Indian Journal of Medical Sciences, Volume 57, Number 7, July 2003, pp. 320-322
Letter to the Editor
Donors do die in Kidney Transplantation in India
Surat Muncipal Institute of Medical Education & Research, Surat-395 010, Gujarat.
Code Number: ms03008
Friedlaender1 had reported of patients coming form the West Bank to India for undergoing kidney transplantation from unrelated paid living donors. The Israeli law requires that all living donors must receive written permission from their ministry after assessment by a hospital committee. A national committee also interviews living donors and recipients who are not first-degree relatives. Unrelated living donors are rarely approved and paid organ donation is illegal. However the Rabin Medical Center in Tel Aviv, Israel has circumvented the law by doing kidney transplantation from unrelated living donors in other countries. These transactions now receive semi-official recognition from the Israeli Ministry of Defence and from health insurance companies, which refunds $40,000 to each such kidney recipient towards costs, which is the cost of kidney transplantation in Israel. Patients who opt for transplantation are offered immediate medical assistance once they return back to Israel. The patients are required to sign agreements of secrecy. The Israeli doctors deny that they do more than accompany patients. This scenario sounds familiar in criminology. The donors are young able to bodied men aged 25-35.
A sort of justification that seems to have been put forward was that a 20-year follow up study2 showed no increase in mortality after kidney donation, and many patients undergo routine unilateral nephrectomy for kidney disease. The article states that these data are largely from more developed countries, but that no evidence suggests that the situation is different in less developed countries. There is also mention of an article from Kassirer3 that "The patient experiences the outcome and it is his values, not the physicians, that should be incorporated." A dialysis patient and member of the UK parliament has argued against legislation banning commerce in human organs proposed after a kidney transplant scandal in the UK. His words were "Those who want organs want them now because life in finite."4
These arguments and such a national mechanism from a developed country such as Israel is indeed shocking. I wonder whether they ever thought of the number of human lives of young able-bodied men aged 25-35 they are extinguishing in order to save the lives of their affluent and sick citizens. If the society can permit such norms then I wonder why there was such a hue and cry over the Nazi experimentations. Furthermore how can the doctors of any nation be involved in such a heinous activity? Should the world today encourage different notions of civilization and medical ethics for their citizens versus others?
The assumed notion of no increase in mortality for donors from developing countries is absolutely absurd. There are developing countries like India where the actual health care delivery apparatus is very weak and leaving aside the long term survival rates, it is quite likely that the donor would die in the surgery stage itself or very soon thereafter. If they do survive, it seems unlikely that they would be able to afford expensive health care in case they develop complications in later life. In India there are many areas where urolithiasis5 is quite common and having a single kidney would be a doomsday scenario for these poor kidney donors.
The Indian Express has reported of a ghastly incidence titled "Doc made killing at cost of poor," on January 16,2003.6 The article alleges of a Rs 100 crore kidney transplant scam centred in Amritsar. The article specifically charges one doctor with conducting 1,500 surgeries and pocketing approximately Rs 40-45 crores. It goes on to say that 6 deaths have been confirmed among the donors, who were labourers, as per one of the accused. These bodies were disposed of without an autopsy as unclaimed bodies. The allegations are that as many as 20-25 labourers lost their lives because of inadequate post-operatinve care. Presently several donor-labourers are in jail while the recipients are free. It is not yet clear whether the doctors are guilty, as Dr Sareen, the accused, has pointed out that verification of the affidavits from so-called donors was the job of the authorisation committee. Presently the Punjab Chief Minister has constituted a Special Investigation Team under OSD (law and order) and two doctors have been arrested. Such an incident is truly socking incase it is true and goes against all notions of a civilised society leaving aside the role of doctors. What is equally socking is the allegation by some of the donors that they had been physically forced to part with their kidneys under threats of violence.7
There is no disputing the fact that the science and art of transplantation of organs has ushered in an era of hope and life for the patients of end stage failures. Yet there are some moralities attached to it. It does not imply that the affluent citizens requiring transplants can have them harvested from the poorer ones and then leave them to die. Nor can governments be allowed to do so. What is United Nations there for? The UN should enforce immediate cessation of such internationally heinous crimes against humanity. The other example of unilateral nephrectomy is equally inappropriate. This operation is for a medical indication and is necessary for the health of a patient. Furthermore it does not risk the health of another person. I am happy that the medical community has come out strongly against such incidents and the Human Rights Commission is keenly following up this issue. I am sure law will take its course and justice shall prevail and all those persons found guilty in this scandal will be strictly dealt with.
Copyright 2003 - Indian Journal of Medical Sciences.