Arvind Kala: Legalise kidney sales

India's law against the sale of body parts hurts kidney-sellers who are poor.

Laws don't work against the economics of a marketplace. India's illegal kidney transplants are proof of that. They take place because our law against the sale-purchase of body parts outlaws a money value being attached to a kidney. But a kidney's priceless for a person with renal failure who needs it. And his need transforms a poor, healthy man's kidneys into a liquid asset. Selling one fetches him say, Rs 1 lakh, bank interest on which can help to keep his family afloat. Meanwhile, his one kidney begins to do the work of two. Contrary to common belief, parting with a kidney is so safe that healthy donors in western nations aren't even charged higher premiums by life insurance companies.

India's kidney trade thrives because the transaction benefits both the kidney-buyer and the kidney-seller. So it's utter nonsense that the two doctors in the unfolding Gurgaon kidney scandal were robbing coolies of their kidneys for eight-ten years. If that had been, some "robbed" coolie would have gone to the police years earlier. Kidney sales are so rampant that newspapers in India routinely carry ads from people seeking a kidney. Andhra Pradesh even has a place called Kidneypuram, which is a big supplier of kidneys for transplant. In fact, a person with renal failure in India doesn't even have to look for a kidney. The kidney comes to him. Pradosh Ghosh, a 55-year-old doctor of Hindalco, told this writer that he was offered a kidney for transplant five years ago while he was undergoing dialysis in Delhi's Apollo Hospital. Sadly, India's law against the sale of body parts hurts the very people it seeks to protect "" poor kidney-sellers. They get only a fraction of the money paid by kidney recipients. The rest is pocketed by touts in between. This wouldn't happen if kidney sales were legal. Then the touts would be eliminated from the transaction.

Iran did this 25 years ago by permitting the sale of body parts under careful state supervision. So Iran has no shortage of organs for transplant. Any individual in Iran can sell his kidney and so many donors come forward that they are turned away. A kidney fetched a seller in Iran the equivalent of US $2,000 five years ago. Contrast Iran with India, where the clandestine trade in body parts endangers the life of both buyers and sellers by driving them into the hands of dubious surgeons in shadowy hospitals.

India being a democracy, advocating a free-market in trading for human organs would be suicidal for a political party. But there's no reason why the Indian medical system should not push for it. Let market forces work to meet the current supply-demand gap, which will only worsen with increasing life-spans.

In fact, the Indian state can cure the country's chronic organ shortage by taking two steps. One is to legalise the sale of body parts as Iran has done. And the second is to buy the organs of accident victims and people who commit suicide. At present, around 80,000 people die in road accidents every year and around 110,000 commit suicide. Their organs go to waste because their relatives don't profit from allowing the organs to be harvested. But the same relatives would permit the organ removal for a payment of Rs 1-2 lakh. Money paid to them won't come from the state. It will come happily from patients needing a kidney, a liver, or a cornea for a transplant. But the Indian state isn't imaginative enough to see this simple truth. So we have a monstrous irony of living poor people selling their organs while the organs of the brain-dead go to waste. A word of caution, however. The Indian state should keep out of the harvesting of body organs from people living or dead. The business should be left to licensed medical companies in the private sector. If private companies can run airlines and telecom networks in India, there's no reason why they won't do a good job of meeting the current organ shortage.

To be fair to India, trading in body parts is also illegal in Europe and North America. But their body-organ shortage is far less severe because a large number of westerners sign up as organ donors. In fact, 60 per cent of body organs for transplant in the US come from brain-dead people. Despite this, a widespread shortage of body organs persists in the world's most prosperous nations. Thousands of their nationals die every year waiting for organ transplants. This situation sustains a global decades-old transplant tourism where organised gangs fly patients to countries where organs for transplant can be illegally bought and grafted. The Gurgaon case isn't an isolated one. Six years ago an Indian doctor in England was suspended for sending patients to Jalandhar to buy body parts.

The trade in body organs flourishes in India because an estimated 100,000 people go down with renal failure every year. Dialysis isn't an option for them. It's prohibitively expensive, painful, and requires a person to be attached to a machine for several hours every few days. In contrast, a person can live many productive years with a transplanted kidney. And their best source is poor donors plus brain-dead people.