Anation like India, already severely affected by numerous pandemics, has tried to put its maximum effort to combat diseases like AIDS, polio to say the least. But amidst all these diseases, one of the largest killers in the world (even in India), the kidney disorder, has got swept under the carpet. This is in spite of the fact that in India, two deaths occur every five minutes (that translates to 200,000 deaths in a year) due to permanent kidney failure. Timely kidney transplantation is undoubtedly the only saviour for these patients but the stringent rules regarding kidney donation and lack of adequate kidney banks are acting as blockades. Sadly, unnecessary delays to get approvals for kidney transplantation in India are pushing many lives towards death.
Till today, kidney ailments are not seen as being fatal – despite the reality being completely opposite. Most of the times, the detection for the same happens at the last stage. And now, the scenario of kidney problems in India has reached a situation where it is set to damage the so-called ‘demographic dividend’ massively. Doctors estimated on the last World Kidney Day (March 8, 2012) that anywhere between 200,000 and 400,000 people develops end-stage kidney disease (kidney failure) every year in India. In the same light, the National Kidney Foundation of India projected that 100 people in a million suffer from kidney diseases in India. As per the Multi-Organ Harvesting Aid Network Foundation, merely 3000-3500 kidney transplants take place every year as against 150,000 requirements. Out of all transplants, only 5% come from brain-dead patients while the rest are contributions from healthy donors.
Of course, the recent years have also seen the illegal kidney transplant racket growing. The infamous kidney racket scandal in Gurgaon is a case in point. Several reports highlighted that hundreds of poor labourers had been duped or forced into donating organs to wealthy clients, including foreigners. The government subsequently took the professed noble initiative to protect them and the rules governing unrelated kidney transplant became very stringent since 2008, following an amendment to the Transplantation of the Human Organs Act, 1994. The law states that “only medically compatible relatives are permitted to donate organs.” However, “non-related and willing live donors can supply a part of themselves by reason of affection or attachment towards the recipient or for any other special reasons, provided that the transplantations have the approval of the Authorisation Committee, established under the Act.”
This amendment may have succeeded in controlling the kidney racket scandal to a certain limit but it has several loopholes. Mostly, it has been severally criticized as being an unduly elongated process to get approvals for unrelated kidney donation. Due to the lengthy procedure and absence of government nominees on the authorisation committee, transplants have been stalled or delayed in several hospitals. One nephrologist from a reputed hospital said, “We appreciate the move of the government but the procedure has been moving at a snail’s pace.”
In one example, in 2011, many transplants in Maharashtra got delayed for a few months in several hospitals due to delays in release of authorisation letters. Although there is no official data on whether any deaths took place due to delayed release of approval letters, there is no doubt that this may have been the case. Kidney transplantation on an average burns the pocket of an individual by almost Rs 400,000 (if the same is done legally!); post-operative expenses come to around Rs.10,000 per month! And in case the deal is illegal, then the recipient’s family has to conjure up another Rs.200,000 to Rs.400,000.
In reality, the stringent laws that have come into force have not been able to completely curb the illegal kidney racket – but worse, in some cases, have ensured that honest and emergency cases of transplants have not been processed in time. The need of the moment is for the government to now set a more stringent time-bound condition on the Authorization Committee to clear any pending case for kidney transplantation within 24 hours of them receiving the application. If such a time duration seems too less, then the government should immediately disband the concept of an authorization committee which does not understand the criticality of life and death situations.
