Doctors' Association for Social Equality

An Observer investigation into India's cash-for-organs trade reveals that transplants are making fortunes for brokers as desperate victims of the tsunami undergo dangerous surgery, reports Dan McDougall in Chennai

The Observer
Sunday February 18 2007

Dan McDougall
http://www.guardian.co.uk/world/2007/feb/18/india.theobserver


The pain is hardest to take at night, says V Kala, as she lifts the crumpled
folds of her faded cotton sari to expose a 13 inch scar across her midriff.
'I lie awake in agony scratching and clutching at the side of my body.
Sometimes it feels like it is still there, throbbing inside of me. It's at
this time I feel most alone with what I've done. The doctors told me to
expect that. I don't want sympathy or kind words. I want you to understand
why I have put myself through this. It was my decision to sell my kidney. My
family was drowning in debt.'

Just over a month ago, Kala, 32, a mother of three, had stood shaking with fear
in Chennai's decrepit Kaliappa hospital. With her were an organ broker, a
local advocate clutching her sworn affidavit saying that the recipient was a
relative, a doctor and the elderly patient her kidney was destined for.

'The broker told me not to bring anyone close to me, in case they changed
my mind. The only person in the room I could relate to was the dying woman lying
on the bed. What struck me as surprising was her age,' said Kala. 'She
was 80, from a Brahmin caste. She looked rich, like she'd had a good life.
She told me she wanted to live longer to see her grandchildren in America. I
wanted to help; now I feel betrayed. I've inherited her suffering.'

Kala walks painfully back towards her dismal concrete hut in Ernavoor, a
desolate fishing village an hour's drive north of Chennai. Trapped on a
sliver of mud between the ocean and the Adyar river, it is one of many poor
hamlets strung along the Bay of Bengal ravaged by the 2004 tsunami. Behind the
long rows of single dwellings, built by the government to compensate fishermen
who lost their homes, hunchback cows graze in vast, rotting piles of rubbish.
The filthy sea estuary in the distance emits the sulphurous smells of poverty
and sewage.

Here in this ravaged community of 2,500 people, The Observer found 51 women who
have sold kidneys in the past six months to escape the pressures of loan sharks
who preyed on them after the tsunami. The majority of donors are women in their
twenties. The recipients are both Western and Indian, and rich.

'At least 80 people we know of have given their organs in recent months,
most are women, but the figure may be 10 times as much,' says S Maria Silva,
head of Ernavoor's tsunami fishermen's association. 'Our community
is little more than a refugee camp, made up of eight tsunami-affected villages.
After the tsunami we were moved to a temporary village known as Kargil Nagar,
but it went up in flames and we were forced here, 14km [about nine miles] from
our fishing boats. The fishermen here are literally washed up; they can't
afford the commute to their boats. Their wives put food on the table now. They
either sell firewood and coconut husks from dawn to dusk and still starve, or
they sell their organs to keep heads above water.'

Before passing a series of laws attempting to ban the practice, India was the
worst offender in the global organ trade. In cities such as Mumbai, foreigners
could easily obtain transplants, although the level of medical care and likely
success of the operation varied. The Indian government insists those days are
gone, but the cash-for-kidneys business continues, mainly in small private
hospitals where regulations are weak and technology plentiful. A hospital needs
only a blood supply, dialysis machine and post-operative care facilities to
carry out a transplant.

According to Dr Ravindranath Seppan, of the Chennai Doctors' Association
for Social Equality, which campaigns against the trade, the situation is
desperate. He said: 'Although India banned commercial trading in human
organs in 1994, it is clear a lucrative underground market has emerged in
Chennai's suburbs. India's rich are turning to India's poor to live
longer, and as the economy grows this abominable situation will also grow.'

Dr Seppan points to a study published in the Journal of the American Medical
Association where researchers surveyed 305 Indians who had sold their kidneys,
and found 96 per cent had done so to pay off debts, but three-quarters remained
in debt and 86 per cent said their health had seriously declined since the
operation. The World Health Organisation issued guidelines in 1991 to avoid the
exploitation of organ donors. They were endorsed by 192 countries, including the
UK, but are not binding. And at least one country, Iran, has a legally regulated
system to trade organs.

