Selling A Kidney In India

Cops in Kanpur probing India’s big kidney racket are flummoxed by the trans-continental network put in place by organ harvesters to service a market of over 10 lakh people seeking transplants every year.

On Thursday, June 19, 2019, the court in Kanpur refused bail to Deepak Shukla, CEO of Delhi’s prestigious PSRI hospital, saying the cops had incriminating evidence that he was actively conniving with kidney harvesters. Investigators in Kanpur say those arrested have confessed operating on a hop-skip-jump model, live-organ donors simply disappearing from one hospital to another after the transplant process, leaving virtually no trail.

But one day, the cops scented the trail and picked up three youngsters from a Cafe Coffee Day store in Kanpur.

“All those arrested said the donors came to them, they were keen to be paid for their body parts but feared getting caught. And that the donors were not solicited, nor forced into parting with their kidneys. But with prolonged interrogation, their lies started falling off like house of cards,” Ashok Lal, a senior officer of UP Police, told this reporter.

Lal said among the 12 people arrested last week, two were in the business for more than two decades, including Rajkumar Rao who had been operating from a swanky apartment in South Kolkata and had been in and out of jails over 12 times. Those in kidney racket call him Boss, or Guruji, Rao - claimed Lal - has traded over a thousand plus kidneys across India and abroad.

In each deal, he earned a little over Rs 10 lakh. He, and his gang, did not care it is illegal to buy or sell organs. Those arrested were in touch with international market for transplantable organs and worked closely with unscrupulous doctors who, post operation, used expensive hotels as recovery rooms. The kidney harvesters take full advantage of the growing need for transplants.The World Health Organization (WHO) says 20 per cent of the 63,000 kidneys transplanted worldwide annually from living donors were bought illegally. The WHO estimates around 2,000 Indians sell a kidney every year and South Asia is the world’s leading transplant tourism, with India among the top kidney exporters. Bulk of the kidneys from India go to foreigners from the United States, Canada, Israel, Britain, Saudi Arabia, the United Arab Emirates and Bahrain.

That is the official figure, the unofficial figure is over ten times. Not just kidneys, now lungs, pieces of livers and corneas also command a price. And India is at the heart of this burgeoning illegal organ trade bazar despite banning organ trade in 1994. If caught, lawbreakers can be jailed under Indian laws up to five years.

Cops in Delhi and Kanpur say the ring includes doctors, nurses, paramedics and hospitals that perform such illegal transplants of organs to rich Indians and foreigners. Once, bulk of the donors were poor labourers who were paid a pittance of $2,500 for a kidney, some forced to give up organs at gunpoint. But now, the donors list has expanded and include people from all walks of life, including saints and nuns.

Both the donor and the recipient make up a story to tell the hospitals because of stringent rules that only relatives or third cousins can be donors.

Now donors are posing as neighbours, friends, business acquaintances, even friends of children of the recipient. Not all doctors agree, those who want to make quick cash, agree. And then the process starts.

Lal says doctors, when caught, say they cannot interrogate patients and donors because they are not cops, and the Hippocratic oath prevents them from turning away a sick patient with an organ ready to be transplanted. “The doctors and agents rarely admit that they are tempted by the cash involved in the entire process.” He said those needing a kidney and dependent on dialysis machines, the wait for a new organ is daunting.

In New Delhi, Kolkata, Mumbai, Chennai and Bengaluru, the average wait for a new kidney is 15 years in a government hospital. In the private hospital, the wait can be less if the donor is ready. “And then there are the charges which are one fourth of the cost in the West,” says Ashok Pradhan, a kidney patient in Kanpur.

The rates are charged uniformly in India by the agents, claim those who have interacted with the brokers. Poor, healthy people are preferred and offered anywhere between Rs 3-6 lakhs per kidney. The agent takes another Rs 10 lakhs, the team of doctors and medical staff takes anywhere between Rs 10-12 lakhs. And added to this is the travel cost, hotel and recovery expenses of the donors which hovers around another Rs 2-5 lakhs. So, on an average, a kidney and its transplant in India costs almost Rs 70-80 lakhs. Across Europe and the United States, the state pays for the cost but the waiting list is huge. As a result, many flock to India where the demand remains on a perennial high. The WHO has tried hard to legalise organ sales but it has found no backers. Across South Asia, cops claim there are hundreds always ready to sell organs, or children.

Dr Feroze Pasha, a top surgeon at Apollo Hospital in Delhi, say it is very tough to control the racket because it’s all about humans handling humans. “Demand for organs are always on a high, very high. And then, how do you know someone else is being faked in as a relative, someone’s blood details are being matched and pushed forward for clearance? It’s all humans doing things for humans, not machines unless the operation starts.” Dr Pasha says often rackets like these have opened a Pandora’s Box of questions but no state government has been able to answer fairly. Cops say this is the network that they aim to bust but each time they fail because the organ traders either jump bail or bribe their way out of the police lockups.

Consider this one. The Lucknow-based Sanjay Gandhi Post-Graduate Institute of Medical Sciences, a premier nephrology hospital, had a list of over 31,000 people in Uttar Pradesh seeking kidney transplants last year but only 150 transplants took place due to unavailability of donors.

