Surgeon K.C. Reddy
Lakshmi Natarajan, kidney seller
India
The kidney bazaar: a matter of life, debt and ethics
October 6, 1991
By Barry Shlachter
MADRAS, India - The frail young woman quietly awaits her turn in a
Madras hospital. She's one of a dozen impoverished Indians hoping to sell a
kidney to a stranger.
It's the last resort for Varantha Muthulakshmy, a 31-year-old mother of
two. She has been harassed by creditors who had lent her husband money
before he abandoned the family.
"I can't bear this debt anymore; I can't bear to go home," said the
4-foot-11 housemaid, neatly dressed in a pale red sari. "If I can sell my
kidney for 27,500 rupees ($1,100), I'll pay the debt and save the rest
for my eldest daughter's wedding dowry."
And if, for medical or other reasons, she cannot sell a kidney?
"I'll poison my children," she said with grim determination. "Then kill
myself."
Advanced surgical skills and grinding poverty have combined in India to
create an open trade in human body parts - kidneys bought and sold in
an unregulated organ bazaar - that has embarrassed the government and
divided the medical profession.
Such transactions also occur in Brazil, Turkey, Egypt and parts of
Eastern Europe. China, though officially rejecting such reports, is
believed to have profited from the export of organs removed from executed
prisoners.
But in terms of sheer volume and openness, India is considered to be
unparalleled. Some hospitals advertise kidney transplants in the Yellow
Pages; others send promoters abroad to recruit potential recipients.
Though condemned by the World Health Organization and international
medical societies, the practice flourishes in Bombay, Calcutta and Madras,
where the poor sell their kidneys to middle-class Indians and to
wealthy gulf state Arabs, Malaysians and Singaporeans who fly in for
one-stop transplants.
However, the ethical issue is not as cut and dried as many critics
suggest. Indians with renal failure who need a transplant but don't have a
related donor currently have no practical alternative.
India still operates under an early 19th century law that makes the
removal of organs from brain-dead patients a crime, preventing creation of
a Western-type cadaver donor system. Forty-six nations have changed
the definition of death during the past two decades to take advantage of
such systems.
To surgeon K.C. Reddy, the trade in human organs in India comes down to
the maxim, "Buy or let die."
Reddy is one of scores of Indian surgeons transplanting purchased
kidneys but is among only a few willing to defend it openly at international
conferences. Still, he would like to see the practice regulated to
weed out what he calls a "mafia" of unscrupulous kidney brokers.
"I am not ashamed," the British-trained physician said of his purchase
of kidneys for patients. "I can sleep nights."
But to many Western medical ethicists, such as Dr. Art Caplan, 41, of
the University of Minnesota at Minneapolis, the commercial trade in
organs is patently unacceptable because it puts the kidney seller through
life-threatening surgery solely for money.
The need for cash might also prompt people with diseases such as AIDS
or hepatitis to conceal their condition in order to sell organs, Caplan
said. Moreover, because surgeons profit from the surgery, such
commercial kidney transactions might reinforce the notion that doctors are
partly motivated by greed, he said by telephone.
"The danger is in starting to treat people as if they were merely a
source of organs," Caplan said. "We don't view our body as property or
want to dehumanize people as portable organ farms."
The stocky, 49-year-old Reddy, whose surgical team has not lost a donor
in 850 transplants - 600 of them involving purchased kidneys - not
only is convinced of the merits of the practice, he believes that India
might well be trailblazing for the West, where the morally acceptable
cadaver donor system has yet to meet the demand for transplant organs.
"I'm not an ethicist, I'm not a philosopher," said Reddy, who practiced
in Maryland before returning to India in 1983. "But those selling a
kidney may not have an option for survival. What useful purpose is served
by telling him and the (prospective recipient) to go to hell?"
The Star-Telegram has learned that the Indian government, stung by
foreign criticism of the open organ bazaar, is preparing a law banning
commercial kidney sales. But Reddy asserted that such legislation would be
impossible to enforce.
"What is needed is regulation," said Reddy, vice president of the
Indian Society of Organ Transplantation. "Banning doesn't help."
