Posts for category ‘kidney racket’

National Geographic: Inside the Body Trade
| November 16, 2007 | 2:21 pm

National Geographic Explorer just aired an hour long documentary on the global market for human body parts. In the program they interviewed a Chinese doctor who helped remove organs from executed prisoners and transplanted them into foreign medical tourists. It also documented the painful lives of people awaiting organ transplant in the United States and flew out to Chennai to interview the donors and brokers who have made this coastal metropolis the worlds most famous organ farm. I worked with the documentary team for a month and helped coordinate the India piece of the puzzle. My job was to locate a donor and a broker who could give a personal look at the kidney trade. Much of the research I did was based on the WIRED News series that released in May. Here’s a clip from the documentary.

What isn’t mentioned in this clip, but is talked about in the larger documentary is that Mallika isn’t only the victim of a predatory broker and corrupt medical institution. Her son is a victim as well. A year after her surgery her son Kannan came down with a bad case of jaundice that destroyed his kidneys. Unable to giver her remaining kidney, now she has to watch her son suffer and possibly die because he has no way of getting a donor organ.

The program aired on November 11th and 15th at 8:00 PM. But I’m sure you will be able to catch a rerun some time.

And you didn’t catch it: The “National Geographic Safe House” in Chennai was my apartment.

Chennai Kidney Doctor Arrested in Mumbai
| October 10, 2007 | 1:30 am

Almost five months after authorities in Chennai abandoned any attempt at prosecuting the kidney scandal that has rocked this city, police in Mumbai have arrested a renowned kidney surgeon who has admitted to arranging organ transplants for patients from all over the world. Most of the operations took place at St. Thomas Hospital in Chennai. The Mumbai police say that Palani Ravichandran has preformed between 40 and 100 of the illegal operations every year since 2002.

KN Arun of The New Indian Express reported today that:

A large number of recipients on whom he had preformed kidney transplants were rich patients from abroad, especially the Persian Gulf countries and Malaysia, whom he charges Rs. 10 lakh to 15 lakh ($25,000 – $35,000) each.

Kidney transplants have been a huge problem in Tamil Nadu in the last few year. According to government statistics released by Tehelka, over 2000 people a year sell their kidneys in the city. In most cases brokers offer them several thousand dollars for their donations, but end up swindling the donors out of the lion’s share of the cash. I have written extensively about the issue on this blog and on WIRED News.

But Ravichandran is a different sort of kidney transplant surgeon. His methods are much more sinister than the typical Chennai doctor. It appears that for the last several years he has worked with two local brokers identified by my sources as Bandana Rai and Dipen Rai who rent a string of houses throughout the city to hold potential donors while they await their operations.

Ravichandran and the Rais have been able to escape detection for so long because they do not use local kidney donors. Instead they travel to Nepal and bring back young men and women who are willing to sell their kidneys for cheap. After trafficking the would-be donors across the border near Siliguri, West Bengal, they take a train to Chennai and spend about a week getting the necessary tests for surgery. Afterwards they are promptly send back to Nepal.

Deepak Adhikari who writes for Nepal Weekly, recently wrote a blog post about the Nepal end of the network.

This recent arrest should be a wakeup call to the Chennai authorities who have so far been lackadaisical about pursuing cases of brokered kidney transplants. Police claim that they do not have the legal authority to arrest brokers for violating the Transplantation of Human Organs Act of 1984–and claim that only the department of health and family services has that power. This is, of course, simply an excuse to maintain the status quo.

The truth is that the Chennai police and local government are perfectly happy to let the kidney trade continue because there is political pressure from across the medical spectrum to provide organs for people needing transplants. The government has sheepishly admitted that they are more concerned about wealthy patients than poor kidney donors who get scammed in the transactions.

There are also rampant allegations that members of the police and transplant authorization committee receive large bribes to approve surgeries. One source I spoke with who gave her kidney six months ago said the bribe was $25,000 per committee member–or about $700.

It is also telling that it was the Mumbai police who arrested Ravichandran–it appears that while he has enjoyed a startling amount of immunity from police while he has been working in Chennai.

Radio Spot on NPR
| June 8, 2007 | 2:05 pm

For those of you who just can’t get enough of me talking about the kidney trade, check out my recent appearance on NPR (National Public Radio, for those of you tuning in from India).

