S. Gopal

This Condolence Resolution was adopted recently at a meeting of teachers, students and staff of the Jawaharlal Nehru University:

Professor S. Gopal was one of the world's front-ranking scholars who reshaped the discipline of modern Indian history in recent decades. His fervent commitment to history as a manifestation of India's national urges in opposition to imperialist domination was and still remains one of the hallmarks of the discipline's evolution in recent times. In his death the academic community has thus lost a stalwart whose contribution will survive long after his passing away.

Professor Gopal was also in many ways the maker of the Centre for Historical Studies at JNU in the early 1970s. The Centre still operates within the vision provided to it by Professor Gopal. The vision was marked by liberalism of views and a scientific attitude. Himself a liberal intellectual to the core, Professor Gopal felt happiest when his opinions were debated and disputed by practitioners of the discipline like him, young or old, students or colleagues.

With such an enormous scholarship Professor Gopal carried himself lightly and with great humanity as well as humour. In his demise we have lost a scholar of the highest calibre and a human being of great character.

Among the innumerable honours and awards that came his way, the Padma Vibhushan was the most recent.

This meeting of the members of the faculty, students and staff of JNU expresses its deep sense of grief at the passing away of Professor Gopal and conveys its condolences to the bereaved family.

Prabhat PatnaikJNU, New Delhi

Prabakaran and Sri Lanka

Liberation Tigers of Tamil Eelam (LTTE) leader V. Prabakaran attracted worldwide attention through his press conference on April 10 (Cover Story, May 10). "Will he or won't he?" was the question on everyone's lips. The article "Neither war nor peace" has provided the three scenarios - war, peace or no war-no peace - that could emerge from the ceasefire agreement between the Tamil Tigers and the Sri Lankan government.

However, there are signs that give some hope of peace - the global war on terrorism, the bold initiative taken by Ranil Wickremasinghe, the mediation of Norway, the craving for peace amongst all ethnic groups in Sri Lanka, the interest shown by the U.S., and so on.

Even the LTTE cadres and their leader may have a desire to come out and lead normal lives. The concern expressed, in your editorial "What lies ahead for Sri Lanka?" is foremost in everyone's mind.

A. Jacob SahayamKarigiri, Tamil NaduGujarat

I have reasons to disagree with Praful Bidwai's line of arguments, especially on his 'unmasking' exercise ("Plumbing new depths", May 10).

The article truly reminds us that we have passed the age of modernity and have now entered an age of post-modernity especially as Bidwai 'deconstructed' the Prime Minister's speech and claimed to have 'unmasked' Atal Behari Vajpayee. This is perhaps the irony of post-modernity. Unlike modernity, in post-modernity an author/speaker has no control (or freedom of interpretation) whatsoever, over his/her creation or even speech; it is the audience that should decide, and no wonder some 'Westoxicated' intellectuals are using that opportunity in the case of Gujarat. Quoting Vajpayee completely out of context may serve the political interests of some intellectuals. The need of the hour is neither the witch-hunting that some self-styled secularists are engaged in, nor juggling with phrases such as 'pogrom', 'state-sponsored genocide' and so on. What the people of Gujarat really need is the healing touch of peace, brotherhood and fraternity.

Arindam RoyBurdwan, West Bengal

* * *

R.K. Raghavan has commented that "when a seething sea of humanity pours out into the streets, neither the police nor the Army can be equal to the situation" ("Incompetence or connivance?", March 29). One wonders how a murderous, fanatical and inhuman mob intent on burning people alive can be described as a sea of 'humanity'.G. RadhakrishnanThiruvananthapuram

Coup in Venezuela

When it comes to Western liberal democracy, as we saw in the case of President Hugo Chavez of Venezuela, people are made to believe that American interests are synonymous with people's interest. However, this time the level of manufactured consent was just not sufficient to topple his elected government ("The triumph of Chavez, May 10).

On the Venezuelan episode, when almost the entire media missed the bus, perhaps intentionally, it is good to see Frontline reporting the coup. Perhaps, the Indian media's concern for Latin America and Africa is not enough.

