Dire poverty fuels India's lucrative trade in kidneys

from the Toronto Star

But sellers often lose organ only to find shame, depression after their finances fail to improve
Sonya Fatah

CHENNAI, India–When Geetha Vijaya heard that a "kidney broker" was scoping out her neighbourhood looking for donors, she put her kidney up for sale. Her husband, an auto-rickshaw driver owed loan sharks about $800 and earned, at best, a little more than $100 monthly.

Burdened by daily visits from creditors, Geetha arranged for her kidney removal. On Jan. 4, 2006, after her kidney was removed at Aswene Soundra Hospital in Chennai, she collected $900 and paid off her husband's debt.

"The money disappeared as soon as it came," Geetha chuckled good-naturedly in her cramped one-room home in the city's largest urban slum, Villivakkam.

Just two years after her surgery, the couple is in debt again. Suffering from dull but chronic back pain, the 31-year-old is frustrated that selling her kidney didn't turn out to be the long-term investment she had imagined.

"At the time, I justified it to myself because of the money and because the person who got my kidney had been suffering for seven years. But now I feel sad, sometimes very low, thinking about it."

Villivakkam, or "Kidney Vakkam," as it has been known for decades, as Chennai's central hub for the lucrative organ trade. Hundreds of its residents have had their kidneys removed over the years, the long scar along one side of the waistline a permanent reminder of that sale.

The kidney trade is illegal in India, but still thriving. Last month, police arrested alleged transplant kingpin Dr. Amit Kumar who had fled to Nepal after a kidney racket was broken up in New Delhi.

Kumar, whose wife and children live in Brampton, Ont., is accused of masterminding an illicit racket that transplanted more than 500 kidneys for his high-paying patients, most of whom come from overseas, including Canada.

Today, illegal kidney rings can be found across India, where 100,000 to 150,000 people suffer from renal failure every year and only 4,000 authorized transplants take place. Targeting inner-city slums and rural areas, middlemen and brokers seek out willing "donors," offering India's poor a quick way to escape financial debt or to bankroll a costly wedding for an eligible daughter.

Most kidney sellers approach brokers directly. But a few, like Mary Gurwadan, 35, head directly to a hospital. Gurwadan, who lives in a slum along the city's railway line, made her way over to Pandalai Nursing Home in the centre of the city to collect the $750 she was promised. Virtually all of India's kidney sellers live under the poverty line, eking out a living as construction workers, cycle-rickshaw drivers, fishermen and other low-paying jobs. When they fail to pay off their debts, loan sharks move in, often resorting to high pressure to get their money back.

Forced into finding quick financial solutions, thousands of India's poor have gone under the knife happy to sacrifice a piece of themselves to resolve their financial crises. But as many have discovered, the money goes quickly. Later, there's nothing left to sell.

"If I was given the chance again, I would never sell my kidney," said Kalvati, 30, in Tsunami Nagar, an area in north Chennai where tsunami victims were resettled. Kalvati owed neighbours more than $250 four years ago. A broker offered her the princely sum of $2,500 but after she was operated upon at Meenaxi Mission Hospital in Madurai, he only gave her $1,000.

"Sometimes, I sit back and I think, `Why did I sell it?'" she said. "Sometimes I get palpitations thinking about it, about a decision I cannot reverse."

Almost all of those who had sold one kidney and were interviewed for this article said they feel a deep loss, even shame, at having given up a body part to cover their debt. "Shame. Shame. Shame," chanted one seller, chastising herself.

For those who study the underground organ trade, it's clear that the biggest price paid by donors is the long-lasting psychological scars: Their perennial debtor status makes many of them despondent.

"What we've noticed is that if the true motive of donation is money, then eventually depression sets in because nothing has changed in the donor's life and, in fact, their financial situation is worse," said Dr. Sunil Shroff, who runs the Multi Organ Harvesting Aid Network, a Chennai-based organization that works on advocacy and on improving understanding around cadaver-based transplants.

Organ sale is illegal in India. The Transplantation of Human Organs Bill was passed into law in 1994 and strictly prohibits the sale of organs. Yet, a commercial underground industry has mushroomed because of the lack of legal kidneys.

"The problem in the kidney trade is poverty," said Shroff.

"Kidney scams, prostitution, child labour, these are all persistent problems in India and are a response to a larger community problem. This is the larger problem of a social evil."

The kidney trade is hardly new to India. The financial desperation that motivates most kidney sales was the theme of a popular 1980s Bollywood movie, Saheb, starring one of India's most popular stars, Anil Kapoor. Kapoor's character was forced to abandon his dream of playing professional soccer after he sold his kidney so his parents could afford his sister's wedding, highlighting the tragic consequences of his sacrifice.

All of the kidney sellers interviewed for this story said they had lost part of their earning capability because of health problems.

Sonya Fatah is a freelance journalist based in India.