Shaken by the Gurgaon kidney scam, the government of India is promising a double-pronged strategy to tackle the continuing racket in organ transplant.
It will introduce significant changes in the organ donation laws and also launch a nationwide organ transplant awareness programme, it is reported.
Only on Thursday night, the police had cracked down on a circle of doctors who reportedly performed more than 500 illegal kidney transplants in the last eight years in the National Capital Region.
Doctor Amit Kumar, the mastermind of the racket, is still missing. His victims were mainly labourers who were promised jobs.
Such scams keep breaking out time and again. The federal Health Ministry hopes that the changes now being contemplated in the Transplantation of Human Organs Act, 1994 could make organ transplant that much easier and prevent the need for illegitimate operations.
For one, the amendments will legalize swapping of vital organs between willing but incompatible donors.
Current rules restrict organ transplant to blood relatives (father, mother, son, daughter, wife, husband, sister and brother), near and distant relatives and also those who come forward to donate out of love and affection.
It is this last category that often leads to abuse as determination of "love and affection towards the patient" can be subjective.
Swapping is where relatives are willing to donate but are medically incompatible for transplant.
As a consequence of the changes, such relatives can donate their organ to a compatible patient and, in turn, get an organ that is compatible with the patients related to themselves.
"A copy of the draft has also been given to the Delhi High Court. Wider consultation is being carried out to finalise the recommendations that will make organ transplant easy for genuine patients. We will notify the final rules soon," said Vineet Chaudhry Chaudhry, Joint Secretary in the federal Health Ministry.
Also on the anvil are sops for live cadaver donors like a 50% discount on second-class rail tickets, life-long free medical check-up and care in the hospital where organ donation takes place, a customised life insurance policy of Rs 2 lakh for three years with one-time premium to be paid by the recipient in case of a mortality and a preferred status in organ transplant waiting list if the next-of-kin of a brain-dead donor requires a transplant in future.
Blood relations will also not have to pass through a screening authority anymore or undergo several tests. Simple documents like a birth certificate will be enough.
Under the new law, post-mortems will be conducted round-the-clock in all government hospitals across India. This will help hospitals harvest healthy vital organs from brain-dead patients.
At present, most post-mortems are done during the day. This leads to loss of crucial time, which makes most organs unusable.
Once a patient is declared brain dead, almost 37 different organs and tissues can be donated, including vital ones like heart, kidneys, liver, pancreas and lungs. Whereas, when a brain dead patient is kept for autopsy for hours, his/her heart finally fails, after which only a few tissues like cornea, bone, skin and blood vessels can be transplanted.
As part of the overhauling of the entire mechanism, ten organ retrieval centres are planned across the country, each costing Rs 10 crore, are planned.
Dr Harsh Johri from Gangaram Hospital, who was member of a Health ministry committee constituted by the Delhi High Court to review provisions of the Act, said, "Civilized society can't allow sale of organs. A vibrant cadaver donation programme can minimize this practice."
He added: "Though the national programme will be launched in a couple of months, it will take at least two years before its real impact is felt. The objective of the Act was to ensure there was no commercialization. But we presently face a desperate shortage of organs, thanks to restrictions in the present law."
Joint Secretary Vineet Chaudhry said the awareness programme would lay stress on harvesting healthy organs from brain-dead patients, encourage the practice of organ donation after death by offering a number of incentives, and educate the poor on organ donation so that they don't fall prey to clandestine organ trade cartels.
Union Health Minister A Ramadoss admitted, "For every case like Gurgaon, there are so many unknown cases," but hoped the programme now being contemplated would help counter such trends.
Initially, Ramadoss had planned to launch the programme in January. But the bird flu outbreak pushed it back.
Meantime the Hindustan Times reports that illegal organ trafficking accounts for as much as 10 per cent of all transplants worldwide, quoting the World Health Organisation.
Organ Watch, a Berkeley-based NGO tracking the global traffic in human organs, says trafficking is not just limited to smuggling kidneys but involves illegally procuring and transporting other vital organs and tissues such as heart, intestines, eyes, lungs, liver and pancreas.
And while most countries are grappling with this illegal trade, Asia that has in the last two decades come to corner a large share of this flourishing black market is earning the dubious distinction of being the world's warehouse of illegal organs. Promising quick, easy and cheap procurement of life-saving organs to foreigners who see it as their last hope, the region witnesses billions of dollars changing hands every month among iniquitous brokers, desperate patients, poverty-stricken donors and dishonest doctors.
In fact, 90 per cent of the donors in the region come from below the poverty line and 90 per cent of these donors agree to donate only to ease their financial troubles. Apart from India, China, Bangladesh, Nepal and Pakistan are among those countries where maximum illegal sale of human organs happen.
Till 2006, China was the top host country for transplants. However, recently tightened regulations may change this. In July 2006, China banned the sale of human organs. In 2007, it restricted organ transplants for foreigners in order to give priority to sick Chinese. However, the country continues to be criticised for taking organs from executed prisoners. In the absence of less developed medical facilities and the presence of a porous Indo-Nepal border, many Nepalese people come to India to score a better deal for their kidney or liver.
Pakistan is considered the world's second biggest centre for the organ trade, as it has no legal framework on transplantation, except a draft law passed in February 2007 that allows organ donations from the dead. According to WHO estimates, up to 1,500 "transplant tourists" have visited Pakistan in recent years. And in 2005, desperation drove a 26-year-old Bangladeshi mother take out a classified ad in a local newspaper, offering to sell one of her eyes.
The WHO issued guidelines in 1991 to avoid the coercion or exploitation of all organ donors. While 192 countries endorsed them, these guidelines are not binding and as a result, most of its recommendations have gone ignored