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Giving a bit of yourself
IN A curious coincidence, on the eve of the recent breaking of the story on the ``organ sale racket'' in Mylapore, I was at a talk on `Life after Death' by Dr. M. K. Mani, one of the pioneers in nephrology in India, a strong advocate of ``cadaver organ donation'' and a determined opponent of transplanting organs that are purchased.
But with the paucity of cadaver donations, people like Dr. Mani are fighting a losing battle. In the eight years since the Transplantation of Human Organs (1994) Act was passed, there have been only 450 cadaver transplants in the country. Yet, according to The Indian Transplant Newsletter (ITN), it is estimated that 3,500 kidney transplants are done a year in India with organs donated by relatives or, more often, from unrelated persons. In almost all the latter cases, the kidneys were purchased from the poor.
The law says sale of human organs is illegal — presumably on the same much-debated grounds that make suicide and euthanasia illegal, a position challenged by those, including many a doctor, supporting such acts on the argument that an individual in his right mind has the right to do what he wants with himself provided that, at least in the case of organ sale and euthanasia, there is medical advice and authorisation. Sadly, the legal position is often overlooked, particularly how the law is being circumvented, and the focus is on the price ``the poor donor'' gets for his kidney.
It has repeatedly been stated that the donor gets only about Rs.25,000-30,000 for a kidney, whereas the middle man charges the recipient anywhere from Rs.60,000 to Rs. one lakh. It would be interesting to find out where the difference goes; is it only to the middleman, or are there other beneficiaries along the way to a successful transplant? In fact, one doctor I know points out that the law has only put up the price for the recipient by creating opportunities for several people to make money out of the transaction.
Dr. Mani, on the other hand, wonders whether any price is a fair price for an organ. He points out that the Rs.30,000 paid to a poor donor goes, in 90 per cent of the cases according to a recent survey, to settling his debts and leaving him still poor. About 75 per cent of these donors, according to that same survey, get caught in the debt trap again, particularly as the expenses to take greater care of themselves increase, and therefore regret the `donation'. In the circumstances, the law, keeping in mind the straitened circumstances of donors, strikes me a probably the best way to go. But that doesn't stop me wondering whether the issue is one of ethics or of price. If a donor is offered Rs.10 lakhs, would it make a difference in the thinking? And if it would, might it not be worth looking at a body of elders arriving at a fair price for a saleable, life-saving commodity, for it has been made amply clear that a person could survive and lead a good life on two thirds of a kidney and could therefore spare one of his two kidneys to another whose two thirds is failing?
Certainly, if the need for kidneys and other organs is in the thousands, cadaver organ donation alone is not going to meet the need. Particularly, as in cadaver organ donation, the person would have to be `brain dead' in a hospital at the time — except in the case of corneas (eye donations) and the formalities of getting family concurrence, even if the person had in life willed his body or carried a card to that effect, gone through within the few hours that are the lifespan of the organs. Nevertheless, cadaver donation could be considerably more than at present, given that about a dozen `brain dead' persons are there on any day in any major urban hospital in India, according to ITN.
At least encouraging thinking on these lines in Madras is MOHAN (the Multi Organ Harvesting Network) established in the mid-1990s by a group of doctors and other professionals.
In January, 1997, MOHAN launched its `donar cards', with the signing of which a person agrees to donate his body after death for removal of such organs as the eyes, heart, lungs, kidney, liver, pancreas and bones. But as Dr. Mani points out, such a promise alone is not enough — in the US it is made on the driving licence — for it still needs the family's concurrence after death.
But MOHAN, after distributing over one lakh cards, feels optimistic that the present all India average of around 60 cadaver donations a year will increase in Madras itself in the next few years.
But I can't see organ sales coming down, unless there's some rethinking on both law and attitude to price.
S. MUTHIAH
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