India has the dubious distinction of being the great organ bazaar, where various human body parts are available for a price. The trade is run by a nexus of skilled medical professionals and cut throat businessmen.
Hypertension, diabetes mellitus, polycystic kidney disease, in-born errors of metabolism, infections or autoimmune diseases can cause the kidneys to fail. Once the filtration rate drops to 20-25 per cent of normal, the patient has fatal end-stage renal disease. To live, the patient has to opt for long term dialysis or a kidney transplant.
According to the United Network for Organ Sharing (UNOS), almost 100,000 patients are awaiting a legal kidney transplant.
The donated kidney may come from a deceased donor or a living donor, who may be genetically related or non-related. Earlier, the donor and recipient had to be genetically similar. They needed to have the same blood group and share other minor blood antigens (HLA groups). Now with a technique called plasmapharesis and high doses of the new immunosuppressant regimens (Cedars-Sinai High Dose IVIG therapy), these criteria do not have to be met. This means that now spouses, siblings, friends or even strangers can donate a kidney to each other, even if they have different blood groups.
There is a yawning gap between demand and supply, and this provides a lucrative business opportunity for unscrupulous individuals. There is a nexus between travel agents (medical tourism), brokers and medical professionals. They arrange for financially desperate individuals to sign an affidavit claiming a blood relationship with the recipient. These potential donors are not evaluated medically and psychologically. As the supply falls (sometimes even the poor refuse to sell their kidneys), the brokers resort to illegal activities. Donors are duped or kidnapped and some unsuspecting individuals have their kidneys stolen. Since everyone has two kidneys, the removal of one poses no danger to life.
A typical patient lives 10 to 15 years after a kidney transplant. The quality of life also improves as the patient feels more energetic and has less food and fluid restrictions.
All nations have strict criteria for legal kidney transplants. The person should be less than 60, should not have incapacitating heart or lung disease, incurable terminal infections, cancer or mental illness or be a drug addict, smoker or an alcoholic. But in the black market, money is the only determining factor.
Traditionally, the donor kidney was removed through a large incision. Now, laparoscopy has made the incision smaller and the hospital stay shorter. The recipientâ€™s diseased kidneys are not removed. They are left in situ and the donor kidney is placed in a different location, usually in the iliac fossa, an area in the lower abdomen. The new kidney is connected to different blood vessels, usually the external iliac artery and vein. The ureter from the donor kidney is then connected to the bladder. Instead of two kidneys the recipient now has three.
In most cases, the kidney will start functioning immediately and reach normal levels within 3-7 days. Rejection of the new kidney is prevented by starting immunosuppressive medications immediately. Permutation and combination of tacrolimus, mycophenolate, prednisone, cyclosporine, rapamycin or azathioprine may be used. They have to be continued lifelong.
Despite intensive treatment, 10-25 per cent of the patients reject the new kidney in the first 60 days. If this occurs, adjustments in the medication have to be made. The patient may need to return to dialysis or opt for another transplant. Other complications are severe infections, development of a type of post transplant lymphoma (cancer), bone problems, stomach ulcers, hirsutism, electrolyte imbalances, baldness, obesity and acne. Pre-existing diabetes and hypercholesterolemia may be aggravated.
Transplants provide a new lease of life for the terminally ill. Some patients have lived for 25 years and longer, only to eventually die from unrelated causes. Some athletes have even made a comeback after receiving a transplant.
Transplants provide miracles, but the demand exceeds supply. This is why black marketeering, racketeering and unethical practices flourish. It may be worthwhile to ponder over certain issues:
Have we not failed as a society if the economically underprivileged have to resort to selling parts of their body to survive?
Do people not have the freedom to do as they wish with their bodies?
Instead of exploitation, and the middle man making the money, can organ donors not be given a fair deal financially?
Can they not be provided health insurance to look after them after the surgery?
With no proper laws and controls, are we not in danger of being kidnapped and killed for our organs?
Sources: The Telegraph (Kolkata, India)