It would be interesting to note how the U.S. media reacted to the Chavez coup. The New York Times on April 13 called it a 'resignation' and went as far as branding Chavez a would-be dictator. It also said that Venezuela needs 'a strong leader with democratic mandate', conveniently forgetting that Chavez had such a mandate in the 1998 elections.

On April 14, The Chicago Tribune wrote: "It's not every day that a democracy benefits from the military's intervention to force out an elected President." It said that Chavez no longer would be free to pursue his habits such as toasting Fidel Castro, flying to Baghdad to visit Saddam Hussein, and praising Osama bin Laden. On April 16, it again wrote that "Mr. Chavez's return is no good news for democracy." The story was no different with other newspapers.

Dr. Auswaf AhsanManipal, Karnataka

Israel

In his excellent essay, Aijaz Ahmad writes: "Resistance, of course, goes on. There are, for example, influential veterans of the peace movements such as Shlomo Avinery..." (April 26). The actual reference is to Uri Avnery, the fearless leader of Gush Shalom, one of Israel's few truly principled peace groups, which calls for an end to the occupation without reservation. His columns are posted regularly on the Gush Shalom website and are worth reading. Shlomo Avinery is a Professor of Political Science at Hebrew University and a firm supporter of the Israeli state.

John LacnyPennsylvania, U.S.

Nuclear achievements

T.S. Subramanian's article on the Nuclear Fuel Complex (March 29) was informative and inspiring. It highlights India's achievements in the nuclear field, including a veritable 'world's first' in the production of a particular grade of seemless tube, and another in the development of a novel nuclear carbide fuel, to say nothing of the impressive number of sophisticated machines and alloys made in the facility. It is an article that gives you the impression that Indians can do anything in the high-tech sector, given the opportunity and the resources.

Varun ShekharCanada

Tourism

This has reference to "Towards responsible tourism" (March 1).

All the delegates to the South Asian Regional Conference on Ecotourism (SARCE) were willing to work with the principle of 'responsible tourism'. However, it was disheartening to see that the peoples whose interests were being deliberated upon were absent. These are the peoples whose lives have been intricately linked to nature and whose access to these resources and ultimately their livelihood concerns are being threatened by an onslaught from the tourism sector in the garb of ecotourism. International organisations like the United Nations Environment Programme and national governments have gone ahead and declared 2002 as the International Year of Ecotourism (IYE) without proper consultations. Numerous indigenous communities and groups have opposed the declaration. They have also contested their exclusion from the resultant preparatory meetings. The delegate fee for SARCE was beyond their reach. Meetings such as SARCE are thus non-representative and it is conveniently left to the industry and government departments to define 'ecotourism'. Informed local consent and participation, a fundamental value of ecotourism, is violated in the preliminary stage itself.

It was made clear at the conference that the industry is motivated by profits. This is a contradictory and dangerous impulse in ecotourism since it supports profit as a means to environmental protection. Ideally, ecotourism should be seen as a set of values that support environmental protection as a means to profit, even at the risk of destroying that profitability. Can the industry do this? This is precisely the reason why ecotourism has wreaked the same kind of havoc that mass tourism has in countries such as Belize and Thailand.

It is also important to note that tourism is an important sector in the World Trade Organisation's (WTO) General Agreement on Trade in Services (GATS). Words like sustainability, benefit sharing, conservation and democratisation are excluded from the GATS lexicon. Despite the Commission on Sustainable Development (CSD) and the Convention on Biological Diversity (CBD) taking note of the adverse impact of tourism on biodiversity and local people, the WTO operates under a different development paradigm. It believes that trade liberalisation pursued under the principles of non-discrimination will ultimately benefit developing countries, achieving the goal of sustainable development along the way. In the ongoing GATS negotiations, the European Union has been pushing for further commitments in the tourism sector. It is thus important that the language spoken at this conference is reflected in policy when India commits its tourism sector in the ongoing GATS negotiations.