He and other supporters of the organ trade argue that the practical
benefits outweigh any ethical concerns:
- No cadaver donor system exists in India.
- Kidneys are sold voluntarily by Indians, for whom selling is often a
once-in-a-lifetime chance to escape poverty.
- Moreover, India, which possesses a proud, non-Western culture, should
not be tailoring its national medical policy to U.S. or European
needs, Reddy and his supporters say.
There's also a heavy donor need. Few Indians who suffer kidney failure
live beyond four years on dialysis, largely because of the poor
conditions and impure water available. Moreover, only a fraction of the
necessary dialysis equipment exists for 60,000 new renal failure cases each
year. And the cost for most is prohibitive: $200 a month, or about
two-thirds the average annual per capita income.
"I cannot live with dialysis. It's torture," said K. Sahadevan, 54, one
of Reddy's patients, who is back on dialysis after a kidney donated by
his sister failed.
The blood-cleansing procedure is done three days a week, four hours a
day, preventing Sahadevan from working as a railroad computer
programmer. With no other relative able to donate an organ, Sahadevan said he
will cash in his pension to buy a stranger's kidney.
No practical alternative exists for Indians who need a transplant but
don't have a willing related donor.
Anuradha Rao, executive director of the Madras-based Consumer Action
Group, is among those uncomfortable with a trade in which the poor sell
and the rich buy. Nonetheless, she said it would be a mistake to ban
organ sales.
"Assuming it's on a voluntary basis with minimal health risks and the
recipient has no access to a freely donated kidney (from a family
member, for example), it should be allowed as a last resort," said Rao, who
has family in Arlington.
Lost in the debate so far has been the fact that organ sales have
quietly broken down Hindu caste barriers. Most kidneys are bought from
low-caste, even so-called untouchable, Hindus, and the recipients include
high-caste Brahmans.
"Those who follow a strict Brahman way of life might object but I
haven't heard of any," said Ramakrishna Dikshitar, 72, a scholar of
Hinduism's holy Vedic scriptures.
And while Pope John Paul II condemned Eastern European kidney sales in
June as "shameful abuses," Hinduism lacks a hierarchical structure to
issue religious pronouncements - and wouldn't if it could, Dikshitar
said. "Even if money changes hands, it is still in keeping with Hindu
belief to help others," he said.
Others agreed.
"Ethically, I find nothing wrong with it," said Sriran Panchu, 39, an
attorney who practices consumer law in Madras.
There's no problem as long as prospective donors are carefully screened
and given ongoing medical care, Panchu said. Prohibiting kidney sales
would only invite corruption, forcing the practice underground, he warned.
"Why aren't kidney purchases allowed in the United States?" the
attorney asked. "In some ways, I think we are more advanced."
Such views are not uncommon among Indian intellectuals and
professionals. And they point to a deeper issue: Should the West impose its moral
or ethical perspective on a foreign society with widely divergent
traditions and outlook?
Dr. John Dossetor, 66, director of the Biomedical Ethics Division at
the University of Alberta in Edmonton said: "I am strongly in favor of it
being illegal in our culture. But I don't believe we have the right to
make it illegal for everybody else."
Referring to a move by the Transplantation Society, an international
group of transplant surgeons, to deny membership to anyone involved in
the commercial organ trade, Dossetor said, "I have problems when it is
applied to countries outside the affluent world."
Dossetor, a professor of internal medicine, suggests that there are
cases even in the West in which the sale of a kidney is ethical, if, for
example, the money is used to save another life. He cited the instance
of a father selling a kidney to pay for his child's leukemia treatment.
Opposition to organ sales is not confined to physicians in the West.
Some Indian doctors also condemn the practice, and have openly feuded
with proponents.
"No money should be involved in organ donation, for that automatically
makes it a trade in flesh," said Madras surgeon M.K. Mani, who said in
a newspaper column that he gives credence to accounts of patients
learning after surgery that a kidney had been extracted without their
permission.