Government Gives Green Light to Kidney Racket
| May 29, 2007 | 9:28 pm

The government has dropped the charges against 13 hospitals after a four month investigation into the kidney racket citing “the welfare of the patients” waiting for organ transplants as the reason. In the last two years over 2000 the hospitals have preformed over 2000 illegal kidney transplants and have colluded with criminal gangs of organ brokers to steal organs from the state’s poor and destitute. I have been covering the story for WIRED News and in this blog since the story first broke and this seems an appropriate coda for my investigation in light of the rampant corruption and lack of ethics that permeates ever corner of the medical administration here.

The Directorate of Medical Services, the organization in charge of the investigation, is trying what it calls a “humanitarian approach” that favors wealthy people with renal failure over the poor who must sacrifice their own health for another person’s treatment.

Dropping the charges means opening up the flood gates to more illegal surgeries as the DMS has effectively admitted that it will not enforce the rule of law even under extreme instances of medical negligence. The DMS has let the worst offenders completely off the hook (Devaki Hospital, and Madurai Meenakshi Mission Hospital) after asking them to abide by the rules in the future.

This excerpt from the Indian Express yesterday says it all:

“The hospitals had committed only simple mistakes like discrepancies in forms and HLA matching. We have kept in mind the suffering of patients waiting for transplants. Many of them are on dialysis ans need to undergo surgery. The hospitals have agreed to follow the rules and regulations. They will submit an undertaking and obey the rules [in the future]” an official said. (My guess is that the official was Bava Fathurudeen who I have written about earlier)

This is an outright lie that goes to show exactly how high the corruption rises in the administration. A month ago I went to the police and told them I had hard evidence on Devaki hospital that they were preforming illegal kidney transplants. I had uncovered records of the procedure with signatures of doctors (Thiagarajan and Reddy) on one person in Ernavoor and if I searched a little more I could easily have uncovered hundreds of similar documents. However when I went to the police station the Assistant Commissioner only looked at me blankly and said “we are not interested in prosecuting the case.”

For Bava Fathurudeen to say that hospitals have only made “simple mistakes” is a bald faced like. The hospitals have knowingly been providing illegal services and have gotten the government to tow the line with them. It’s already an established fact that the ethic board that approves transplants knows that 90% of the donors who apply for permission to undergo a transplant are unrelated and being paid by brokers.

So in light of the now defacto legalization of unrelated live-donor transplants why doesn’t the government take the more radical step and push for formal legalization? Call me crazy, but I don’t think that dozens of hospitals who have been actively pursing criminal transplants are going to stop business as usual after only a slap on their wrists. The honor system isn’t going to keep things in check.

Organ Trade Story in Wired News
| May 8, 2007 | 9:04 am

After three months of investigation, rewrites, and new information my series on the kidney trade in Tamil Nadu and the rest of the world finally came out on WIRED News. It’s a five part series that covers the extent of what happened here in Chennai, the economics of organ sales, the stories of donors who were cheated by brokers and a possible controversial solution to the whole mess.

Check out the stories here:

Part 1: Black-Market Scandal Shakes India’s Ban on Organ Sales

Part 2: Inside ‘Kidneyville': Rani’s Story

Part 3: Why a Kidney (Street Value $3000) Sells for $85000

Part 4: The Case for Mandatory Organ Donation

Portrait: A Land Ravaged by a Tsunami and Kidney Brokers

The Problem With Selling Organs
| May 1, 2007 | 6:51 am

Yesterday morning Francis Delmonico, the Director of Medical Affairs for the Transplant Society and an advisory to the WHO Transplant Committee, phoned me because he had seen some of the articles I have been writing on the kidney racket here in Chennai on this blog and in Wired News. He had included several of my posts on the subject at a recent convention of nephrologists in Rio last week and wanted to know more about the information I had gathered in my three months researching the subject.

What strikes me most about the paying for organs issue is that the conversation is still very narrowly defined. In the comments sections of other blogs I have been accused of not truly understanding the situation and sensationalizing medical procedures that ultimately aim to benefit both the donor (with cash) and a patient who has to endure a painful existence on dialysis. Many people believe that what is happening in Chennai is basically a well maintained free-market that is ultimately tailored to the needs of patients. The assumption that many people make is that the trade should be made legal.

