Coming to Sri Lanka for kidneys

by Vandana Kamath

With Indian organ transplantation rules making it near impossible for 'un-related' organ transplant, Sri Lanka is emerging as the organ transplant hub for Bengalureans

Money was not a problem for a patient of her means. But finding a donor match among relatives was an insurmountable challenge. Her MLA-husband couldn't manage to bend the rules either and the doctors in Bengaluru too threw up their hands in despair.

Just when it seemed all was lost, a trip to Sri Lanka, along with her driver, gave her a fresh lease of life. She returned with a new kidney!

With Indian organ transplantation rules making it impossible for chronic kidney disease (CKD) patients to buy organs, Sri Lanka is fast emerging as the market for organ trade for Bengalureans.

At least that is what doctors tracking organ transplantation trends claim. They say at least a dozen patients from Bengaluru fly down to Sri Lanka every month, since flexible rules there with regard to 'unrelated' kidney donation offer them a lifeline.

The rules in India - Transplantation of Human Organs Act - prohibit a patient from receiving organs from persons other than spouse, son, daughter, father, mother, brother, sister, grandparent or grandchildren. Referring to the case of the MLA's wife, a source said, "In Bengaluru, the only person whose blood group matched with hers was her car driver. He was not related to her, he couldn't give his kidney. So, she went with him to Sri Lanka, got the procedure done and returned with a functional kidney."

Preventive laws

In 2010, the Sri Lankan Government cleared the way for a person ailing from a kidney disorder to obtain organs from a non-related donor. Initially, it was practiced only in government hospitals, but subsequently it became commercial after private hospitals encashed on the rule and started catering to patients across the country's borders. It wasn't long before patients from Bengaluru turned their gaze toward Sri Lanka.

Besides Sri Lanka, Iran and Singapore also perform 'nonrelated' transplant procedures. Pointing to the preference for Sri Lanka, Dr Sankaran Sundar, Director and Chief Nephrologist, Columbia Asia Hospital said: "In the case of Singapore, one has to obtain a medical visa and the procedure could cost Rs. 1crore along with post-operative care.

Sri Lanka, on the other hand, has visa-on-arrival and the cost is close to Rs. 1,000,000-1,200,000."

He said transplants are usually cleared by an authorization committee and a monetary incentive to the recipient may be acceptable.

"In fact, it was observed that a lot of monks came forward to donate their kidneys and use the monetary compensation for the benefit of their monasteries," Dr. Sundar said. Nephrologists in India have been pressing for flexibility in rules to curb shortage of organ donation. Dr Sudharshan Ballal, Chief Nephrologist, Manipal Hospital says: "The wait for transplant is so long that the patient prefers moving to Sri Lanka. People who can afford it also consider Singapore where the number of transplants has shot up. The donor is mostly taken from here."

Nephrologists stress that kidney donation between non-relatives is not illegal.

Nephrologist, Dr. Ajit K. Huligol says: "Recently, grandparents were added to the list of permissible donors, but it is absurd because a 75-year-old grandparent will not have a healthy kidney to donate to his grandson.

In rare cases, the authorization committee approves an unrelated donor. Permission is likely to be given if both belong to the same economic class. We have to ensure the donor is financially sound and will not demand money from the potential recipient, but this is rare."

Not illegal

While the rules in India push patients up against a wall, nephrologists warn about the risk in transplants done abroad saying post-transplant infections could pose a danger.

"Recently, a woman patient on dialysis disappeared for a month and came back after undergoing transplant in Sri Lanka. But she suffered a major infection and we had to remove her kidney. Unfortunately, the infection spread and she finally succumbed," says Dr. Huligol.

Countries like Iran have modified their transplant legislations since the 1980s because of the inordinate organ shortage in comparison to the prevalence of kidney-related diseases.

In 1988, Iran adopted a 'living-unrelated' policy and, by 2005, it was observed that kidney ailments had been brought under control to a large extent. An indicator of the program's success was that eventually Iran had no waiting list for kidney donation.

The Sri Lankan connection had rung alarm bells earlier too.

1. In February 2015, Hyderabad Police claimed to have busted an organ trade cartel by arresting four persons, including a doctor, a student, a passport agent and a businessman, who used to get transplants done at hospitals in Sri Lanka.

The doctor, allegedly the mastermind of the racket, conducted transplants at three centres in Colombo and a centre in Tehran, the police had claimed. He used to charge Rs. 3 million per case. He would make a neat Rs. 800,000 profit after paying dues to the hospital and passport agents. The donor used to be paid anywhere between Rs. 300,000- 500,000, police had said.

2. In June 2015, the National Human Rights Commission initiated a probe into the alleged sale of a kidney by a tribal youth from Orissa for Rs 350,000. Initial inquires revealed the youth was contacted by middlemen on behalf of a patient and the transplant was done in Sri Lanka.

Commercialization, social exploitation, middlemen, threat to cadaver transplant programs and ethical issues are contributing factors in the strict regulations surrounding non-related donors. Offering a way out, Dr. Sundar says: "Eliminating middlemen and regulating payment through the government and NGOs could be the solution." He also suggests mandatory follow-up of donors with regular incentives for 10 years and treating them as heroes.

"Honouring them with gold medals and giving them benefits like concession in train/air/taxes and medical treatment could also help in regularizing transplants to a large extent."

- Bangalore Mirror