M A I L B A G

Social, legal and medical aspects of
organ transplant

THE much-hyped “kidney scam” at Amritsar has many social, legal and medical aspects. Perhaps, the public and the media are ignorant about “The Human Organs Transplant Act, 1994” and politicians are expected to cook their cake on the hot plate. God has blessed every human body with two kidneys even when a person can live a healthy normal life with only one kidney. On the other hand, a person with an “End Stage Renal Failure Disease” (ESRD) has only a chance of life if a kidney is got in donation and successfully transplanted. In the absence of a kidney transplant, the ESRD patient has to spend one to two lakh rupees per year on dialysis and another lakh on medicines to sustain life till renal transplant.

The donor can be a patient with brain death, a close relative or an unrelated living donor. Section 19 of The Human Organs Transplant Act forbids exchange of any money between a donor and a recipient. The unrelated donor has to file an affidavit in the court of a magistrate to the effect that the organ is being donated out of love and affection for the recipient. Thereafter the donor has to undergo a battery of tests before the actual transplant. The Authorisation Committee set up by the State Government only ensures that all documents needed under the Act have been supplied. The Authorisation Committee has neither means nor authority to verify the facts stated in an affidavit before a magistrate.

Dr KULDIP SINGH, President (elect), IMA, Punjab, Hoshiarpur

What’s wrong?

I fail to see why trading in organs is morally wrong as long as the trade occurs between two parties acting of their own free will (with absolutely no coercion). If someone is dying waiting for a kidney transplant and has the means to purchase one, why should anyone prevent him from buying a kidney from another individual who can expend one and use the money, perhaps to put their kids through university or for a daughter’s wedding. It betters the lives of two families. What is morally wrong with that? And, in most cases, donors who are left with only one kidney can live long, productive lives. In the process, if doctors or middlemen make some money, they do so because they render a service deemed valuable by parties to the transaction.

Legislating prevention of trade where both willing buyers and sellers exist is ultimately always unsuccessful. Remember gold control or foreign exchange convertibility controls? They only served to create a black market, and raised prices for everybody. Granted, a kidney is a more personal “product” than gold or dollars, but that is even more a reason why the government should stay out of it!

Of course, there should be laws to prevent abuses, but I don’t think the government has the right or the means to determine what is morally wrong or right. Each individual is a far better judge of morality than a bureaucrat in Delhi or an editor, for that matter.

SUTEJ KAPUR, Chicago

Why media bashing?

I am pained at the sequence of articles, editorials coming in various dailies. All this boils down to the media bashing of only two doctors by all agencies (media & the police).

We are all making a scapegoat of the two doctors rather than working out a long-term strategy for rectification of the problem of organ transplant.

The police and politicians are appearing to be drawing mileage for personal gains and political gains by issuing statements regarding the amount of scam and giving their own verdict to the media.

The statements from the CM that the previous government is involved in “huge scam” proves that there is more to it than meets the eye. The other shocking and surprising fact is that the police is feeling shy of following the procedure laid down by the law. You must be aware that clause 22 of the Act does not allow anybody other than the appropriate authority to take cognizance of the offence and initiate investigation, leave aside arrest people.

Various agencies are busy projecting their own figures about the scam ranging from 40 crore to 150 crore, in a way trying to create a success story for themselves.

In no way am I favouring any guilty person, but I do expect a comprehensive and rational investigation rather than going in for a selective witch hunt. If we analyse the whole situation of illegal organ transplant, I think there should be various parties which should be arrested before doctors are arrested, like the recipients, donors, middlemen and other people facilitating the paper work or related formalities.

I think the whole nation should now realise to debate the issue of having a mass movement for organ donation, as we have seen in the case of eye donations.

VIVEK VERMA, Ludhiana

Make it legal

The recent arrest and humiliation of senior doctors of Amritsar has once again brought to focus the present practices of renal transplantation in India. Two things stand quite clear. One, there are a number of patients who need transplantation and for them it is a life saving treatment. Two, in the absence of facilities for cadaver transplantation in the country, one has to depend upon live donors only.

Considering the social realities of life today, it is not easy to get a related donor and in majority of the cases, it is the unrelated donor who “donates” kidney to the recipient “out of love and natural affection”. And securing an unrelated donor is not a difficult task in a country where poverty and deprivation are in abundance. Under these circumstances, most of the patients and their families are more than ready to strike a deal with the “donor”.

In such a situation it is one who buys the kidney and the one who sells the kidney violate the organ transplantation law. On paper, the law appears perfect, but on ground it is completely away from the realities. An operating surgeon has no choice in selecting the donor and he has no expertise to see through the deals struck between the donor and the recipient. He only comes into picture once the donor and the recipient have completed all legal formalities. In the surgeon’s eyes, interest of his patients is supreme and his only interest is to save the patient.

Controversies about kidney transplantation clearly show that laws alone can’t change the social practices in such situations it is the social need that sets the trends. It is a high time we make the sale and purchase of kidney fully legal. I fully realise that this idea may not appeal to many of our politicians and social workers, who themselves pay only lip service to the poor but leave no efforts in projecting themselves as their champions in order to gain political mileage.

Dr RAJEEV GUPTA, Ludhiana