The Underworld of Organ Transplantation in India

In a historic medical feat that has captured global attention, 62-year-old Richard "Rick" Slayman made headlines and emerged as a beacon of hope in the field of organ transplantation. Recently, Slayman underwent a groundbreaking procedure at Massachusetts General Hospital (MGH), marking a monumental stride forward in medical science. MGH is the Harvard Medical School’s largest teaching hospital in Boston in the U.S.

Slayman was battling end-stage kidney disease and urgently needed an organ transplant. Previous attempts at such surgeries worldwide had met with disappointment, making Slayman's successful operation a significant milestone in medical science. On March 16, a team of medical experts conducted a meticulous four-hour procedure, transplanting a genetically modified pig kidney into Slayman's body. It is too early to say how Slayman’s body is going to react to the transplant in weeks, months, and years from now, but nevertheless, it is a great milestone for science.

While Slayman's surgery marks a huge advancement in the field of organ transplantation, this isn't the first instance of utilising pig organs in such procedures. Prior attempts involving pig heart transplants, though pioneering, unfortunately ended in tragedy with the recipients succumbing mere weeks later. While there are multiple challenges and risks involved in these surgeries, scientists across the world have been making groundbreaking discoveries in such transplant techniques.

Despite strides in modern medicine globally, India's investment in organ transplant research and procedures lags behind. The world witnessed its first successful organ transplant with a kidney transplantation procedure conducted by David Hume and Joseph Kelly in Boston's Peter Brigham Hospital in 1954. After that, it took nearly 17 years for India to follow suit and conduct its first successful kidney transplant in 1971 at the Christian Medical College, Vellore, Tamil Nadu. Since then, the progress, both in terms of scientific studies and the number of transplant procedures conducted in the country, has been sluggish.

India's annual tally of 17,000–18,000 solid organ transplants places it among the top contenders globally, trailing only behind the United States and China. However, despite this significant volume, the country falls short in comparison to several high-income nations when considering transplantation rates per million population. Moreover, India grapples with a notably lower deceased organ donation rate compared to numerous other nations. Data from the International Registry of Organ Donations and Transplantation paints a stark contrast, revealing that the United States boasts a deceased organ donation rate a staggering 100 times higher than that of India.

The plight of countless patients awaiting organ donation in India is a painful reality and must serve as a wake-up call to the health ministry to shift its approach to transplantation. With the number of donors failing to keep pace with the escalating demand, the consequences are dire. A staggering waiting list of over three lakh patients every year, coupled with the tragic loss of at least 20 lives daily as they languish on the brink of hope, paints a distressing picture of the nation's organ donation landscape.

The dominance of the private healthcare sector in such transplants has further intensified this crisis, perpetuating a cycle of inequity. The exorbitant costs associated with organ transplantation in private hospitals render this life-saving intervention inaccessible to a vast swath of the population. The statistics lay bare the stark reality: in 2019, over 95% of liver transplants were conducted in 175 private sector hospitals. Meanwhile, despite an estimated requirement of one to two lakh kidney transplants annually, only about 10,000 such procedures were performed each year since 2019.

This inequitable distribution of transplant services not only deepens the socio-economic divide but also perpetuates a system where access to life-saving treatment hinges on one's financial status. Tragically, those most affected by this disparity are often the very individuals who cannot afford the higher costs associated with private healthcare.

The scourge of illegal organ trade represents a grave challenge confronting our country, casting a shadow over the integrity of our healthcare system. Behind closed doors, an underground network of illicit organ transplant rackets thrive, operating beyond the purview of law and ethics. Disturbingly, cases of such nefarious activities continue to surface with alarming frequency. Experts warn that the cases that come to light merely scratch the surface of a much larger and more insidious problem.

Indeed, recent events have shed light on the extent of this illicit trade. Just this week, authorities in Gurugram uncovered an illegal organ transplant nexus, exposing a web of middlemen orchestrating the illicit exchange of organs. Shockingly, the operation involved the exploitation of Bangladeshi citizens, who were coerced into both donating and receiving organs in Indian hospitals.

Moreover, damning allegations have emerged, implicating reputed hospitals in these illicit activities. In December last year, 'The Telegraph', a London-based newspaper, ignited controversy by accusing Apollo Hospital in Delhi of involvement in the illegal purchase of kidneys from poor individuals in Myanmar to cater to rich patients. 

Since its inception in 1994, the Transplantation of Human Organs Act (THO) has been streamlining organ donation and transplantation in India. By acknowledging brain death as a form of mortality and criminalising organ sales, the Act aimed to instil ethical standards and curb illicit practices within the transplantation sphere. However, despite the enactment of THO, India continues to grapple with persistent challenges in combating organ commerce and kidney scandals. The flawed implementation of the law has resulted in increased organ trafficking and commercialisation, exploiting vulnerable individuals who are coerced or misled into parting with their organs, often due to financial desperation.

The Act's shortcomings are glaring, as evidenced by the thriving parallel illegal market for organs, fueled by the scarcity of legal avenues for procurement. Moreover, critical gaps in data reporting, particularly concerning the online entry of information into the National Registry by hospitals and states, undermine efforts to monitor and regulate organ transplantation activities effectively. The absence of well-organised networking systems among key stakeholders further compounds these challenges, obstructing the seamless coordination of organ transplants and heightening existing inefficiencies in organ allocation.

The urgency to address India's organ donation crisis extends beyond legislative measures. We need to raise widespread awareness and combat prevailing misconceptions. Alarmingly, reports indicate a significant gender disparity in live organ donation, with women comprising a majority of donors but a minority of recipients. This inequity shows the need for targeted initiatives to promote gender equality in organ transplantation.

Moreover, negative stereotypes surrounding organ donation further hinder progress in addressing the shortage of organs. Efforts to educate healthcare professionals, including doctors, ICU staff, and emergency medical units, are imperative to dispel myths and misconceptions surrounding donation and encourage greater participation in organ donation initiatives.

Additionally, stringent enforcement of laws is essential to combat illegal organ trafficking and hold perpetrators accountable for preying on vulnerable populations and making money over people’s miseries. The health ministry must take proactive measures to crack down on illicit practices and ensure the integrity of the organ donation process. Without prompt action, the plight of individuals languishing on never-ending waiting lists for organs will persist, leading to unnecessary loss of life. The rest of the vulnerable population will continue to be preyed upon by the illegal organ transplant network that thrives on people’s sufferings.

At The Probe, our commitment to social impact journalism is at the core of everything we do. Funded by well-meaning individuals from the public, our aim is to drive positive social change and make a real-world impact through the stories we report. If you wish to support us, please visit our Truth Brigade page and contribute to a cause that resonates with you the most. It is through your support that we have been able to keep the flame of our journalism alive in these difficult times. Click link to support us to make a difference: https://theprobe.in/truth-brigade