A Pound of Flesh Organ Trade Thrives in Indian Slums

India's slums are a gold mine for organ traders, full of poor people desperate enough to sell their organs. But with a healthy kidney fetching just €500, most donors only make enough to pay off their debts -- and end up even poorer in the long term.

By Thomas Schmitt

Indian slum-dwellers often try to pay off their debts by selling their kidneys. The health risks are considerable, legal regulations provide little or no protection, and the poverty of the vendors persists.

Indian slum-dwellers often try to pay off their debts by selling their kidneys. The health risks are considerable, legal regulations provide little or no protection, and the poverty of the vendors persists.

The note is attached to a tree trunk across from the Central Hospital in Chennai (formerly Madras), a major city in southern India. Written in scrawly handwriting, the note advertizes its author's "top notch kidney" for 30,000 rupees, the equivalent of €500 ($664). Asked about his offer, the vendor -- a 30-year-old Tamil -- says "no middleman" is involved in the deal. He adds that he urgently needs the money to "pay back debts."

This offer is no isolated case in Chennai. On the contrary: The metropolis of around 7 million people has the questionable reputation of being the main trafficking hub for the organ trade in India. And the items for sale are mainly kidneys. After all, every human being has two of those and can get by with just one if needs be.

Sometimes the trade takes on a bizarre character. Villivakkam, a slum in the north of Chennai, is known as "Kidneyvakkam" or "Kidneytown" among the locals. Surveys conducted for the health ministry show almost every family includes someone who has sold their kidney. The situation is similar in the neighboring refugee camp of Tsunami Nagar, which was set up for the victims of the 2004 Indian Ocean tsunami. Here, the kidneys of patients in good health can be bought "for between 20,000 and 40,000 rupees," one former middleman reveals.

"The kidney donors are often poor young women," reports George Kurian from the Christian Medical College Hospital in Vellore. "The buyers, on the other hand, are usually older and well-off men." According to press reports, about 100,000 Indians require a kidney transplant every year. In addition, some two million suffer from serious kidney problems. The demand is huge -- and the kidneys tend to go to those with the most money.

Money Lenders, Middlemen and Corrupt Officials

The Indian government already tried to pass a law regulating the removal and donation of kidneys as early as 1994. But the government could not put a stop to the illegal trade, since the law allows people to donate their organs to complete strangers, provided they are in some sort of "relationship" -- no matter of what kind -- with the interested party.

It is impossible to prevent money changing hands under the counter, even though, theoretically, every transplant needs to be approved by a hand-picked panel of doctors and other experts. But the dramatic increase in demand for kidneys leads to more and more organ donations being approved despite the absence of conclusive proof that the transaction really is a non-commercial "donation." "We know an organized organ trade exists," says C. Ravindranath, the former chairman of the Authorization Committee. "It's just that we can't prove it."

Jogesh Amalorpavanathan, the organ transplant coordinator at the public Central Hospital in Chennai, is only too familiar with the situation. He explains that the illegal organ trade only works because of the well-rehearsed cooperation between crafty money lenders, dubious middlemen and corruptible state employees. The latter provide the counterfeit proof of identity, while the middlemen are responsible for "customer contact" and the money lenders for the financial settlement, according to Amalorpavanathan.

Health Risks

The issue has been hotly debated in the press, prompting the government of the state of Tamil Nadu to order an investigation. But the police unit charged with fighting crime promptly refused to investigate, arguing that only the Authorization Committee has a mandate to look into irregularities in the organ trade. The only response to that explanation from those involved in the trade is a tired smile: Now they can go about their business as usual.

And kidneys are in ample supply: Sums of between €500 and €700 are no trifle in India, and there is a correspondingly large number of people willing to surrender a kidney. But in the long term, the organ vendors don't benefit. A study by the health ministry shows that the organ transplants are associated with enormous health risks. Morever, they don't even improve the donors' financial situation in the long term.

"Ninety percent of the organ donors live below the poverty line," says health expert Thiru V.K. Subburaj. "But by the time their debts have been paid off and enough food and clothing has been bought for the family, most of the money has been used up."

Kidney Exports

But that isn't all. Many organ donors complain about having received too little aftercare and admit that they were left in a weakened state for a long time after the operation. They are no longer able to perform their everyday work as usual. This leads to the follow-up health costs being much higher, in the long run, than the financial benefits associated with the organ sale. It's not even unusual for the donors to "die from the effects of a negligently carried out operation," says Ravindranath from the Authorization Committee.

But the organ recipients wash their hands of this murky trade. Barely 3 percent of those questioned for a survey admitted to ever having heard about the lucrative trade that prospers off the backs of the poorest of the poor.

The media had hoped a recent conference in Chennai could provide a solution. But the debate between the experts was sobering. Tamil Nadu's Health Minister Thiru Ramachandran repeatedly called for more controls -- but these calls fell on deaf ears. On the contrary: Most of the 50 participants went so far as to call for a complete liberalization of the organ trade. "If the wealthy can buy anything they want with their money, then why shouldn't they be able to buy human organs as well?" one participant asked.

Meanwhile, the organ trade has developed into a veritable export industry. Every year more than 1,000 kidneys from India go abroad -- most of them to Arab countries -- even though the domestic demand is far from having been met. Given such demand, it's unlikely that the sordid business is going to end any time soon.


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