New Delhi: A four-and-a-half year old girl got operated upon at a hospital in Delhi in March. Two months later, her father alleged that one of her kidneys disappeared after the surgery. The hospital set up a committee to investigate the allegation and the outcome is awaited.

While it could be that the child was born with only a single kidney, the incident brings back the spotlight on the business of illegal transplants and organ trafficking in India.

In India, around 200,000 people need a kidney every year, but only around 3% of the demand is met, says Dr Sunil Shroff, managing trustee of the Mohan Foundation, a Chennai-based non-government organization working on organ donation. “There is a demand and supply problem. Of these 200,000 in need of a kidney, around 15,000 can afford treatment but only 7,000 of these can afford transplants," says Shroff.

Even if one can afford a transplant, finding a matching donor is difficult. Besides, under the law, only some people related to the person in need are allowed to donate, and this further shrinks the number of prospective organ donors.

The supply-demand gap for donor organs paves the way for illegal transplant and trade of human organs.

Organ trafficking, according to World Health Organization (WHO), is a commercial transplantation, where there is profit, or transplantations occur outside of national medical systems. The WHO estimated in 2007 that organ trafficking accounts for 5-10% of kidney transplants performed annually across the globe, and that in India, around 2,000 Indians sell a kidney every year.

In 2001, a survey was conducted among 305 individuals who had sold a kidney in Chennai by a team of four doctors—Madhav Goyal, Ravindra L. Mehta, Lawrence J. Schneiderman, Ashwini R. Sehgal. “Ninety-six per cent of participants sold their kidneys to pay off debts. The average amount received was $1070. Most of the money received was spent on debts, food, and clothing," said a report titled Economic and Health Consequences of Selling a Kidney in India published in The Journal of the American Medical Association on 2 October 2002.

Rakesh Senger, national secretary, from Nobel Peace Prize winner Kailash Satyarthi’s NGO Bachpan Bachao Andolan (Save the Childhood Movement) says that while trying to locate missing children, many times he has found dead bodies of children without their vital organs. “What was shocking was that their kidneys or other vital organs were missing. In many cases, police just says the body was lying in a stream, where some animal must have eaten the child’s organ," says Senger. “It is much easier to file a case of kidnapping and murder against unknown persons. If you accept the organs were missing, you have to do a thorough investigation. So, the details in such cases get murkier."

While in some cases people donate their kidneys for money, there are cases when the kidneys are removed without the patient’s consent. Shroff says the demand for organs could be met if the country taps into the pool of people who are brain dead and promotes organ donations.

“So many accidents happen in the country. Out of those, several people have brain injuries. We need to tap this pool. If this happens, we may not even require living donors," he says. According to figures published in the medical journal Indian Journal of Anaesthesia in 2013, of the 205 patients declared brain dead at the AIIMS Trauma Centre in the past five years, only 10 became potential organ donors. The study said that 90% of donors were middle-aged males. The cause of brain death in 70% of the cases was injuries sustained in road accidents, 20% after falling from heights and 10% from getting gored by animals.

With the lack of willingness of people who want to donate, an illegal trade market becomes conducive. Cases of illegal organ removal and transplant appear in the media on and off. The most recent case related to largescale organ trafficking was in 2008 when it was found that Amit Kumar, a man who posed as a doctor, illegally removed kidneys of people from different states and transplanted them to high-paying patients in Gurgaon.

In another case in 2007, the police uncovered an illegal kidney trade involving fishermen who lost their jobs after the Indian Ocean tsunami. An illegal transplant racket in Punjab was also uncovered in 2003.

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