But what I have seen in case after case on the streets of this city is that everyone–doctors, brokers, news people, administrators, NGO workers and dialysis patients–are exclusively focused on the plight of the patients paying for an organ. They don’t seem concerned in the least for people who supposedly willingly sold their flesh to an underworld gang.

The truth on the streets of Chennai–and the world at large–is that the trade in human organs is organized by a criminal underground that systematically cheats and mishandles donor and patient interests. The people who sell their kidneys get no good aftercare and often develop health problems as a result of their surgery. Brokers and doctors them off out of the majority of the income from the procedure and once they have left the hospital premises they are no better off then when they signed up for the surgery. No one escapes poverty from selling an organ. In Chennai, organ brokers pay between 30,000 and 60,000 ($700-$1500) for a kidney. A patient will pay between 300,000 and 600,000 rupees ($7,000-$14,000) for the surgery. The rest of the money gets divvied up between the broker, the doctor, official bribes, and hospital administrators).

One woman I met recently named Mallika (see photo) was paid on the low end for her kidney. She made $700 and had to stay in a hospital for three weeks for testing. The broker absconded with the cash that he made. Then, two weeks ago, her 16 year old son was diagnosed with an advanced case of jaundice that caused his kidneys to fail. At the moment he is at Stanley hospital getting dialysis treatments but it is unlikely that she will be able to afford the treatment for long. In a month he will die.

Mallika’s case illustraites the inherent inequality of the system. She’s poor and a member of the city’s organ farm. While she has been a health care provider to a wealthy Indian patient, she has no access to care for her son. She can’t donate an organ to her son to save his life because the underworld has already stolen the only commodity that she had access to.

According to the WHO for the last decade China has executed 5000 prisoners annually in order to harvest organs. The organs they provide account for upwards of 11,000 heart, liver and kidney transplants. Can you imagine being a prisoner in China knowing that your only value to the government is to be a host for organs? It is sort of like being a live fish in a tank at a sushi restaurant. And while the Health Minister has vowed to end the practice (on behalf of the upcoming Olympics) it most likely continues to today.

But what happens if China does cut off this steady supply of transplant organs? There will still be a market for them and somehow wealthy sick people will engage brokers and organized criminals to provide them. They will come from people like Mallika.

In my opinion, in an article that will be published in Wired News this week or next, I argue that the only way to solve the problem is to drive the price of organs down by increasing the supply of cadaver organs. And the only way to do that is to harvest organs from every possible brain dead organ donor without regard to consent. The technology is in place to make it possible to harvest organs from you, me and anyone else who gets killed in an auto accident. Organs can be flown around the world in less than 24 hours and transplants made available to anyone at a fraction of the live-donor costs. But the sad state of the present is that live-donor transplants are logistically easier to manage. The donor can find their own way to the hospital and the negotiations only involve one person (rather than a whole family for a brain-dead organ).

Inevitably, efforts to regulate the organ market just don’t work. In places like Iran and the Phillipines where selling organs is basically legal you find that the state has taken over the role of brokers and rarely looks out for the welfare of patients. And even if one country regulates the trade in transparent way, it will most likely be more expensive than unregulated–illegal markets–and patients will seek shady transplants abroad.

So when this article appears in a couple days on Wired News, I expect that dozens of people will levy the charge at me that I just don’t understand the free market. That I’m sensationalizing the stories of donors and not adequately looking at the levels of despair of a person on dialysis. To this, I can only think about the countless conversations I have had with people who have given their organs, been cheated, and are worse off than they were before.

In the words of Nancy Schper-Hughes, the founder of Organs Watch, “Why should the poor have to pay the body tax?”

click here to see other photos from my thee month investigation.

The Smoking Gun: Documenting the Kidney Trade
| April 20, 2007 | 2:54 am

Yesterday I headed out into the field with my assistant Priya looking for hard evidence of the organ trade. Over the last several months I’ve interviewed dozens of people who have sold their kidneys through brokers at the city’s best hospitals and yet the police have continued to do everything they can to not prosecute the case. They say that the 1994 transplantation of human organs act does not empower them to arrest kidney brokers or shut down hospitals. I’ve written on this problem in the past. As usual, the authorities that be will try anything they can not to uphold the law. More on this later.