Christian Medical College in Vellore, like Mani's Apollo Hospital in
Madras and state-run institutions across the country, accepts only
transplant patients who have relatives willing to donate kidneys. But doctors
acknowledge that occasionally money and property quietly change hands
between family members.
"There is coercion, whether it's economic or psychological, when
non-related donors are involved," J.C.M. Shastry, the college's chief of
nephrology, said by telephone.
Organ brokers routinely buttonhole kidney patients outside doctors'
offices, asking them their blood type, then displaying a list of medically
compatible donors. "There's a lot of money in it," Shastry said. "It's
hard to resist the temptation to make a fast buck."
Because of his hospital's ban on kidney sales, Shastry sends patients
without donors to Reddy, the Madras surgeon who has successfully snapped
the brokers' stranglehold on the organ trade - by buying direct from
people offering their kidneys for a price.
"Reddy is trying to do it methodically, in a correct way, but he's in a minority, a very
small minority," Shastry said.
Reddy weeds out ill or alcoholic candidates, has them screened by a
staff psychologist, then has an independent psychiatrist explain the
risks. Reddy pays $1,100 per organ, provides three years' medical care and
agrees to a free transplant should the remaining kidney fail.
The surgeon tries to deflect criticism that only the rich get
transplants by performing one free operation a month for a poor patient.
Acknowledging that most organ sellers are slum dwellers, Reddy also cites the
case of a medical student who sold a kidney so he could continue
studies after his father died.
Like many sellers, Lakshmi Natarajan's husband settled a debt ($400)
with his kidney money, and had enough left over for his sister's wedding
dowry. (India has banned dowries that force many families into debt,
but the law is rarely enforced.)
"We were left with no money, so then I (too) sold my kidney," said
Natarajan, a tiny woman by any standard. She contracted directly with the
Pandalai hospital and used the money she earned to build a small brick
house.
The home contains two extra rooms that the Natarajans rent to boarders
in Villivakkam, a slum on the outskirts of Madras where several hundred
people have likewise cashed in on the demand for kidneys.
Natarajan also bought jewelry and had three vendors' carts made. She
uses one to sell kolom, a powder for making threshold designs to ward
off evil. Her husband peddles the stuff from a bicycle. They rent out the
remaining two carts.
This from the sale of one kidney.
But the Natarajans' success story is a rarity.
"Most who sell a kidney spend the money left and right getting drunk,"
she said through an interpreter. None of several other kidney sellers
interviewed had made as dramatic an improvement in living standard as
the Natarajans.
Would I do it again?" Natarajan asked, echoing the question.
"If it's only a question of money, I would, but no one thinks about
health."
She said her surgeon, Reddy, asked her before the operation, "Are you
concerned you might die?"
"I told him, ‘I don't care if I die. My children would benefit.’ No one
I know has died from donating a kidney. If someone had, no one would
sell," she said.
Like others, Natarajan defended the practice largely on economic and
humanitarian grounds. "Not only do we get cash, we have given added days
to let someone else live," she said.
But not all organ sellers are so expansive. A group of Natarajan's
kidney-selling neighbors, their money spent, has filed a lawsuit against
Reddy, claiming they were promised post-operation bonuses but were never
paid.
Reddy dismisses the allegations, maintaining that they have been
fabricated by kidney brokers whose livelihood he has hurt by buying directly
and cutting them out of his transactions.
At Vijaya Hospital in Madras, as with most of the 80 or so other
clinics, nursing homes and hospitals that do commercial kidney transplants in
India, "patients themselves arrange for the organs, and the doctors
only check up on whether the patient is fit for surgery," a hospital
spokesman said.
This lack of control can result in mismatched organs and attendant
diseases, critics say. The British medical journal Lancet found that one in
five Arabs who received kidneys in Bombay between 1984 and 1988 died
within one year, a much higher death rate than in the West. Some had
contracted AIDS and hepatitis.
The survey of 122 patients found that 81.5 percent lasted more than a
year.
Reddy contended that that survival rate is excellent for a Third World
country. Of his critics, he said, "As long as they don't provide us a
solution, they have no right to criticize us."
