One-kidney communities

Pallipalayam village and Villivakkam are two major centres of kidney supply and sales. Extreme poverty and indebtedness have pushed hundreds of their residents to sell their kidneys.

THE surge in kidney transplant surgery between the late 1980s and 1995, when the Transplantation of Human Organs Act, 1994 was adopted by several State legislatures, created centres of kidney supply and sales. A centre of supply was typically a pocket of concentrated poverty and indebtedness, from where an initial few desperate people would have sold their kidneys. These "donors" returned home with what they, and the poverty-ridden community, viewed as a small fortune, no matter that they were poorer by a kidney. The more resourceful among the primary "donors" then acted as collection agents for city brokers and doctors in renal transplant centres, and enlisted more of their kind into selling kidneys.

Thus centres of kidney sales grew - in places such as Villivakkam in Chennai, the towns of Pallipalayam and Kumarapalayam in Namakkal district in Tamil Nadu, and Magadi near Bangalore. It was essentially a buyer's market, and the price of a kidney (or at least what the donor actually received) was always kept low; in the two centres - Pallipalayam and Villivakkam - that Frontline visited in October 1997, the seller received on an average Rs.25,000 to Rs. 30,000 for a kidney.

These places are no longer the active open markets they used to be. Immediately after the Act was enforced, fear of the law drove brokers out of business and forced many hospitals to withdraw from active involvement in the trade. It appears, however, that there has been a reactivation of these centres of sale in recent months. Brokers have resurfaced and have learnt how to manipulate the law.

Starting from the late 1980s, the twin towns of Pallipalayam and Kumarapalayam grew into virtual kidney farms. The exact number of kidneys sold by people from the towns cannot be established. However, according to information given to Frontline in 1995 (issue dated March 10, 1995), of the 580 kidney transplants done between 1987 and 1995 at the Karnataka Nephrology and Transplant Institute (KANTI), 400 unrelated donors came from the Pallipalayam and Kumarapalayam area. This statistic came from the institution's Director, Dr. S. Sundar.

Kidney sales in these towns are closely associated with the fortunes of the powerloom industry, for it is from the powerloom workforce that kidney sales are prolific. Over 50 per cent of Tamil Nadu's powerlooms are concentrated in Salem and Namakkal districts (Tamil Nadu has one-fourth of India's 17 lakh powerlooms). The looms produce items largely for export; these include cotton fabrics, towels, bedsheets, dhotis and lungis.

Working conditions in the powerloom factories bring to mind scenes from the history of early capitalism. The industry is part of the unorganised sector and units are not governed by the Factories Act. The estimated 50,000 powerloom workers of the district toil in cramped, ill-ventilated rooms on 12-hour (and sometimes 14-hour) work shifts; they are not covered by legislation on minimum wages and they are not eligible for bonus or Provident Fund and Employees State Insurance benefits. Child labour is rampant. Every manufactory that Frontline visited had children from the age of 10 to 16 working on the threading looms; each one had one crib or more strung from the ceiling. Children grow up in the ear-shattering mechanical clatter of powerlooms. The harsh, invasive din, above which one cannot be heard, is a constant factor in the lives of powerloom workers.

Indebtedness is very high among the workforce: powerloom owners lend workers money as a way of keeping them tied. It is from this debt-ridden and unorganised workforce that kidney sales began. "The sales first began with some workers from a sugar factory," says C. Arivazhagan, secretary of the Namakkal District Powerloom Workers Union (NDPWU). "Powerloom workers soon started selling their kidneys to try to escape their debt. Most of them are deeply indebted to powerloom owners, who lend them money at 50 to 60 per cent rates of interest in order to keep them in bondage."

The life-histories of those who have sold their kidneys are remarkably similar. There is S. Chandrakala and her husband K. Sundaram, powerloom workers, who both sold their kidneys in the early 1990s for Rs.30,000 each to redeem a combined debt of Rs.35,000. They were taken to Bangalore by Sekhar, a broker who was something of a household name in these parts. Their children, aged 15 and 12, work in the factory. Chandrakala and Sunda-ram are enfeebled and their capacity to work is far less than before; they now owe Rs.40,000 to their employer and an outside moneylender.

S. Murthy, a former powerloom worker, sold his kidney four years ago for Rs.30,000 to a patient at the Mallige Hospital in Bangalore. He can no longer do hard labour and has opened a roadside tea shop. He is already in debt to the tune of Rs.10,000. N. Karnan, 30, a powerloom worker from Kumarapalayam, sold his kidney two years ago for Rs.30,000. "I used to be able to do produce 50 metres of cloth on the loom per day. Now I can only do 20 metres," he says. A metre fetches Rs.1.50. Adds Karnan: "If I tell anyone I know not to sell his kidney, he says 'Tell me a way to get out of debt."'

