Kidney racket in Kerala

Reports of illegal kidney donations emerge from Kerala, a State hitherto considered free from such types of exploitation.

R. KRISHNAKUMAR in Thiruvananthapuram

THE latest victims of a thriving illegal trade in kidneys in the country seem to be in Kerala, where kidney-for-cash transactions were so far considered unlikely to happen.

In the last week of May, Madhyamam, a Malayalam daily, published a series of reports on a possible racket that promised Rs.1 lakh to Rs. 1.5 lakhs to poor men living in and around the Poomaala-Maythotti tribal settlement in Idukki district and used them as illegal donors of kidney for critically ill renal patients in some private hospitals in Kozhikode. According to the reports, nine persons, including five tribal people, had illegally donated their kidneys in the past one year. It was also reported that about 30 other people had received token payments from members of the racket to donate their kidneys later in prominent private hospitals in Kozhikode and possibly in Kochi and Thrissur.

Adding credence to the reports, on June 10, two men belonging to the tribal settlement in Idukki alleged at a press conference they held at the Press Club at Kottayam that they had been duped into selling their kidneys on the false promise of a hefty compensation and that they were now suffering debilitating health effects. (They were brought there by P.C. George, an Opposition Kerala Congress (Joseph) legislator.) The men, Kalappura George and Paarathani Kunju (alias Mathai), in their early forties, said that they had been promised Rs.3 lakhs each by a person who called himself 'Reji'.

According to them, George was the first of a series of donors from the area who had approached 'Reji' at a Kozhikode hospital on the basis of a newspaper advertisement or through acquaintances who had already donated their kidneys using the same channels. George alleged that doctors at the hospital (one of them a close relative of a State Minister) who examined him initially told him that his kidney could fetch him about Rs.3 lakhs. But after the transplant operation, he was told that the donated kidney was worth only Rs.75,000.

Mathai said he too approached 'Reji' on the direction of a person who had donated a kidney earlier. Mathai alleged that he was taken to another hospital in Kozhikode and eventually paid Rs.62,500 by the middleman.

Chief Minister A.K. Antony ordered a police inquiry. A day after the reports appeared, Antony said that the State government viewed the reports seriously and that under no circumstance would it allow "such a disgraceful racket in human organs to thrive in the State". He said that the inquiry was ordered with the intention of bringing to book "whoever might be involved, however mighty they may be". The inquiry is to be led by the Deputy Inspector General of Police (Central Range), B.S. Mohammed Yaseen. Another inquiry was ordered by Health Minister P. Sankaran. It is to be conducted by an Additional Director of Health.

IN addition to these, three more inquiries will be conducted into the matter. Based on a public interest petition filed before it, the State Human Rights Commission issued directions to Inspector-General of Police Jacob Punnoose to conduct a separate inquiry into the incidents and submit a report within three months.

The Scheduled Castes-Scheduled Tribes Welfare Committee of the Kerala Assembly has initiated an inquiry on its own. As a preliminary step, the committee has asked a report from the Idukki District Collector and the State Health Secretary. The members of the committee will visit the tribal colonies after the current session of the Assembly ends in July.

The Kerala Branch of the Indian Medical Association (IMA) has constituted a three-member committee to inquire into the allegations. However, at a press conference held on June 8 in Thiruvananthapuram, IMA representatives said that whatever may have been the inducements offered, the donation of kidneys could not have taken place without the concurrence of the donors.

In fact, as early as June 9, State Minister for Scheduled Castes and Scheduled Tribes Development M.A. Kuttappan told mediapersons that according to preliminary inquiries by his department, only three tribal persons were involved in the matter, though there were other donors from the area. He said that all the victims were "not so poor or starving" as reported in the media. He added that they "might have been lured by the promise of money by middlemen". Kuttappan said that it was clear from the inquiry that the sale of kidneys had taken place illegally under the promise of money and that middlemen were involved.

Subsequently, however, the government seemed to be changing its stand. In reply to a submission in the State Assembly on June 13, and in the context of allegations about the involvement of a doctor who is a relative of a State Minister, Antony said that preliminary inquiry by the police and the Health Department seemed to suggest that "all regulations were followed" in the kidney donations. He said that the police found that eight people from the Idukki tribal settlement had donated their kidneys and they had told the police that they had done so out of their own free will. The Chief Minister said that the police inquiry seemed to suggest that the transplantation had taken place "legally". However, he added that the inquiry would focus on the circumstances under which eight persons from the same locality came forward to sell their kidneys.

The Chief Minister's statement in the Assembly indicating the direction in which the police inquiry was moving came in for much criticism. The Opposition has demanded a judicial inquiry into the incidents. In a letter to the Chief Minister, Opposition Leader V.S. Achuthanandan said that he visited the tribal colony in Idukki and found that the reports about the illegal kidney trade were true. Achuthanandan said that the Chief Minister's statement that "all regulations were followed" was a clear indication that the government was not taking the allegations seriously and was, in fact, trying to save the culprits.