As health care increasingly becomes a marketplace transaction, a fierce debate
about commercialising transplants has emerged. On one side are campaigners such
as Dr Seppan, who believe the poor suffer, and on the other side many who
believe that payments can only help the dire shortage of organs for those who
desperately need them.

One of Britain's top kidney consultants, Dr Andy Stein, of Walsgrave
Hospital, Coventry, called last week for the organ trade to be legalised,
claiming that donors will suffer if it continues to go underground. As people
live longer, increasing the demand for organs, supplies diminish, thanks to
increased survival rates in intensive care units. Improved road safety has also
cut the number of organs obtained from car crash victims. Frustrated by NHS
waiting lists, unknown numbers of sick Britons go abroad to find brokers, some
of whom offer kidneys illicitly harvested from slums in countries such as China,
India, the Philippines and those in eastern Europe.

But the internet offers the easiest solution. In 2004, bids for a human kidney
reached $5.7m on eBay, before the company shut the sale down. An eBay spokesman
later admitted: 'From time to time, we get a kidney or a liver.' The
company classes such sales in the same category as people who try to sell rocket
launchers, and close down the site after informing the police.

Maria Silva and other women from Ernavoor, who complain of excruciating pain in
the wake of operations, are now taking matters into their own hands. A fortnight
ago, dozens of residents marched on the house of Prakesh Babu, a local broker
responsible for 15 sales in the past four months, demanding his arrest.

V Mary, who sold her kidney through Babu, said: 'We don't expect him to
resurface. He fled when we went to his home. Babu persuaded me to sell. I was
paid 35,000 rupees (£460) and he told me he cut himself 8,000 rupees
(£100), but I know he took 10 times as much.'

Mary's hut is a cramped room with a dirt floor, shared by a family of five.
It is suffocating in the heat. She admits her estranged husband frittered away
most of what was left on drink after the moneylender was paid.

Mary's neighbour, S Rani, 36, is clearly in pain. She sold her kidney to
pay her 23-year-old daughter's debt to a local hospital. 'My daughter
had a caesarean when she had my grandson and lost a lot of blood. She spent a
month in hospital, running up a bill of 30,000 rupees. To make matters worse, my
son-in-law's family was demanding a 20,000-rupee (£290) dowry debt
and my husband had run away. I went to the hospital gates looking for a broker
and I had the operation a month later in another hospital in Chennai. I woke up
twice during the operation and was sent home after only two days with a handful
of sedatives.'

She said: 'My broker was Shana Lakshmi. She once sold her own kidney and
now she helps sell others. I was promised 1.5 lakh (£2,000) but only
got 40,000. She paid me on the train platform on the way home, and I was in too
much pain. I had to take what I was given. Now I can hardly walk.'
Rani's daughter runs towards us waving her mother's medical files -
written in English, which she can't read, asking me to translate.

In the fluorescent light of the dialysis ward of the Kaliappa hospital, feeble
patients sit in armchairs hooked up to ancient fridge-sized machines that
simulate the job of the kidney: it's a life-preserving process for people
whose kidneys have failed, but they have to be connected three hours at a time,
three days a week.

Outside the ward, Rana Vishnawatan, an elderly Indian businessman, drinks from
a water fountain: 'My kidney is failing and I don't want to be one of
those people in there getting my blood changed in and out of the machine like a
car going for an oil change,' he says. 'Nor can I afford dialysis. You
tell me, what choice do I have? My family is looking for a broker. Either one
comes to me or I make one come. I don't have much time.'

'This system may seem horrendous to you, but it may not seem quite so bad
when your family is starving in a gutter. The kidney business is not a trade -
understand that - but a form of co-operation. It is not buying or selling. One
person is dying of hunger. The other has money, but is on dialysis three or four
times a week. If we all decide to cooperate, we can help save each other.'