insights

IT is vital to the non-enforcement of the statutory ban on trade in kidneys that information on the cases of unrelated live 'donations' be treated like classified information. One would think that given the registration and other requirements of the Transplantation of Human Organs Act, 1994, information on the hospitals and doctors doing the transplants and particulars of recipients and 'donors' belonged to the public domain. But that is clearly not how it is in Karnataka.

Frontline has data drawn from two sets of sources that offer interesting insights into the unrelated kidney donation scene in Karnataka. The first set of data contains details of 288 cases of unrelated live kidney transplants conducted in five Bangalore hospitals between June 1997 and December 2001. These data were collected by the Department of Health and Family Welfare from the hospitals. The second set of data, also sourced from official records, contains the details of 274 cases of unrelated transplants that went up before the Authorisation Committee between 1998 and December 2001.

These two sets of data represent about half the 1,012 cases of unrelated live kidney transplants that were done in Bangalore over the past half-decade, and there is some overlap of information in the two. Both sets give the names, addresses and ages of donors and recipients; the hospitals at which the transplants were performed; the names of the transplant doctors; the dates of the transplants; and the reasons recorded for the 'donations.' In several cases, the second set of official records also provides valuable information on the relationship between the donors and recipients (such as 'servant' or 'employee').

A study of the data sets showed the following trends:

* Most donors and recipients are from Bangalore. They also come from other parts of Karnataka and from other States such as Jharkhand, Bihar, Gujarat, Maharashtra, Kerala and Tamil Nadu. In many cases, donors are from the same State (for example, Jharkhand) or the same city (for example, Calcutta) as the recipient, indicating that agents may have formed a nationwide network.

* There are several areas of donor concentration, although these become less marked over the years, suggesting perhaps that agents are learning to spread their net in order to prevent detection. Mandya district, however, remains an area of high donor concentration. Some other areas where donor clusters appear are Kaveri Nagar slum in Bangalore, Peenya, and Tumkur.

* Addresses of donors given to the Authorisation Committee are often faked. Frontline's attempts to meet donors from Kaveri Nagar and CV Raman Nagar in Bangalore failed, as the addresses and names submitted to the Authorisation Committee turned out to be false.

* Patients also come from abroad, mainly from Nigeria and Bangladesh. While in the past foreign patients found donors in India, now they bring donors from their own countries, suggesting an attempt to disguise the financial transactions involved.

* Transplants are predominantly an exchange between men. Of the 288 cases in the first data set, 213 recipients and 199 donors are male. Recipients are aged between 15 and 68, and donors between 22 and 70. (In some hospitals, the cut-off age for donors seems to be 55, since from about the age of 40 kidney function decreases by one per cent every year.)

* Donors from a particular hospital tend to submit to the Authorisation Committee the same reason en bloc for the donation; the reasons offered vary among hospitals. For example, between June and August 1998, all donors at Bangalore Hospital gave 'Affection and Attachment' as the reason for kidney 'donation'. The reasons changed to 'Out of Compassion' for the period between September 1998 and June 1999. At Mallya Hospital, Bangalore, between January 1998 and March 1999 all donors claimed to donate 'Out of Compassion' while between April 1999 and November 1999 donors from the same hospital claimed to be 'Well Wishers'. Between June and August 1997 donors from Lakeside Hospital were also 'Well Wishers' of the recipients. Kidneys handled by this hospital were donated 'Out of Compassion' between September 1997 and April 1998 and out of 'Emotional attachment' between May 1998 and November 1999.

* According to the second set of official records, a shocking 65 of the 274 kidney 'donors' were employed as housemaids, watchmen, factory workers, or were in other dependant relationships to the recipients or their families prior to the transplant.