Living or dying

The Nepal Police are hunting for the kingpin of a multi-crore Indian kidney racket who is reported to have fled to Nepal and stayed in hotels here. The man on the run, one Amit Kumar, is also suspected to have links with a hospital in Kathmandu. So far,police have arrested 13 people on the charge of taking people to India for selling their kidneys. Kidney business is not a new thing in South Asia, particularly in India where there are good transplant facilities in several cities, such as Madras, Bangalore, Bombay and New Delhi. As a result, patients from the rest of South Asia and even from beyond go to India as it has the best transplant centres in the whole of South Asia. As cadaver transplants are to pick up there yet, all transplanted organs have to come from live donors.

As it is often difficult for patients to get a related donor, the only alternative to death available to them is to have an unrelated donor, who, naturally, will be willing to part with his or her vital organ at a price. If there were a direct deal between the two sides, and the donor were ‘well compensated’, that would be some consolation, apart from the legal and moral implications it holds. But most of the kidney business is much worse, thanks to the brokers and their collusion with some of the doctors, who together run a racket luring unwary and innocent, particularly poor, people, to part with their organ, often with attractive promises, which are often not met fully, and most worryingly, without telling them beforehand the full short- and long-term consequences of ‘donating’ a kidney for their health. The brokers pocket most of the money patients paid, and the donors often get only a small fraction of it.

Nine years ago, the parliament introduced a law on organ transplantation, and four years ago, the government issued a procedural order to regulate matters regarding organs and their donation. But effective enforcement is required. Work had proceeded on starting renal transplantation at Bir Hospital, and in the late 1990s, it was reported that almost all infrastructure had been created for transplantation. But it never got off the ground. At about that time, a urologist and a Naya Baneshwor-based nursing home made much of a couple of transplants they had carried out, despite the absence of a law governing the entire process — but the patients died soon afterward. Renal transplantation requires total care of a high order. Without this, failure rate would be high. But the ever-growing number of patients makes a strong case for expanding the existing pre-transplantation services, such as increasing the number of dialysis machines, and setting up a high-quality transplantation facility in a government hospital so that ordinary Nepalis, too, may have some hopes of survival. Kidney failure is a time-consuming and highly expensive state in which the patients and their families are faced with moral, financial and other dilemmas. Pre-transplantation dialysis cost, transplantation expenses and long-term post-transplantation medication and care are all very expensive. Most of the patients die because of their inability to afford the cost of treatment.