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Kidney crunch

Only 3.3 per cent of 1.8 lakh people suffering from renal failure every year find a donor in India. But there’s never a shortage of donors for politicians or the influential

Here is an interesting paradox. While politicians and sportspersons make a beeline for the US and Europe for treatment, India has become one of the most favoured destinations for medical tourism (https://www.newslaundry.com/2018/03/23/foreign-medical-treatment-irrfan-khan-manohar-parrikar-sonia-yuvraj). There’s one notable exception. They prefer domestic hospitals when it comes to organ transplant.

The reason for this is very simple. The rules for donation of an organ in the West are transparent and stringent. Take the case of the US. There are multiple criteria in place, like ‘longevity matching’: a 30-year-old donor can give a kidney only to someone of the same age group. In India, there’s no such criterion.

There are acute shortages in the US, but rules are non-negotiable. As per last year’s figures of the United Network for Organ Sharing, the kidney transplant waiting list consist of more than 97,000 people in the US; the wait for a deceased donor could be between 5 and 10 years depending on the state in which one resides.

The situation in India is even worse. As per the Director General of Health Services of Ministry of Health and Family Welfare, there a ‘wide gap’ between patients who need transplants and the number of organs available. An estimated 1.8 lakh persons suffer from renal failure every year; however, the number of renal transplants done is around 6,000 only. That is, only 3.33 per cent of renal failure patients get a transplant done.

Despite this, politicians and the affluent get their transplants done in India. And they, for some strange reason, always manage to find a willing donor within a few days. More often than not, the donor is not a family member or a close relative, not even a cadaver, but a hale and hearty person, unrelated of course, who decides to donate his or her kidney ‘out of affection and attachment’ as is provided for in the Transplantation of Human Organs Act (THOA) 1994.

Yes, as per THOA, there is provision for ‘other than near relative donor’ who can part with a kidney out of ‘affection and attachment or for any other special reason’ with the approval of the ‘authorisation committee’. The ‘other special reason’ is subject to liberal interpretation by the ‘authorisation committee’, which is more than accommodative when it comes to politicians and the influential.

Of course, donors could be deceased — those declared ‘brain-stem death’. A living donor could be near relatives like mother, father, son, daughter, brother, sister or spouse.

When it’s a question of life and death, like in cases of renal failure, family members do their best to save the life of a near and dear one. In a society with wide economic and social disparities, the poor have the odds stacked against them, while the politicians and influential maintain an aura of secrecy about who the donor is. It’s considered impolite to even ask questions about it.

Take the case of Minister for External Affairs Sushma Swaraj. She underwent a kidney transplant in December 2016 from a ‘living unrelated donor’ as no suitable donor was available within the family. The surgery lasted for six hours and was performed by at the cardio-thoracic centre of All India Institute of Medical Sciences (AIIMS) by a team of doctors that included AIIMS director Dr MC Mishra, surgeons VK Bansal, V Seenu and nephrologist Sandeep Mahajan.

 

The speculation about Swaraj’s donor in the media invited an irate reaction from her husband Swaraj Kaushal. He tweeted: ‘The media reports about Sushma’s surgery are so detailed. I think we will have to prepare for a live telecast. Alas! A lady in public life is also a citizen of India and entitled to some privacy.” The need for transparency often is in conflict with public profiles. But don’t public figures have an additional responsibility to set a good example for the rest of society?

 

Apart from the huge gap between demand and supply, poor infrastructure in government hospitals, lack of organised systems for organ procurement from deceased donors and lack of awareness add to the problem. The private hospital runs up astronomical bills in the absence of proper regulation. This makes life difficult for uninsured and poor patients.

 

Also, authorities have failed to prevent and control organ trade. The World Health Organisation (WHO) declares South Asia, particularly India, as the leading global hub for transport tourism. India, despite the acute shortage at home, is one of the top kidney exporters, some 2,000 Indians sell their kidneys, many of them to foreigners. That perhaps explains why India elite don’t travel abroad for organ transplant — on the contrary, many foreigners come to India because of relatively lax enforcement when it comes to finding a suitable donor.

 

As per the latest news, Swaraj’s cabinet colleague, Finance Minister Arun Jaitely, suffering from kidney ailment, is undergoing dialysis. He was in AIIMS for a couple of days earlier this week. The doctors attending to Jaitley, who was supposed to undergo a kidney transplant, preferred dialysis and medicines for the time being. It’s hoped that finding a donor won’t be difficult.