In our search of two different slum areas Priya and I uncovered documents signed by doctors at Devaki hospital demonstrating that they preformed illegal surgeries. The documents, her health records, show that she used a forged name as well as the dates of the operation, attendants involved in the surgery, lab techs, drawings of her kidney and signatures from both doctors and hospital administrators. In other words, I have the smoking gun.

On the same trip I located the address of a broker living in a northern stretch of the city who lives in a mini-palace and everyone seemed to know who he was. When I asked a local coolie about him I got this reply “Everyone knows him. On this street, all the houses are his.” This leads me to reconsider my assumption for earlier that brokers tend to be poor themselves and are taken advantage of by people higher up on the chain of corruption.

Does anyone care?

Probably not. I went to the police later in the day and told them what I had found and asked them to release some information to me about three brokers they had arrested two months ago. In most countries on earth (including Pakistan which has the same basic legal system) First Information Reports, or FIRs, are available to anyone who asks for them. The reports contain names and addresses of the people arrested as well as the charges they have been brought up on. It is important that these documents are open to the public or the police could arrest anyone they want to and no one would be able to find out about it. When I went the the police station four different officers said they were not obligated to release the FIR to me. Other journalists get FIRs with no problem. Obviously this is one of the prices I pay for being a foreign journalist.

Later when I was speaking to K. Thukkaiandi, IPS who is the Inspector General of Police, Crime he just shook his head and said point blank “I will not give a report to a foreign journalist.” I pressed my case and said I had new information about criminal activity involving the kidney racket.

“We are not interested in prosecuting that case,” he said sternly.

While that is fairly obvious by the way that the police and the corresponding departments in the ministry of health have handled the case so far, I was happy that he gave me at least one transparent piece of information.

I left the station without an FIR, but I have since retained a lawyer and am pressing the issue through the courts.

As for the broker, I will have more information soon.

Suspect Surgeons Advise Tamil Nadu Organ Transplant Future; Get Government Nod
| March 2, 2007 | 10:18 am
Health Minister KKSSR Ramachandran

This afternoon I attended a meeting held by the government of Tamil Nadu that was meant to be the beginning of an official response to the kidney racket. In the last thirteen years thousands of kidney have been sold on the black market with the tacit approval of the ethics board that is charged with monitoring organ transplants. A month ago I wrote a story for Wired News where a member of the ethics committee admitted to knowingly authorizing illegal transplants through brokers.

The meeting today was meant to be a step forward out of a ethical murkiness of organ transplants and call together a wide array of doctors, NGO-wallas and ethical savants for their opinions on live-donor transplants and the solutions that might lie ahead. But intentions are not everything.

“The kidney rackets have been operating in this community for a long time. . .90% of the donors we know about come from below the poverty line, and 90% of those donate for money,” said V.K. Subburaj Deputy Secretary of Health and Family Welfare during his inaugural address.

From a statement like that it would follow that the attendees charged with formulating Tamil Nadu’s future policy would decide to get tough on organ donations and look for positive solutions through cadavers.

Yet when K.K.S.S.R. Ramachandran, the minister of health, asked for people to introduce themselves from the audience, it soon became apparent that the agenda for the meeting was actually being set by the kidney brokers. Just about all of the doctors who came are currently under investigation by the police for assisting in illegal kidney transplants. Representatives from hospitals in Madurai, Coiambatore, Chennai and Trichy that have all been outed in the media for working closely with brokers sat self-satisfied in their easy chairs waiting for their chance to influence policy.

The most obvious among them was Dr. K.C. Reddy of Devaki Hospital–who allowed a broker named Dhanalakshmi to operate for years outside his hospital and in the past has been a vocal proponent of live-donor donations. He was practically jovial. Though he wouldn’t say a word to me.

When the opening remarks were over the press was kicked out and the doctors began to discuss their recommendations in private.

It was like putting the inmates in charge of the prison. The very people who were implicated in creating the organ racket in the first place were allowed to chart the course for the future. Allowed to set the clock backwards and make it seem like all their illegal actions over the last dozen years were actually for the best.

