Kidneys for quick cash
As investigations into the kidney sale and transplant
scam rocks India and Sri Lanka, a kidney donor who once connected to the
sellers and buyers, tells his story:
For Vivekan (not his real name), the request for a kidney came when
he was just 22 years of age. At that time, some five years ago, he did
not fully understand the gravity of the request.
Having moved from the central hills to work in Puttalam as a cleaner
at a prawn farm, his meager salary was all he had to support a family of
seven, comprising an alcoholic father, tea plucking mother and four
Vivekan moved from Nanu Oya to Puttalam at the age of 19, and three
years later, when a 'client' met him (he did not even know how he was
identified as a possible kidney donor), he ended up parting with one of
his kidneys. It was much later that he realised that there were a few
dozen 'kidney donors' in the poverty stricken area he hailed from, where
people were selling their kidneys for cash and asked no questions.
But Vivekan was different. He was quick to understand that selling
his kidney was a one-off act. Once sold, he could not sell more. But in
his village and in the surrounding areas, there were others who wanted
to sell their kidneys, if discreet inquiries were made, and making the
connection between donor and donee could take him to the next level.
Not that Vivekan, having sold his kidney at 22, to an unknown donor,
is now managing a kidney donor ring. But he remains a useful cog even
now, making the right connections; linking people in central Sri Lanka
from where, authorities reluctantly agree, many of the donors do come
It was not that easy, says he, to locate a few 'potential donors'
from his own native place. "Our villages have a few donors. They also
have an idea as to who got the contacts. But they are so silent because
the police sometimes follow them. It is strange when you say that the
authorities are looking for donors and vendors now and countries are
collabroating. They operate all under the authorities' nose - and often
with their blessings, I feel," Vivekan said candidly.
Vivekan's kidney was removed (no guesses allowed here) at one of the
five hospitals recently mentioned in Indian media reports for carrying
out unauthorized kidney transplants. He was paid handsomely - inspiring
him to take the next step and become a 'kidney entrepreneur' - combing
the area, looking for poor enough people willing to donate kidneys for a
good sum of money.
Five years ago, when his own kidney was removed, he got nearly
US$2000. "The kidney prices have dropped since then, despite what people
say. That's partly because making arrangements have become difficult
within Sri Lanka. Indian patients, often bring their donors with them
now. Things have changed in the past two years with everyone keeping an
eye on the kidney trade," said Vivekan.
The last time he 'coordinated' a patient, it was an Indian patient
travelling from South India but flying through Mumbai. He would not say
when or offer more details about the patient. But the donor was young
and from a close by village.
The kidney was sold for a mere Rs. 100,000 but his coordination fee
was high: Rs. 40,000 (including travel expenses).
For Vivekan, it is however not the regular fee. "Not everyone pays
like that. They know we are poor people, even ready to sell our organs
for money. They offer little money, stagger payments and sometimes,
don't pay at all."
Before his time, he knew of organ donors who did not even get paid
after their kidneys were removed. "I would ask that a lump sum be paid
to the donor when he or she prepares for hospitalisation for kidney
removal. The rest is paid post surgery," Vivekan explained.
In a year, he used to link around 3-4 donors, and add about Rs. 150,
0000 to his annual income. "I am scared now. The patients are worried
because both countries, India and Sri Lanka, are keeping an eye on organ
donation. Both countries have tightened the laws from what I hear and
the police are offered information by the villagers who don't like me
making an additional income," he said, quite disgusted. For Vivekan, the
illegality of the operation and the risks involved are not too much of a
concern. Born to poverty and raised in poverty, he said that authorities
did not understand as to why it was the poor people who ended up as
kidney donors oftentimes, both in India as well as Sri Lanka.
"It is the one possible way to get a lump sum into our hands. I know
of a man who partially built his house after donating his kidney and a
woman who gave her daughter in marriage, using that money. So what if
they sold their own organs?"
To my unasked question, whether this involved women, his slow
response was: "Yes, but just a handful."
When active (though now fearing the law), he would accompany the
donor to Colombo and help in clearing formalities including
hopsitalisation, (with the assistance of someone whose name he says he
would never disclose).
When requested, he was also involved in escorting the donors to
various locations where they would be picked up by the patients. Once
the commission was paid, he simply cut his links off, and allowed
another to coordinate the rest of the 'transplant saga,' including the
facilitation of organ donors' return to their respective homes.
Vivekan, in the past few years, has both 'connected' local donors and
facilitated foreign donors arriving mostly from India to reach the
patients or their places of stay. "The payments differ," he said.And
where do the foreign donors and 'clients' stay? An amused Vivekan
responded: "there are luxury apartments close to many of these
hospitals. The donors stay for about three weeks before return," adding
that, he has learned by 'sharing information,' that foreign donors
already possessing passports was preferred and paid more.
"That's a high value donor," he said.
The Indian nexus
After India banned the sale of organs through the Transplant of Human
Organs Act of 1994, there has arisen a flourishing racket selling organs
like kidneys. The price of a kidney in the Indian underworld market
ranges from US$ 1000 and US$ 2500. According to the TIME magazine, a
doctor who pays US$ 1000 to a poor donor, in turn, charges his patient
US$ 37, 500. Therefore, post 1994, huge money is being made by Indian
doctors illegally, an oft-concealed fact.
Recently, it was discovered that in Gurgaon, near New Delhi, some 500
poor people had sold their kidneys to unscrupulous doctors. There were
news reports indicating that doctors went around slums and villages in
this region and booked "donors" after doing some cursory tests at their
The donors were quoted as having claimed that the US$ 1000 to US$
2500 they would get was good money for giving one of their two kidneys,
given the fact that one kidney would be enough to live.
The India media also reported cases of cheating. In Chennai, where
the Kurukkupet slum became notorious for kidney sales, donors claimed to
have been cheated badly. "I was paid US$ 1000 while I was promised three
times as much," donor Muttamma said.
However, the prospect of being cheated and suffering complications
due to lack of post operation care, has not prevented the poor from
selling one of their kidneys. According to the Chennai-based Multi-Organ
Harvesting Network (MOHAN), poverty is the main reason for selling
kidneys and that too cheaply.
There also cases of the poor and hapless being abducted and forcibly
operated upon. The media have quoted victims who said that thugs had
abducted them to be operated upon under duress.
According socially conscious Indian nephrologists, there is a huge
gap between voluntary donations and the need for kidneys. In India, few
people (ideally blood relations) volunteer to donate a kidney. The ratio
of voluntary donor to patients who need a kidney is 1:1 million, while
in the US, France and Spain, the ratio is as high as 20:1 million.
Doctors attributed the yawning gap in India not to selfishness or
some religious injunction, but to ignorance. There isn't sufficient
awareness of the need to donate and about the fact that is perfectly
safe to donate one of the two kidneys one has.
Given the world-wide supply crisis, the Brussels-based International
Society of Nephrologists has suggested controlled sale of kidneys, and
has fixed the price at US$ 40,000 per kidney.