Nevertheless, the Indian government reacted to foreign attacks in the
summer by drafting a bill that would outlaw the commercial trade in
organs, setting a maximum punishment of $400 in fines and seven years'
imprisonment.
The measure is to be presented to Prime Minister Narasimha Rao's
Cabinet soon and most likely will be introduced in Parliament in November,
said L.M. Singhvi, India's high commissioner to London and a
constitutional law expert whose committee drafted the proposal.
The bill would for the first time permit a determination of brain death
at selected Indian medical centers with the aim of encouraging a
cadaver organ donor system, he said. Currently, a doctor faces criminal
action for removing an organ from a person whose heart is still beating,
though there may be no brain activity.
But even those close to the committee question whether the law, if
enacted, can be enforced.
"It won't work," said one government official, who spoke on condition
of anonymity. "But it's the only law that will pass, and then perhaps it
can be amended."
In Madras, Reddy said a ban would be challenged immediately in court by
patients demanding that the government either permit kidney sales or
provide sufficient dialysis equipment, which the nation cannot afford.
Moreover, he said that the proposed law would not stop kidney sales-
"There would be enough loopholes in it to fly a Boeing 747 through it" -
and that public acceptance of brain death would be difficult to obtain
in India.
He also said that cultural beliefs would prevent a workable cadaver
donor system from evolving in the country.
"If my daughter was left brain dead from a car accident, neither her
mother, the wife of a doctor, nor I myself would permit the removal of
her organs," Reddy said. "As long as her heart beats, I'd still count on
a miracle, and we Indians believe in miracles. I know that when her
organs are carved out, no miracle could save her.
"This is her father thinking," he added. "As a transplant surgeon, I'd
be seen as a bloody hypocrite."
But Professor Devinayaka Sundaram, chairman of Madras University's
sociology department, believes that the Indian public would come to accept
a cadaver system as it has other medical advances, such as vaccination
against smallpox.
"The success of a cadaver donor program depends on the extent to which
commercial interest is discouraged," he said. "It's a question of time. Like blood
donation, organ donation will be eventually institutionalized."
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October 6, 1991
By Barry Shlachter
MADRAS, India - The frail young woman quietly awaits her turn in a
Madras hospital. She's one of a dozen impoverished Indians hoping to sell a
kidney to a stranger.
It's the last resort for Varantha Muthulakshmy, a 31-year-old mother of
two. She has been harassed by creditors who had lent her husband money
before he abandoned the family.
"I can't bear this debt anymore; I can't bear to go home," said the
4-foot-11 housemaid, neatly dressed in a pale red sari. "If I can sell my
kidney for 27,500 rupees ($1,100), I'll pay the debt and save the rest
for my eldest daughter's wedding dowry."
And if, for medical or other reasons, she cannot sell a kidney?
"I'll poison my children," she said with grim determination. "Then kill
myself."
Advanced surgical skills and grinding poverty have combined in India to
create an open trade in human body parts - kidneys bought and sold in
an unregulated organ bazaar - that has embarrassed the government and
divided the medical profession.
Such transactions also occur in Brazil, Turkey, Egypt and parts of
Eastern Europe. China, though officially rejecting such reports, is
believed to have profited from the export of organs removed from executed
prisoners.
But in terms of sheer volume and openness, India is considered to be
unparalleled. Some hospitals advertise kidney transplants in the Yellow
Pages; others send promoters abroad to recruit potential recipients.
Though condemned by the World Health Organization and international
medical societies, the practice flourishes in Bombay, Calcutta and Madras,
where the poor sell their kidneys to middle-class Indians and to
wealthy gulf state Arabs, Malaysians and Singaporeans who fly in for
one-stop transplants.
However, the ethical issue is not as cut and dried as many critics
suggest. Indians with renal failure who need a transplant but don't have a
related donor currently have no practical alternative.
India still operates under an early 19th century law that makes the
removal of organs from brain-dead patients a crime, preventing creation of
a Western-type cadaver donor system. Forty-six nations have changed
the definition of death during the past two decades to take advantage of
such systems.
