The kidney quandary

Sri Lanka yet to unravel locals' involvement in an ongoing kidney transplant racket:

by Chathuri Dissanayake

Poverty is linked to organ donation (squarespace.com)

Three months ago, the Indian media exposed a thriving kidney trade between the two countries, shocking the Sri Lankan health sector and raising eyebrows about the organ transplant rackets and system failures.

Indian media, quoting their police sources, named six Sri Lankan doctors who were allegedly linked to the racket together with six privately-managed hospitals.

Reeling under intense scrutiny and public pressure, local health authorities appointed not one but two different committees to investigate the matter. The problem however, is not new. The report produced by one of the two committees and submitted to the Ministry of Health in February only opened a Pandora's Box with some parliamentarians claiming to be aware of the ongoing racket.

The report was not published and there was no follow up action.

A ban on kidney transplants on foreigners was promptly imposed following the allegations. A separate police investigation launched by the Colombo Crime Division(CCD) is making slow progress, adding to the confusion.

Although eight Indian nationals (donors) were arrested, only six had undergone surgery to remove their kidneys. So far, the police had failed to establish a link between to kidney donations to any monetary transactions. .

Old issue with new spin

Sri Lanka's Transplantation of Human Tissues Act enacted in 1987, explain in detail the legal procedures applicable for organ donations and transplant within the territory. Sri Lanka has taken many strides in tissue transplant surgery and has since become a popular destination for medical tourism. In the end, Sri Lanka has ended up as a cheap and hassle-free option for kidney transplants for those aiming to bypass legal barriers in their home countries.

The kidney controversy erupted in 2011, placing Sri Lanka under the spotlight as a country linked to a flourishinginternational kidney trade, complete with foreign buyers and sellers.

Many foreign nationals exploited the loopholes in the regulations to trade in kidneys. At the time, local regulations did not specify any criteria regarding the nationality of the 'donor' and the 'donee.' Following revelations that Sri Lankans were 'donating' their organs - mostly kidneys, not only to other Sri Lankans but also to foreigners - especially the Maldivians and Israeli (for money), the authorities imposed a new set of regulations to prevent Sri Lankans from 'donating' their organs to foreign nationals.

This resulted in foreign patients having to bring their own donors to Sri Lanka. Undeterred, racketeers found a new way to bypass the authorities, again. Many foreign patients - especially Israelis, began bringing their long-lost "relatives" from all over the world, prompting local health authorities to further tighten the laws governing tissue transplant in the country.

The Health Ministry next introduced another regulation, limiting donors and recipients to one and the same country, but had limited success.

Fresh controversy

In 2013, fresh allegations emerged, following the death of a donor at a Sri Lankan private hospital. In the latter part of 2013, the Ministry of Health appointed a two-member team, Director of Private Health Sector Development Dr. Kanthi Ariyaratne and the Deputy Director, Dr. A.I. Jagoda, to probe the matter.

It is reliably learnt that the 2013 investigation was limited to a mere data gathering exercise. The report and the statistics were submitted to the Director General of Health Services, Dr. Palitha Maheepala.

According to Health Ministry sources, the authorities refrained from taking stern action against the racket due to fears of the island's growing medical tourism industry having to suffer negative consequences.

In January 2016, the issue resurfaced when the Indian media disclosed details of a kidney racket that linked both countries. Six men arrested for allegedly selling their kidneys disclosed the names of six doctors from Sri Lanka's private healthcare system -Lanka Hospital, Western Infirmary (Pvt) Ltd., Nawaloka Hospital and Hemas Hospital - all Colombo-based hospitals - and the Kandy Nursing Home.

However, these hospitals are known for carrying out streamlined transplant surgeries monitored by the Ministry of Health.

Following the Indian media splash, Health Ministry quickly appointed a three-member team, comprising Director of Private Hospital Services Dr. Kanthi Ariyaratne, Western Province Health Services Director Dr. Deepthi Perera and a senior official of the Health Ministry's Investigation Unit. A report was due in one week.

Within a fortnight, Health Minister Dr. Rajitha Senaratne appointed another high-powered five-member team to inquire into the matter, headed by Deputy Director General (DDG) of Health Services, Dr. Jayasundara Bandara. Minister Senaratne also called upon the Inspector General of Police for a separate independent police inquiry. The police investigation report was later handed over to the Colombo Crime Division(CCD).

The ministerial investigation uncovered a number of irregularities in the approval procedures, a member of the five -member team told the Sunday Observer, on the basis of anonymity. According to the member, there was no evidence to implicate any of the consultant nephrologists or surgeons performing surgeries at the private hospitals that were mentioned.

"The probe uncovered the involvement of middlemen, but not doctors or Health Ministry officials. This limits our ability to take action. This is the reason for referring the inquiry to the police," the source explained.

The police investigation resulted in the arrest of eight Indian nationals, currently held in custody at the Mirihana Immigration Facility. Some 286 items in their possession too have been submitted to court.

CCD sources confirmed the recovered items included rubber stamps of Indian doctors and lawyers as well as letterheads. Police are currently checking whether the documents are forged, the source said.

Sri Lankan hospitals now under close scrutiny (squarespace.com)

In addition, police are to scrutinise all documents submitted to the Health Ministry by the six persons, for the verification of authenticity. So far, no link has been made between the surgeries and monetary benefits for the donors.

"Two of the arrested persons do not have passports. We suspect the passports are with the middlemen. We are pursuing the matter," the source added. Admittedly, faced with language barriers and logistical issues, the police are making slow progress and are turning to the Indian Police for some leads.

"We are seriously limited in our capacity to investigate due to language constraints. Correspondence with the Indian authorities is also proving difficult. We now hope to send a team to India," CCD's Director General, ASP K.N.J. Wedasinghe said.

GMOA action

The Government Medical Officers' Association (GMOA) has remained vocal about the issue from the beginning and has openly expressed its suspicions over 'Indian motives' in accusing Sri Lankan doctors of being involved in the kidney racket. The GMOA has been calling for the undisclosed ministerial report, without success. The GMOA has called for a copy of the February report, said GMOA Secretary, Dr. Nalinda Herath.

"The Minister claims of sharing the report with the relevant authorities but has not disclosed the identities of those authorities," Dr. Herath said, adding that the contents of the report are well concealed as far as the public and the medical profession are concerned.