Kidney sales in Palli-palayam and Kumarapalayam slumped immediately after the Act came into force, but are once again on the increase. And although the number of kidneys sold has not reached the old levels, there is always the danger of that happening unless conditions in the powerloom sector improve.

FOR eight years between 1987 and 1995, the slum in Bharathi Nagar in Villivakkam, a Chennai suburb, was the hub of the kidney trade in Tamil Nadu. At the height of the boom, partly fuelled by foreigners flocking to South India for kidneys, the slum was called Kidney Nagar or Kidney-vakkam.

About 500 families, accounting for half of Bharathi Nagar's population of about 5,000, live in closely built thatched huts in the slum. Nearly all of them are daily-wage-earning construction workers, rickshaw pullers or petty hawkers. There are also migrants from drought-hit areas in Vellore and Tiruva-nnamalai, who settled here in the 1980s after selling land in their villages.

M. Koteeswari, an activist of the All India Democratic Women's Association who lives in a house near the slum, told Frontline that the "uncertain lives of the daily workers forced them to take the desperate measure of selling their kidneys." The trade, according to a small-time broker, started in 1987. By 1995, when the Transplantation of Human Organs Act, 1994 came into effect, more than 500 people in the slum - averaging one per family - had sold their kidneys, the broker recalls.

According to "donors" and brokers in Bharathi Nagar, most of the kidneys purchased from people in the slum were transplanted in patients at a well-established nursing home and a medium-sized hospital in Chennai that specialised in paid-donor renal transplantations. Although kidneys were purchased from other areas in the city too, Bharathi Nagar yielded the largest harvest of "donors".

A striking aspect of the kidney trade in Bharathi Nagar is that at least 300 of the "donors" were women, according to Lakshmi (name changed on request), a broker who was active during the boom in renal transplants. Koteeswari recalls that many deserted women were forced to sell their kidneys to raise money to support themselves and their children.

Shakuntala, 38, "donated" her kidney in 1988 when she worked as a construction worker. She told Frontline that her family had been in debt to the tune of Rs.15,000 and had been unable even to pay the rent. "My husband squandered the money I got from selling my kidney; six months later he deserted me, since my ability to earn was impaired after I sold my kidney."

Harassed by her husband, Vijaya left home with her three children. Desperate for money, she sold her kidney, but got only Rs.25,000, although she had been promised twice as much. Hearing that Vijaya had come into money, her mother-in-law took her back but the rapprochement was short-lived. After losing Rs.5,000 to her mother-in-law, Vijaya moved out again with her children.

Shakuntala and Vijaya report that they took their health problems to the hospital for about three months but were told that "nothing was wrong" with them. When they attempted to get the remaining Rs.25,000 that had been promised, they were told at the hospital that the money had been invested in an insurance policy, but were not given any documents. Both say that their organs were used for patients from Malaysia and that they were prevented from meeting the recipient's family.

Asked if she had had any health problems after the loss of her kidney, Shakuntala mentions breathlessness, pain in the arms and legs, fatigue and pain while urinating. According to Koteeswari, the "donors", being illiterate, are unable to relate their health complaints to specific ailments. Nevertheless, their capacity to earn has clearly diminished. Six months after the surgery, Shakuntala gave up her Rs.100-a-day job as a construction worker and began to sell flowers, self-employment that fetches at best Rs.40 a day. Vijaya did the same.

Some of the "donors" gave Frontline the names of two doctors in the two Chennai hospitals, who they said had acted as "brokers". Lakshmi says she worked as a broker at one of the hospitals till October 1995, and that renal transplants from live unrelated donors are still being done at the hospital.

Lakshmi, the broker, notes that despite the controls on the kidney trade, the price of a kidney has not increased in 10 years; this, in her view, reflects the desperate financial condition of those wanting to sell their organs. She adds that at a leading hospital in Chennai, agents hover near the canteen looking for prospective donors.

Lakshmi's assessment is that the Act has changed the situation a great deal. She claims to have told patients from Rajasthan (who had come to Chennai to buy kidneys) to go elsewhere as the situation has become "very difficult" in Tamil Nadu. Donors and recipients, she says, now have to be "matched properly in terms of language and appearance and both parties have to be tutored."

Lakshmi confides to Frontline that she has been warned by the Authorisation Committee in Chennai not to bring any more cases. "The Committee cross-examines donors and recipients closely these days," she complains. She acknowledges that kidney brokering is an unlawful activity but claims: "I only wanted these poor donors to get a better price for their kidneys by putting them in direct contact with the recipient rather than going through brokers attached to hospitals." She makes an offer to the Frontline correspondent: "I am now more selective in arranging donations. But if you or your close relative wants a kidney, I can help."

Asked if she regrets having sold her kidney, Shakuntala says: "Well, I got the money, didn't I? I really have no regrets. What makes me sad is that nobody bothers about me after taking the kidney from me. After all I saved a life (a young boy from Malaysia), didn't I?"