To surgeon K.C. Reddy, the trade in human organs in India comes down to
the maxim, "Buy or let die."
Reddy is one of scores of Indian surgeons transplanting purchased
kidneys but is among only a few willing to defend it openly at international
conferences. Still, he would like to see the practice regulated to
weed out what he calls a "mafia" of unscrupulous kidney brokers.
"I am not ashamed," the British-trained physician said of his purchase
of kidneys for patients. "I can sleep nights."
But to many Western medical ethicists, such as Dr. Art Caplan, 41, of
the University of Minnesota at Minneapolis, the commercial trade in
organs is patently unacceptable because it puts the kidney seller through
life-threatening surgery solely for money.
The need for cash might also prompt people with diseases such as AIDS
or hepatitis to conceal their condition in order to sell organs, Caplan
said. Moreover, because surgeons profit from the surgery, such
commercial kidney transactions might reinforce the notion that doctors are
partly motivated by greed, he said by telephone.
"The danger is in starting to treat people as if they were merely a
source of organs," Caplan said. "We don't view our body as property or
want to dehumanize people as portable organ farms."
The stocky, 49-year-old Reddy, whose surgical team has not lost a donor
in 850 transplants - 600 of them involving purchased kidneys - not
only is convinced of the merits of the practice, he believes that India
might well be trailblazing for the West, where the morally acceptable
cadaver donor system has yet to meet the demand for transplant organs.
"I'm not an ethicist, I'm not a philosopher," said Reddy, who practiced
in Maryland before returning to India in 1983. "But those selling a
kidney may not have an option for survival. What useful purpose is served
by telling him and the (prospective recipient) to go to hell?"
The Star-Telegram has learned that the Indian government, stung by
foreign criticism of the open organ bazaar, is preparing a law banning
commercial kidney sales. But Reddy asserted that such legislation would be
impossible to enforce.
"What is needed is regulation," said Reddy, vice president of the
Indian Society of Organ Transplantation. "Banning doesn't help."
He and other supporters of the organ trade argue that the practical
benefits outweigh any ethical concerns:
- No cadaver donor system exists in India.
- Kidneys are sold voluntarily by Indians, for whom selling is often a
once-in-a-lifetime chance to escape poverty.
- Moreover, India, which possesses a proud, non-Western culture, should
not be tailoring its national medical policy to U.S. or European
needs, Reddy and his supporters say.
There's also a heavy donor need. Few Indians who suffer kidney failure
live beyond four years on dialysis, largely because of the poor
conditions and impure water available. Moreover, only a fraction of the
necessary dialysis equipment exists for 60,000 new renal failure cases each
year. And the cost for most is prohibitive: $200 a month, or about
two-thirds the average annual per capita income.
"I cannot live with dialysis. It's torture," said K. Sahadevan, 54, one
of Reddy's patients, who is back on dialysis after a kidney donated by
his sister failed.
The blood-cleansing procedure is done three days a week, four hours a
day, preventing Sahadevan from working as a railroad computer
programmer. With no other relative able to donate an organ, Sahadevan said he
will cash in his pension to buy a stranger's kidney.
No practical alternative exists for Indians who need a transplant but
don't have a willing related donor.
Anuradha Rao, executive director of the Madras-based Consumer Action
Group, is among those uncomfortable with a trade in which the poor sell
and the rich buy. Nonetheless, she said it would be a mistake to ban
organ sales.
"Assuming it's on a voluntary basis with minimal health risks and the
recipient has no access to a freely donated kidney (from a family
member, for example), it should be allowed as a last resort," said Rao, who
has family in Arlington.
Lost in the debate so far has been the fact that organ sales have
quietly broken down Hindu caste barriers. Most kidneys are bought from
low-caste, even so-called untouchable, Hindus, and the recipients include
high-caste Brahmans.
"Those who follow a strict Brahman way of life might object but I
haven't heard of any," said Ramakrishna Dikshitar, 72, a scholar of
Hinduism's holy Vedic scriptures.