So it was no shock when the results came in and the doctors had reached a consensus that 1) Live unrelated donor transplants should be legal and that people should be allowed to buy and sell kidneys on the market. 2) Foreigners should be allowed to buy organs in India, but need to seek approval from the committee 3) All of the committee’s authorization decisions should be final and not open to appeal 4) Members of the ethics board in charge of overseeing that the system is not abused cannot be held accountable for coercion between brokers over donors or forged documents. And, to put it in the speakers own words, “should not be harassed by the police or press”.

So lets just throw transparency out the window and start an open-air-organ bazaar in Nungabakkam why don’t we. If the committee’s statements get taken up by the government (which is a real possibility) then we can look forward to thousands of completely above the board organ thefts. There were no stipulations to properly look after the rights of the people donating kidneys (except for one proposal for 5-10 years of free health insurance) and no mention of brokers at all.

But some people, thankfully, were not completely taken in by the committee’s organ mafia. V.K. Subburaj said that there was still need for further debate, and that cadaver donations were still the only real option. The same went for members of the MOHAN Foundation, who have organized 200 cadaver donations in the last three years.

To top it off, no people from the press were permitted to ask questions or attend the closed door sessions with the gang of doctor-criminals discussing how to divide the spoils if the laws change.

At this point it is in the hands of K.K.S.S.R Ramachandran ,the health minister, a DMK appointee who’s claim to the ministerhood seems to rely on his loyalty to the party and an incident in his past when he was burned by acid during a political rally. I don’t know much about Ramachandran except that he has endorsed cadaver programs in the past and that he doesn’t speak much English. Though one quote that he said during the meeting (which was translated for me) ran a chill though my veins:

“If there was a situation today where I needed a kidney I am sure that my son wouldn’t offer up his own, instead he would say that he would pay any price for one.”

And the price today is the blood of the poor.

Before he left a reporter from the Hindu asked if he would prosecute hospitals that had preformed illegal transplants. He said he would when the investigation turned up evidence. So far, it seems, he hasn’t looked very hard.

Indians Buy Organs with Impunity
| February 9, 2007 | 1:53 am
For the last week I have been covering the kidney racket scandals here on my blog and occasional posts on Bodyhack, but I was saving some of the juiciest bits for an article on Wired News. And now it’s out. When I first started reporting on this story I spoke with several women in Ernavoor who sold their kidneys to brokers and were cheated out of the majority of what they were promised. From there I followed the leads until I ended up in the office of someone who sits on the Transplant Ethics Committee who told me that they had unofficially sanctioned the organ trade for the last 13 years. I have a series of stories due out on this issue later this month on Wired News. Keep tuned in on this blog for updates. – Scott

Indians Buy Organs With Impunity

WIRED NEWS. CHENNAI, India — Police raids here last month that led to the arrests of at least three alleged dealers in human kidneys have thrown a spotlight on lapses by local medical regulators and recharged the global debate over legalized organ sales.

More than 500 people across the state of Tamil Nadu say they’ve sold their kidneys to organ brokers, in violation of a ban enacted in 1994. Since then, however, the agency responsible for enforcing the ban has frequently turned a blind eye.

“We do everything in accordance with the letter of the law on paper, but we know that almost all of the documents we see are false,” said a member of Tamil Nadu’s Transplant Authorization Committee, who spoke to Wired News on condition of anonymity. “It is an open secret. It is either, approve a transplant with forged documents, or a patient is going to die.”

Humanitarian arguments excusing black-market organ sales may seem a stretch given the stark danger of exploitation that led to the ban in the first place. Given the failure of India’s official system, however, some medical policy experts say some form of legalization may be the best solution.

Under India’s 1994 legislation, a state-appointed ethics committee must approve all transplants. The committee must interview all prospective donors before approving each transplant. On average the committee hears 20 requests a week and approves 15. The anonymous committee member said brokers routinely produce forged documents so that the transaction takes on the appearance of legality.

“The major issue as far as India is concerned is getting rid of the brokers. This would mean government regulation or administration of any compensation policy that would be developed,” said Transplant News editor Jim Warren, who advocates compensating people at a standard rate and providing state-sponsored health insurance for life.

Such a system, however, might not work if the state is offering less than the global market, says Nancy Scheper-Hughes, a medical anthropology professor at the University of California at Berkeley and founding director of Organs Watch.

“Free health care sounds good on paper, but the problem is that when a country goes legal then it enters into competition with the international market in organ transplant tourism,” says Scheper-Hughes. “When the state offers incentives along with a lesser pay scale, but a broker from another country offers slightly more cash without the medical benefits, most people opt for the cash and you run into the same problems you had before legalization.”