Syed LiyakhatBangalore

Balayogi

The obituary on G.M.C. Balayogi (March 29) states that Balayogi was the first Speaker to die while in office. But according to India 2002 published by the Ministry of Information and Broadcasting, Speaker G.V. Mavlankar died while in office in 1956.

Abhilash P.A.Chennai

G.V. Mavlankar was the first Speaker of the Lok Sabha to die while in office. The error is regretted.

RESPONSE

What is wrong with buying and selling human organs to save a life

Vidya Ram does an admirable job of addressing some of the ethical quandaries surrounding the growing market in paid donor human organs and the momentum that is growing in some medical circles to regulate rather than to prohibit buying and selling body parts ('Karntaka's unabating kidney trade', Frontline, April 12, 2002). What is wrong with a regulated market that could possibly save so many lives? Given the desperation of those stranded on national waiting lists or trapped in dialysis, the neo-liberal market-based solution appears to be straightforward - those who are to purchase a human organ should not be prevented from doing so. In fact, some surgeons, bioethicists, and public health officials are now arguing just that. For example, the Philippine Ministry of Health has recently proposed to establish an organisation called "KID-Net" whereby desperately poor sellers from the slums of Manila would deposit, for a price, their "surplus" kidneys into a national kidney bank for distribution to desperately ill transplant patients. The hope is that both parties - buyers and sellers - could benefit from the transactions. The human and ethical dilemmas are thereby reduced to a simple market calculation based on supply and demand.

The problems with this rational solution to the chronic shortages in transplantable organs are many. To date, only kidneys, bone marrow, and liver lobes can be taken from living donors and transplanted into ailing patients. Living donation is a risky procedure and obviously cannot supply the "demand" for hearts, lungs and other irreducible or irreplaceable body parts. Nephrectomy (kidney removal) and partial removal of the liver for transplant, even under the most favourable surgical and post-operative medical conditions, are not risk-free procedures. In the United States, at least two kidney donors have died during the past 18 months, and another is in a persistent vegetative state as a result of living donation. The unnecessary suffering and death of Mike Hurewitz, 57, following the removal of part of his liver in order to transplant it to his brother at the Mt. Sinai Medical Centre in New York City in January 2002, underscores the dangers of treating live organ donation in a cavalier and reckless fashion. While his brother was cared for as a highly privileged patient under the best possible medical circumstances, the living donor was denied adequate aftercare and was treated as a mere "supplier" of medical material.

The problems multiply, of course, when the buyers and the sellers are unrelated because the sellers are likely to be extremely poor and trapped in life-threatening environments where everyday risks to their survival are legion, including exposure to urban violence, transportation and work-related accidents, and infectious disease that can compromise their kidneys of last resort. And when that spare part fails, kidney sellers in poor countries often have no access to dialysis, let alone to organ transplant. While poor people in particular cannot "do without" their "extra" organs, even affluent people need that "extra" organ as they age. One healthy kidney can compensate for a failing or weaker kidney.

The few available, longitudinal studies of the medical and social effects of nephrectomy on kidney buyers and sellers are unambiguous. Even under regulated systems in which "compensated gifting" is used to reimburse donors, kidney sellers frequently suffer from chronic pain, unemployment and social stigma, accompanied by severe psychological problems. Organs Watch researchers working in nine countries have found that kidney sellers often face daunting medical problems after nephrectomy, including hypertension and, in the worst instance, kidney insufficiency owing to lack of access to adequate medical care. Many kidney sellers travel to distant locations for their clandestine surgical operations and on returning home to their rural villages or urban shantytowns in South America, South or South-East Asia or Eastern Europe, frequently find themselves unable to sustain the demands of agricultural or construction work, the only labour often available to men and women of their skills and backgrounds. In some parts of the world, such as Eastern Europe, kidney sellers experience deep shame and social ostracism. In Moldovan villages they are stigmatised as "prostitutes", excommunicated from their local churches, alienated from their families and co-workers, and, if single, are often excluded from marriage. Parents there warn their nubile daughters to "look for the tell-tale scar of a kidney seller", because such men are often unable to provide economically for their wives and children. The children of kidney sellers in rural Turkey are ridiculed by their classmates as "one-kidneys". In areas like the slums of Manila, where kidney selling is widespread and routinised, young men now look to sell other parts of themselves - one eye, part of their liver, and even one testicle.

