India: Transplant racket dupes the poor, mainly women, of their kidneys, promised payment & health Print E-mail

 

Friday January 4, 2013

More detained in Bangalore kidney racket

Bangalore Bureau

 A woman from Halebudunuru, near Mandya, showing the scar after her kidney was removed in January 2011. (Deepa Kurup)

Intensifying investigations into a kidney transplantation racket involving government officials and major hospitals in the city, the Ramanagara district police detained a few more persons for questioning on Thursday.

They are part of a kidney sale network thriving in and around Bangalore. A senior police officer, part of the investigation team, said the detentions were made based on information provided by a tout, Srikanth from Ramnagar. Preliminary investigations have revealed that Srikanth had been running this racket for the past five years.

The Kumbalgod police, who suo motu registered a complaint on Wednesday, said they were on the lookout for the donors and the recipients to make them party to the case. The police, while looking at the tout angle, are also probing the involvement of major hospitals, the role of Food and Civil Supplies Department officials who helped create fake documents, and jurisdiction police officials who verified the documents.

The victims hail from financially weaker sections and are spread across Mandya, Ramanagara and Bangalore districts. In many cases, they have not received even the promised sum of Rs. 1.5 lakh, though up to Rs. 20 lakh was charged for each illegal transplant.

The Hindus independent investigations in Mandya district have revealed that the racket is indeed thriving in rural pockets and villages here. For instance, at Halebudunuru here, the organised racket involves several women donating their kidneys to recipients, mostly from Bangalore.

All of them had their surgeries performed in leading multispeciality hospitals in the city. In every instance, the donors testified before a committee and claimed to be willing donors or well-wishers of people, who they had never met until the deal was fixed. The price of a kidney ranged from Rs. 70,000 to Rs. 3 lakh, depending on the gullibility or extent of poverty of the donor, residents said.

Parallel committees
The amendments brought to the Transplantation of Human Organs Act 1994 in 2008 that permit the setting up of hospital-based authorisation committees have loosened the regulatory regime in Karnataka. This could be one of the reasons for the surge in kidney transplants, doctors here believe.

While there is a State Authorisation Committee appointed by the Karnataka government, the new rules permit the setting up of hospital-based panels if a transplantation centre exceeds 25 operations a year. Three private hospitals in Bangalore Manipal Hospitals, Columbia Asia and Narayana Hrudayalaya have their own committees.

While the heads of these institutions claim that the committees are appointed by the State government, they also have doctors from the hospital with two nominees from the government.

This, sources said, is an easy method of loosening the process of approving transplants. The much abused Section 9 (3) of the Act, which permits unrelated transplants if it can be proved that the donor does this out of affection and attachment, and not for monetary considerations, is also proving disastrous, the sources said.

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Friday January 4, 2013

Amendment facilitated parallel approval panels in hospitals

By Afshan Yasmeen

Rules permit such panels if a hospital performs more than 25 transplants a year

The surge in number of kidney transplants in the State could be linked to the amended rules in the Transplantation of Human Organs Act 1994. The 2008 amendment has succeeding in loosened the regulatory regime by allowing the constitution of hospital-based authorisation committees.

New rules

While there is a State Authorisation Committee appointed by the government, the new rules permit setting up of hospital-based authorisation committees if a centre (hospital) exceeds 25 transplants a year. Three private hospitals in Bangalore Manipal Hospitals, Columbia Asia and Narayana Hrudayalaya have their own committees.

While the heads of these institutions claimed that the committees are similar to the State Authorisation committee (headed by legal experts) and are appointed by the State government, they are also permitted to have in-house doctors and two government nominees.

Another loophole

Sources said this was an easy way to liberalising the process of approving organ transplants. Another big loophole is the much abused Section 9 (3) of the Act, which permits unrelated transplants if it can be proved that the donor did this out of affection and attachment and not for monetary considerations.

Asserting that this grey area needs to be addressed appropriately, a senior doctor from M.S. Ramaiah Hospital said: The big question is when the patients blood relatives dont have the compassion, why is somebody else having it? The answer is obvious and everyone knows that money has changed hands. The government should either completely ban unrelated transplants or should openly allow them.