And while Pope John Paul II condemned Eastern European kidney sales in
June as "shameful abuses," Hinduism lacks a hierarchical structure to
issue religious pronouncements - and wouldn't if it could, Dikshitar
said. "Even if money changes hands, it is still in keeping with Hindu
belief to help others," he said.
Others agreed.
"Ethically, I find nothing wrong with it," said Sriran Panchu, 39, an
attorney who practices consumer law in Madras.
There's no problem as long as prospective donors are carefully screened
and given ongoing medical care, Panchu said. Prohibiting kidney sales
would only invite corruption, forcing the practice underground, he warned.
"Why aren't kidney purchases allowed in the United States?" the
attorney asked. "In some ways, I think we are more advanced."
Such views are not uncommon among Indian intellectuals and
professionals. And they point to a deeper issue: Should the West impose its moral
or ethical perspective on a foreign society with widely divergent
traditions and outlook?
Dr. John Dossetor, 66, director of the Biomedical Ethics Division at
the University of Alberta in Edmonton said: "I am strongly in favor of it
being illegal in our culture. But I don't believe we have the right to
make it illegal for everybody else."
Referring to a move by the Transplantation Society, an international
group of transplant surgeons, to deny membership to anyone involved in
the commercial organ trade, Dossetor said, "I have problems when it is
applied to countries outside the affluent world."
Dossetor, a professor of internal medicine, suggests that there are
cases even in the West in which the sale of a kidney is ethical, if, for
example, the money is used to save another life. He cited the instance
of a father selling a kidney to pay for his child's leukemia treatment.
Opposition to organ sales is not confined to physicians in the West.
Some Indian doctors also condemn the practice, and have openly feuded
with proponents.
"No money should be involved in organ donation, for that automatically
makes it a trade in flesh," said Madras surgeon M.K. Mani, who said in
a newspaper column that he gives credence to accounts of patients
learning after surgery that a kidney had been extracted without their
permission.
Christian Medical College in Vellore, like Mani's Apollo Hospital in
Madras and state-run institutions across the country, accepts only
transplant patients who have relatives willing to donate kidneys. But doctors
acknowledge that occasionally money and property quietly change hands
between family members.
"There is coercion, whether it's economic or psychological, when
non-related donors are involved," J.C.M. Shastry, the college's chief of
nephrology, said by telephone.
Organ brokers routinely buttonhole kidney patients outside doctors'
offices, asking them their blood type, then displaying a list of medically
compatible donors. "There's a lot of money in it," Shastry said. "It's
hard to resist the temptation to make a fast buck."
Because of his hospital's ban on kidney sales, Shastry sends patients
without donors to Reddy, the Madras surgeon who has successfully snapped
the brokers' stranglehold on the organ trade - by buying direct from
people offering their kidneys for a price.
"Reddy is trying to do it methodically, in a correct way, but he's in a minority, a very
small minority," Shastry said.
Reddy weeds out ill or alcoholic candidates, has them screened by a
staff psychologist, then has an independent psychiatrist explain the
risks. Reddy pays $1,100 per organ, provides three years' medical care and
agrees to a free transplant should the remaining kidney fail.
The surgeon tries to deflect criticism that only the rich get
transplants by performing one free operation a month for a poor patient.
Acknowledging that most organ sellers are slum dwellers, Reddy also cites the
case of a medical student who sold a kidney so he could continue
studies after his father died.
Like many sellers, Lakshmi Natarajan's husband settled a debt ($400)
with his kidney money, and had enough left over for his sister's wedding
dowry. (India has banned dowries that force many families into debt,
but the law is rarely enforced.)
"We were left with no money, so then I (too) sold my kidney," said
Natarajan, a tiny woman by any standard. She contracted directly with the
Pandalai hospital and used the money she earned to build a small brick
house.
The home contains two extra rooms that the Natarajans rent to boarders
in Villivakkam, a slum on the outskirts of Madras where several hundred
people have likewise cashed in on the demand for kidneys.
Natarajan also bought jewelry and had three vendors' carts made. She
uses one to sell kolom, a powder for making threshold designs to ward
off evil. Her husband peddles the stuff from a bicycle. They rent out the
remaining two carts.