Achuthanandan pointed out that some people involved in the trade had gone on record to say that their kidneys had been sold illegally and that they had not been paid the promised amount. One of the victims had said that a doctor had tried to bargain with him regarding the price of his kidney. Achuthanandan said that the victims had also disclosed that a person named 'Reji' had acted as the middleman. He alleged that even after all these developments, if the police and the Health Department had come to the conclusion that "all regulations were followed", as the Chief Minister announced in the Assembly, then such an inquiry could only be a farce. "What more proof do you need to see that it is a ploy to help the powerful people involved in the scandal?" Achuthanandan asked.

The Opposition Leader said that the Authorisation Committee, set up according to the provisions of the Transplantation of Human Organs Act, 1994, which gave sanction for several donors from the same area, was also at fault. He said that the committee was guilty of the serious offence of not conducting an inquiry when eight people from the same area came ready to donate kidneys in hospitals in Kozhikode within a span of one year. Achuthanandan also said that the doctors at the private hospitals in Kozhikode could not absolve themselves of the blame by pointing out that they had conducted surgery only on donors who had been cleared by the Authorisation Committee. The doctors were legally bound to explain the health effects of kidney transplantation and to provide proper care to both the donors and the victims, he said. Moreover, he said that it was a principle acknowledged the world over that doctors should refuse to conduct kidney transplant operations if there was even an iota of doubt that money had changed hands.

Meanwhile, the authorities of a private hospital allegedly involved in the controversy held a press conference in Kozhikode to deny that their institution was in any way connected with the kidney racket. The hospital's managing director is reported to have said that hospital authorities need look only into the health status of the donors and the recipients and that the job of verifying their legal credentials was that of the Authorisation Committee. The hospital authorities said that the allegations regarding one of the doctors in the hospital, a relative of a State Minister, were politically motivated and that the hospital was ready to face any inquiry into the incident.

However, these claims were challenged immediately. The Kerala Sastra Sahitya Parishad (KSSP) held a press conference in Kozhikode to emphasise that the Authorisation Committee and the private hospitals concerned could in no way escape responsibility for the illegal kidney trade that had taken place in the State. KSSP State vice-president Dr. K.P. Aravindan, State committee member K.K. Janardhanan and health division convener V.T. Nasser criticised the stand of the private hospital authorities that once the Authorisation Committee had given its sanction for transplantation, the hospital had no responsibility to see whether it was legal or not. They said that the hospitals could not have missed the point that the donors from a tribal settlement in Idukki were in no way related to their patients and should not have gone ahead with the transplantation.

KIDNEYS-FOR-MONEY transactions constitute a criminal offence according to the Transplantation of Human Organs Act, 1994. Kerala adopted the provisions of the Act in 1995. The State constituted an Authorisation Committee to conduct inquiries and grant approvals for transplantation. It also set up an 'Appropriate Authority' (the Medical Education Director) to grant registration to, or cancel the registration of, hospitals that are allowed to conduct transplant operations, to enforce standards, to investigate complaints and to inspect them periodically to ensure the quality of transplant procedures and the follow-up medical care provided to both the donors and the recipients.

Under the Act, only "near relatives" (spouse, son, daughter, father, mother, brother or sister) can ordinarily donate kidneys. It also allows cadaver-based transplantations. The law allows "unrelated donors" to donate their organs only if they are doing so for reasons of "affection and attachment towards the recipient or for any other special reasons" - a fatally flawed clause used since its inception by the illegal kidney trade as a cover for the blatant sale of kidneys (Frontline, April 12). The Act only requires that the "unrelated donor" should convince the Authorisation Committee that he/she is "donating" and not "selling" his/her organs for either one of the reasons mentioned in it.

Until the controversy arose, a single Authorisation Committee based in Kozhikode had been overseeing the requirements for sanctioning kidney transplantation under the 1994 Act. The committee was headed by the Principal of the Kozhikode Medical College, Dr. M.R. Chandran. But when reports about a possible kidney racket appeared in the media, the committee members announced that it was not right for them to continue in office and wanted the government to dissolve the committee. After an emergency meeting of health officials on June 14, the government announced that it has decided to constitute three authorisation committees, for the south, central and northern zones of the State. Each committee was to have five expert doctors, including the chairman, as members.

Clearly, all the components that make a major kidney racket seem to be present in the incidents that have been reported so far: poor donors willing to 'donate' their organs for money; well-to-do patients critically in need of a kidney and ready to pay for it; a network of agents that links doctors and private hospitals to the rich patients and the needy donors; and institutional mechanisms that are only too willing to blink at flagrant violations of the law.

Although the contours of the racket may become clear only after the inquiries are completed, there is no doubt that a classic case of kidney-for-cash transactions effectively using the loopholes in the law seems to have taken place in Kerala. The statements of the two men who held the press conference in Kottayam, the statement of the Chief Minister in the Assembly with regard to the preliminary findings of the police inquiry, the contention of the authorities of one of the hospitals, the reaction of some of the IMA representatives, all these seem to suggest just that. What has been revealed so far may well be only the tip of the iceberg.