Another nephrologist, who questioned the credibility of the process followed by these hospital-based committees, said all approvals by them should be vetted by the State Authorisation Committee.

The numbers

While the State Authorisation Committee had approved 759 transplants from June 2010 till date, a total of 374 transplants took place at the three authorised private hospitals in the same period.

State Authorisation Committee chairperson G.K. Venkatesh said the committee totally depended on the verification provided by the revenue and police officials.

At least two applications from Ramanagaram for transplants were rejected because of police objections. We follow a rigorous procedure of verifying the details provided by the applicants after they have been certified by the revenue and police officials. We interrogate the donor and recipient separately to ensure there is no foul play, Dr. Venkatesh explained.

New guidelines

The State committee had evolved several new guidelines such as enclosing a marriage certificate and getting the Tahsildar certify the family tree. A few applicants have questioned these measures through Right to Information (RTI) Act and have asked us if we have any Government Order on this, Dr. Venkatesh said.

Hospitals claim

Meanwhile, the three private hospitals also claim to follow a fair process of approving transplants.

Sudarshan Ballal, Medical Director of Manipal Hospitals, said the hospitals committee headed by the former Chief Justice of Tamil Nadu followed an elaborate verification process.

Nandakumar Jairam, chairperson and medical director of Columbia Asia, said his hospitals committee is also a quasi judicial body following all rules and regulations.

It is headed by former Karnataka High Court judge Shivshankar Bhat.

Expert

Ishitaque Ahamed, consultant nephrologist from Narayana Hrudayalaya, said the hospital had two channels of screening the applications. Applications cleared by an internal committee headed by one of the chief operating officers, M.S. Rao, again go through a rigorous verification process by an external committee. This committee is headed by medical superintendent Asha Naik, who is a non-practising gynaecologist, he added.

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Friday  January 4, 2013

Expendable cogs in a well-oiled racket

By Deepa Kurup

The sale of organs is prohibited under the Transplantation of Human Organs Act 1994, which was amended in 2011 to expand the definition of near relatives. This loophole permits unrelated persons to donate organs after deposing before an authorising committee. (File photo - The Hindu)

The police crackdown on the illegal trade in kidneys in Ramanagaram district merely scratches the surface of what appears to be a thriving racket that involves agents, sub-agents, multi-speciality hospitals and top doctors, who together form an intricate and exploitative network facilitating the sale of kidneys by impoverished donors to affluent patients suffering from end-stage renal disease.

This racket flourishes unchecked in neighbouring Mandya district, despite the police crackdown in 2002 that identified the district as a hotbed for kidney trade. Little seems to have changed since then, it would appear, as women such as Sujatha (39), Thimakka (45) and Asha (36) have managed to circumvent the law with relative ease, and earned themselves what they see as a ticket out of poverty, and more specifically, indebtedness.

In their village, Halebudunuru -- comprising 1,300 households -- there are at least 10 women who have sold their kidneys in the past three years, residents say. The two women, who fleshed out the contours of this racket, told The Hindu the standard procedure involved being "chosen" by a tout, making weekly trips to Bangalore for medical tests, short meetings with the donors, and a string of false testimonies before the police and court committees where they attest to having close relations with the recipient, and finally, payment before surgery. The cost of a kidney ranged between Rs. 70,000 and Rs. 3 lakh.

Sujata, a daily-wage labourer at the diary co-operative here, donated her kidney in January 2011. She says she thought this would tide her over her debts, which spun out of control after her daughters wedding and dowry, which cost her Rs. 2 lakh, a spate of illnesses in the family and educational expenses for the children. To escape her insurmountable burden, she sold her kidney for Rs. 1.5 lakh to a senior judicial officer, whom she met for the first time at a leading multi-speciality hospital in Bangalore. I was taken to court where I had to say that I had worked as his domestic help for 20 years, she said, fully aware that the entire transaction was illegal. But what else could I have done? she asked, pointing out that being landless, they had no option but to sell all that they owned. Two years later, she says her health has deteriorated; she suffers from acidity and breathlessness, and severe back pain.