How can a government-regulated system set a "fair price" on a living person's healthy body part? The global market sets the value based on medical consumers' prejudices, such that in today's thriving kidney market an Indian kidney can fetch as little as $1,000, a Filipino kidney $1,300, a Moldovan or Romanian kidney $2,700, while a Turkish seller can command up to $10,000 and an urban, educated Peruvian can receive as much as $30,000. The circulation of kidneys transcends national borders, and international markets will coexist and compete aggressively with national, regulated systems.

The new consumerist, market-oriented medical ethics that is gaining acceptability today creates a semblance of ethical choice (for example, the right to buy a kidney) in an intrinsically unethical context. Bioethical arguments about the right to sell an organ or other body part are based on cherished notions of contract and individual "choice". But the social and economic contexts that make the "choice" to sell a kidney in a slum of Baghdad, a Brazilian favela, or a Filipino shantytown are anything but free or autonomous. The idea of consent is problematic when a seller has no other option left but to dismantle his or her own body. Putting a market price on body parts - even a fair one - is exploiting the desperation of the poor, turning their suffering into an opportunity. And the surgical removal of non-renewable organs is an act in which medical practitioners, given their ethical standards, should not be asked to participate. Not too long ago, the eminent transplant surgeon, Dr. Thomas E. Starzel of the University of Pittsburgh, referred to all transplants relying on organs taken from living donors, whether paid for or purely altruistic, as "medical malpractice". Surgeons whose primary responsibility is to provide care should not be advocates of paid self-mutilation even in the interest of saving lives.

The demand side of the organ scarcity problem also needs to be confronted. Part of the current scarcity derives from the expanding of the waiting lists for organs to include very small infants and patients over 70 years, a practice that needs to be questioned. Liver and kidney failures often originate in public health problems that could be treated more aggressively on a preventive basis. Ethical solutions to the chronic scarcity of human organs are not always palatable to the public, but they also need to be considered. Foremost among these are systems of educated, informed "presumed consent" in which all citizens are assumed to be organs donors at brain death unless they have officially stipulated their refusal beforehand. This practice, successfully implemented in parts of Europe, preserves the value of organ transplant as a social good based on a social contract in which no one is included or excluded based on the ability to pay.

The division of the world into organ buyers and organ sellers is a medical, social and moral tragedy of immense and not yet fully recognised proportions.

Professor Nancy Scheper-HughesDirector, Organs WatchUniversity of California, Berkeley

REFERENCES

1. Nancy Scheper-Hughes, "The Global Traffic in Human Organs"; Current Anthropology 2000, 41: 192-224.

2. Marina Jimenez and Nancy Scheper-Hughes, A three-part special report in The National Post (Toronto, Canada), 2002. Part 1: "Europe's Poorest Sell Their Kidneys - Desperation Feeds the Kidney Trade", The National Post, March 29, 2002. Part 2: "Dr. Vulture: The Unholy Business of Kidney Commerce", March 30, 2002. Part 3: "Organ Theft Extends its Tentacles - From Turkey to Sao Paulo people go in for surgery and come out short of a kidney", April 2, 2002. These can also be found online at national post.com

3. Michael Friedlaender, "The Right to Sell or Buy a Kidney: Are We Failing Our Patients?" Lancet 2002; 359: 971-73.

4. J. Radcliffe-Richards, Daar A.S., Guttmann R.D., et al. "The Case for Allowing Kidney Sales"; Lancet 1998; 351:1950-52.

5. Zargooshi, Javaad. "Iranian Kidney Donors: Motivations and Relations with Recipients"; Journal of Urology 2001; 165: 386-392.