Experts say there needs to be a built-in system for checking the individuals’ motivations to be sure they’re not being coerced. And there should be a fair and established price. But it rarely works in a billion plus nation like India where brokers easily find people seeking kidneys and selling kidneys.

On paper, the rules are fairly clear. There are three types of donors allowed under the Act — first liners (blood relatives), second liners (close to blood but not genetic, say spouse, etc.) and outsider liners (those who fall outside the immediate kin). And then, every hospital authorised for organ transplants work through an authorisation committee which looks at the documents of the donor. Cops say it is the organ coordinator — he screens the donor and clears papers for the transplant - who is in touch with touts. Cops say files of identities of patients - on inspection - don't match the original identity of donors and recipients. Fake Aadhar cards were used as proof by the touts.

Officials in Faridabad’s Fortis Hospital, who spoke on conditions of anonymity, say India’s massive kidney trade racket spans not just several states but also a number of countries. Sometimes, the racket is busted, like it happened in the case of Sonika Dabas, the kidney transplant coordinator at Fortis, who was arrested by UP police. Within 48 hours, the cops arrested  Dipak Shukla, a high-profile surgeon and CEO at South Delhi-based Pushpawati Singhania Research Institute (PSRI) Hospital.

Rajesh Yadav, superintendent of police (crime), Kanpur, says it will take months, probably a year, to get to the bottom of the case. “Almost every hospital in India works closely with touts luring poor donors to donate their kidney in exchange for a cash or jobs. This can stop if each police from all affected states come forward to offer details. But it does not happen, investigations stop midway.”

Yadav says in one such case, the donor got Rs 10 lakhs. It was easy cash because the donor knew he could survive with a single kidney and the cash came in handy for his daughter’s marriage. An official at the PSRI hospital said the management was fully cooperating with the ongoing investigation. A similar response came from Fortis Hospital. Ashok Sharma, a resident of Delhi and a friend of Dr Shukla said he suspected the PSRI CEO was framed because he took on the kidney mafia. “Dr Shukla had a taint-free career.” But cops in Kanpur say Dr Shukla was a suspect for many years, his name emerged during the interrogation of several donors over the last six months. Dr Shukla has been booked for cheating, wrongful confinement, trafficking, criminal conspiracy and under sections of the Transplantation of the Human Organs Act, 1994.

Two officials from PSRI - Sunita Prabhakaran and Mithun — have already secured a stay on their arrest from court after the Kanpur police sent them notices, claimed Yadav, adding the gang’s alleged global face, Dr Ketan Kaushik, a private practitioner, is absconding. Dr Kaushik, claimed the cops, brought patients from Sri Lanka, Turkey and other countries in the Middle East where transplantation charges are very high.

But the big man of the show is Kolkata businessman T. Rajkumar Rao, currently in jail in Kanpur, who has been in the business for more than two decades, claim cops. But every time he is arrested, Rao managed bail and resumed his business.

Rao, described as Asia’s biggest kidney harvester, grew up studying in the convent, reading Phantom comics and watching Amitabh Bachchan blockbusters. According to police records, Rao has conned over 16,000 debt-ridden farmers, Tsunami sufferers and impoverished tea garden workers to build his Rs 75 crore empire. Many compared him to the late Sansar Chand, the poacher who was responsible for killing of over 400 tigers and 2000 leopards in India’s wildlife reserves.

Rao worked with his partner Dipak Kar, a school dropout who is on the run. The duo would visit neighbouring Nepal and Bangladesh to identify gullible victims. The two had a strong network of over 300 people who worked across South Asia (except Pakistan) for potential donors. Rao and Kar divided their empire into five regions. East (the largest zone) had Bengal, Nepal, Bangladesh, Bihar, Assam, Manipur, Orissa, Jharkhand, Tripura while North had Punjab, Haryana, Uttarakhand, Rajasthan and Uttar Pradesh while South had Sri Lanka, Tamil Nadu and Andhra Pradesh, West had Maharashtra and Goa while the Central zone catered to Madhya Pradesh and Chattisgarh.

The two operated through their network and also through Facebook pages as kidney and transplant support groups. Cops in Kolkata who interrogated Rao and Kar say the two were found feeding people poison that would create stomach pains and cramps. Once inside a dispensary, the patients were drugged and kidneys removed. Rao’s illegal business is now counted among the biggest human organ scandals in the world. The two holidayed abroad and have properties and real estate in as many as ten cities across India.

Senior Superintendent of Police Kanpur, Anant Deo says what was extremely distressing is that Rao dealt with over 25 top hospitals in India where surgeons did not even ask about the background of the donors and if they followed guidelines stipulated by the law.

An old survey conducted among 300 people in Chennai – a favourite hunting ground of Rao – showed majority selling one of their kidneys to pay off debts for an average Rs 45,000. The report, titled Economic and Health Consequences of Selling a Kidney in India was published in The Journal of the American Medical Association.

Meanwhile, hearings continue in Kanpur even as the cops try their best to arrest India’s big kidney harvesters.

(Source: BTVI)