Tragically, this transaction did not rid her of her debts. The post-operative pain prevented her returning to work for a year. In retrospect, I am back where I started.

Like many women in this village, Sujata has borrowed heavily from microfinance institutions (MFI). Two years after she paid off a chunk of her loans, her credit situation is no better. Her current equate weekly microcredit payments (from four MFIs) total Rs. 1,670. A quick calculation reveals that the interest rates for all these micro loans range between 40 and 60 per cent. Her husband has also many outstanding loans from private moneylenders.

For Ms. Thimakka (45), selling her kidney did bring her respite from a large chunk of her debts. Thimakka sold her kidney to a Mandya businessman, posing as his brother, for Rs. 3 lakh. The transplant was done in a leading multi-speciality hospital in Bangalore, where she says many similar cases were taken. Thimakka too was part of two microcredit groups and had borrowed heavily from private moneylenders. Ask her why she decided to take such an extreme step, and she snaps: With recovery agents at your doorstep every day, offending you and threatening you, what else do you do? Who do we turn to for help? She claims it has not impacted her health, and quickly adds, that even if it did she would have no remorse. "My life with all those loans was worse than death. I was scared to get out of my house, and go to work at the dairy. I was trapped," she says.

But, residents here allege, that since then she has encouraged others too to do what she did, and put them on to touts.

The loophole
The sale of organs is prohibited under the Transplantation of Human Organs Act 1994, which was amended in 2011 to expand the definition of near relatives, include harsher punishments for unauthorised removal of human organs and for receiving and making payments for human organs. However, even the new law retains the loophole that permits unrelated persons to donate organs after deposing before an authorisation committee.

(The names of the women have been changed to protect their identities)

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 Friday January 4, 2013

Promised big money, they end up getting a pittance

By Imran Gowhar

A big chunk of the promised money disappears as the agents commission and the victims are blackmailed and threatened into silence

The busting of the kidney racket by the Ramanagaram police and the arrest of a tout has again turned the focus on the agents who are actively operating in this region.

The police are looking for other touts who are on the run, a senior official supervising the investigation said, and identified the arrested tout as Srikanth.

There are several like him operating in the region, networking with hospitals and police and revenue officials to make the transplant process smooth.

These touts lure poor people by dangling huge sums but at the end of the day, the donors are left with a pittance. They are threatened and blackmailed into silence, the officer said.

Gayatris story
Take the case of Gayatri, a 35-year-old and mother of two from Mandya district, who was approached by Mahade, a tout, promising her Rs. 1.1 lakh for a kidney. Ms. Gayatris husband, a petty businessman, had incurred huge losses and the couple was being harassed by moneylenders.

Ms. Gayatri then decided to donate her kidney to partly clear her husbands debts.

As per the deal, she was paid around Rs. 30,000 as advance and was taken to Prashanth Nagar in Vijayanagar, Bangalore, where she was made to stay in a house for a week, posing as a close relative of the recipient, a college student identified as Swetha, niece of a businessman.

Police verification
The Vijayanagar police, as part of the formalities permitting transplant between close relatives, visited the house during her stay and gave their clearance. Ms. Gayatri was then asked to go back to her village. A few days later, last August, she was taken to a hospital on HAL Airport Road in Bangalore, accompanied by Mahadev, where the kidney was transplanted. After spending a few days in the hospital, she was discharged. Since then she has been waiting for the remaining amount.

This is not an isolated case. We have received information about many such cases which are being probed, the police official said, adding efforts are on to trace Mahadev and others who are part of the racket.

Police denial
When The Hindu called the Vijayanagar police station, they denied having any such information. A senior officer said he had verified the documents of three cases in the recent past, which belonged to close relatives. Apart from this I don't remember clearing the file of a transplant case involving a girl as recipient.

When The Hindu called the Vijayanagar police station, they denied having any such information. A senior officer said he had verified the documents of three cases in the recent past, which belonged to close relatives. Apart from this I don't remember clearing the file of a transplant case involving a girl as recipient.

When contacted, Ramnagaram Superintendent of Police Anupam Agarwal refused to comment stating that divulging details would hamper investigations.g that divulging details would hamper investigations.