This from the sale of one kidney.
But the Natarajans' success story is a rarity.
"Most who sell a kidney spend the money left and right getting drunk,"
she said through an interpreter. None of several other kidney sellers
interviewed had made as dramatic an improvement in living standard as
the Natarajans.
Would I do it again?" Natarajan asked, echoing the question.
"If it's only a question of money, I would, but no one thinks about
health."
She said her surgeon, Reddy, asked her before the operation, "Are you
concerned you might die?"
"I told him, ‘I don't care if I die. My children would benefit.’ No one
I know has died from donating a kidney. If someone had, no one would
sell," she said.
Like others, Natarajan defended the practice largely on economic and
humanitarian grounds. "Not only do we get cash, we have given added days
to let someone else live," she said.
But not all organ sellers are so expansive. A group of Natarajan's
kidney-selling neighbors, their money spent, has filed a lawsuit against
Reddy, claiming they were promised post-operation bonuses but were never
paid.
Reddy dismisses the allegations, maintaining that they have been
fabricated by kidney brokers whose livelihood he has hurt by buying directly
and cutting them out of his transactions.
At Vijaya Hospital in Madras, as with most of the 80 or so other
clinics, nursing homes and hospitals that do commercial kidney transplants in
India, "patients themselves arrange for the organs, and the doctors
only check up on whether the patient is fit for surgery," a hospital
spokesman said.
This lack of control can result in mismatched organs and attendant
diseases, critics say. The British medical journal Lancet found that one in
five Arabs who received kidneys in Bombay between 1984 and 1988 died
within one year, a much higher death rate than in the West. Some had
contracted AIDS and hepatitis.
The survey of 122 patients found that 81.5 percent lasted more than a
year.
Reddy contended that that survival rate is excellent for a Third World
country. Of his critics, he said, "As long as they don't provide us a
solution, they have no right to criticize us."
Nevertheless, the Indian government reacted to foreign attacks in the
summer by drafting a bill that would outlaw the commercial trade in
organs, setting a maximum punishment of $400 in fines and seven years'
imprisonment.
The measure is to be presented to Prime Minister Narasimha Rao's
Cabinet soon and most likely will be introduced in Parliament in November,
said L.M. Singhvi, India's high commissioner to London and a
constitutional law expert whose committee drafted the proposal.
The bill would for the first time permit a determination of brain death
at selected Indian medical centers with the aim of encouraging a
cadaver organ donor system, he said. Currently, a doctor faces criminal
action for removing an organ from a person whose heart is still beating,
though there may be no brain activity.
But even those close to the committee question whether the law, if
enacted, can be enforced.
"It won't work," said one government official, who spoke on condition
of anonymity. "But it's the only law that will pass, and then perhaps it
can be amended."
In Madras, Reddy said a ban would be challenged immediately in court by
patients demanding that the government either permit kidney sales or
provide sufficient dialysis equipment, which the nation cannot afford.
Moreover, he said that the proposed law would not stop kidney sales-
"There would be enough loopholes in it to fly a Boeing 747 through it" -
and that public acceptance of brain death would be difficult to obtain
in India.
He also said that cultural beliefs would prevent a workable cadaver
donor system from evolving in the country.
"If my daughter was left brain dead from a car accident, neither her
mother, the wife of a doctor, nor I myself would permit the removal of
her organs," Reddy said. "As long as her heart beats, I'd still count on
a miracle, and we Indians believe in miracles. I know that when her
organs are carved out, no miracle could save her.
"This is her father thinking," he added. "As a transplant surgeon, I'd
be seen as a bloody hypocrite."
But Professor Devinayaka Sundaram, chairman of Madras University's
sociology department, believes that the Indian public would come to accept
a cadaver system as it has other medical advances, such as vaccination
against smallpox.
"The success of a cadaver donor program depends on the extent to which
commercial interest is discouraged," he said. "It's a question of time. Like blood
donation, organ donation will be eventually institutionalized."
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