The Tamil Nadu agency has unofficially sanctioned the illegal organ trade for the past 13 years, the unnamed committee member said. Without illegal organ trade, he says, patients have no hope because in India, organ donation after death is extremely rare. Without incentive, donors are practically nonexistent.

The committee member denies that brokers bribed members of the transplant committee. But local police believe there’s more behind the Tamil Nadu organ trade than altruism.

“These brokers are not rich people,” said police superintendent Chandrabasu (his only name) of the Crime Branch Central Investigation Department in Chennai. “Out of the (several thousand dollars) they took as their commission from the operation, most of that went to bribes. They would only make about ($300) per transaction in the end.”

Flouting the law may have saved lives; but, by allowing brokers to operate with impunity, the Transplant Authorization Committee has allowed poor people to fall victim to organ brokers — the same problem that was rampant before the 1994 organ donation law.

In January, a group of poverty-stricken women living in a tsunami refugee camp 7.5 miles north of Chennai confessed at a public meeting that they sold their kidneys through brokers.

“When I went to the ethics committee, there were four other women sitting next to me who had also been arranged by the broker,” said one of the refugees, known as Rani (her only name), in an interview with Wired News.

She said she received only about $900 of the $3,300 she was promised by the broker who arranged her transplant. “We went up one at a time and all (the committee) did was ask me if I was willing to donate my kidney and to sign a paper. It was very quick.”

With no viable solution in sight, the Tamil Nadu Transplant Authorization Committee took matters into its own hands, and authorities are scrambling to respond.

The police have three brokers in custody for forgery, according to superintendent Chandrabasu. The director of Medical Services says his division is investigating reports that 52 hospitals may have been involved in illegal transplants.

Tamil Nadu’s health minister last week suggested possible ways of strengthening the government ethics committee. He did not return phone calls requesting comment for this story.

- – -

Scott Carney is a freelance contributor to Wired News and writes for the Bodyhack blog.

Enforcing the Kidney Case
| February 6, 2007 | 10:36 pm

On Monday I had a chance to get a sneak peek at the inner workings of law enforcement in Chennai. I was tracking down the story on the organized mob of kidney brokers that have been preying on poor people in chennai for the last 13 years and I was at the Crime Branch Central Investigation Department office in Thenampeyt speaking to the superintendent of police about how they are going to charge the three alleged brokers that they have in custody. While the brokers are clearly in violation of the Transplantation of Human Organs Act (1994) they claimed that they were not empowered to prosecute the brokers under it. The police instead are opting to charge the men only with forgery. To charge them under the act the superintendent told me that only Bava Fathurudeen, the Director of Medical Services was empowered by the government.

So 20 minutes later I was in Fathurudeen’s office asking him about what his department was doing to prosecute the kidney brokers. The act reads that anyone caught selling organs, offering organs, advertising for organs, operating as a broker, or makes and financial transaction that offers cash for kidneys is punishable for between two and seven years in prison.

But Fathurudeen didn’t seem to know that. Instead he said that his division was busy investigating hospitals across the state and hadn’t even heard that the police had a few brokers in custody. In fact, when I told him that news reports are claiming that over 500 people have had their kidney taken by brokers he was a little shocked. “Really, that many?” he asked. Apparently the only people keeping on top of the investigation are the bloggers and reporters covering the case. The authorities just seem like they want it all to go away.

In addition to not really knowing what is going on, Fathurudeen’s incoherency extended into his own quixotic and confused way of talking. He was unsure of his words and at least three times during the interview crept–yes, crept–into a back office to confer with his office assistants about what to say. When he came back to speak with me he continued to stutter and looked to other people around him for answers. Incidentally, his secretaries looked quite competent. I have a feeling that they are the ones running the show.

It seems that while I have been able to track down multiple brokers simply by interviewing women who had their kidneys taken, no one in law enforcement seem to be taking the necessary steps to prosecute the crime. Instead, kidney sales are becoming defacto-legal.

I have a story coming out about this tomorrow in Wired News where I reveal just how complicit the government really is. Later in the month I should have a series of articles about the kidney racket.

Photo: Bava Fathurudeen has been blindsided by this case.