OPINIONS

Kidney scams and more

Saturday, December 7, 2013

by Dr Neeraj Nagpal

DOCTOR ARRESTED scream the headlines. Recently, we have been inundated with news of Kidney Scams. Questions arise to mind immediately: Why do doctors steal kidneys? I myself am a member of the authorization committee for transplantation at a local corporate hospital along with a retired judge, additional deputy commissioner, nominees of civil surgeon among others. Intrigued by such news I tried to go into details of some such cases.

Dr Neeraj Nagpal

The authorization committee of a hospital screens all donors and recipients before permission is given for transplant. As per law, in this screening committee meeting both the donor and the recipient appear separately and present documents to prove their relationship with each other. Affidavits and verifications by local Tehsildar, Sarpanch etc as to the identity and relationship of the donor with the recipient are checked. The verification is done by asking questions based on documents presented so that any discrepancy can be picked up. Medical history and reports of donor are also checked to see suitability and fitness of the donor. Without approval of the authorization committee no organ transplantation can be done.

Why is it then that a person who has been videographed stating that he out of love and affection is giving his kidney to his sister and has presented proof of his relationship before an authorization committee suddenly turns around and claims that his kidney has been stolen from him. The answer to this is greed pure and simple. The desperation of an end-stage kidney disease patient who is told that transplant is his only hope can only be understood either by the patient himself or by his relatives. This desperation is exploited by unscrupulous persons who procure this kidney for them. Touts and professionals identify and contact these patients on dialysis needing transplant. They strike a deal with patients or their relatives to find for them willing donors who get paid for the kidney. Later either because the touts do not pay promised amount or the donor realizes he could ask for more money, the ‘dispute’ snowballs into a full blown “scam”.

In these murky dealings, members of the authorization committee as well as the transplant surgeon’s team, including anaesthetists, assistants and resident doctors who have no role to play, get trapped. The crime gets done at local level where false affidavits and other documents are prepared (in one case at Lucknow). At the most the authorization committee can be accused of incompetence or negligence and the surgical team of not even this. An anaesthetist is called for surgery and he checks the patient from anaesthesia point of view, gives anaesthesia during the surgery, brings the patient out of anaesthesia and does post-anaesthesia check-up. He does neither have the competence nor the training to detect a fake brother from a real brother nor is that his job. Similarly, a doctor hired to give postoperative care to the patient has no role to play in preoperative conspiracy but because of having been a part of the surgical team gets roped in.

Is doing transplantation a crime in this country? If it is not, then do not treat transplant surgical teams as criminals. Unfortunately, in their job they come across such persons who without their knowledge may have committed a crime but these are the persons who should be punished and not the surgeon or the anaesthetist. Already deceased donor transplant programmes all over the country suffer due to myths and religious beliefs. Please do not kill the live related donor transplant programme also by this ‘Witch Hunt’.

Do we hear of the touts or persons who prepare false documents, false affidavits, or the Sarpanch and Tehsildar who verify the donor ever get prosecuted? It is so much easier to arrest the doctors even if their connection with the ‘crime’ is nebulous and distant to say the least. ‘Witch Hunt’ of the kind that was practiced in medieval times is now being done with ‘Doctors’ now replacing witches. Punishing doctors even when innocent, dragging them to police station in chains, seeing them being produced in court and being sent to jail give a perverse pleasure to many. No compensation for the trauma undergone by these doctors even after they are acquitted is ever forthcoming.

There is no justification of sale of human organs. However, sale of human organs does happen and is a fact known to all. Reasons are not far to seek in a country where the difference in lives of the rich and the poor is so stark that even the unimaginable happens frequently. The crime is not in being a highly qualified expert with years of experience in saving lives. The crime is being committed before the patient even approaches the doctor and the authorization committee. The deal has already been made, papers prepared, coaching on what is to be said in front of the authorization committee already done. The doctors are conducting a transplant to save a person’s life. They are not aware or part of the procurement process. If anything, they are the victims of the conspiracy. Some serious thought needs to be put into this matter by the authorities for the next patient needing a transplant, may be your own family member and the doctors may simply have given up by then.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh
9316517176

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6 Comments »

Comment by Maj Pankaj Rai (Retd)
2013-12-08 13:58:24

Admittedly, in most of the cases the despicable practice of sale of human organs and illegal transplant surgeries is prompted by greed and middle men. However, what happens when the transplant surgeon is himself a part of the authorization committee in violation of Rule 4A read with Sec 9 and performs illegal transplant surgeries which is an offence punishable under Sec 18? I agree that such instances are an exception rather than the norm but such exceptions do occur.

 
Comment by Harkant Singh
2013-12-09 23:17:19

Maj Pankaj Rai — Can a transplant Surgeon be a part of authorisation committee?? I wonder. Who creates the ‘Committee’??? So many ???

 
Comment by Maj Pankaj Rai (Retd)
2013-12-10 16:06:05

Mr Singh – the transplant surgeon is NOT supposed to be a part of the authorisation committee. That is one way in which scams take place. Fortunately, such instances are rare. However, I can give you one specific instance of what should not have happened but has happened. Fortis Hospital Bannerghatta Road Bangalore employs one Dr Ramcharan Thiagarajan who has done four cadaver organ transplant surgeries while he was the Medical Coordinator of ZCCK. This is an offence punishable under Sec 18 and since the Hospital continues to employ the suregon, it is a fit case for closure of the entire hospital. I have complained to both KMC and the State Government to take action against the surgeon and hospital respectively.

 
Comment by Dr S K Mathur
2013-12-11 07:15:05

I do not agree that to be a Transplant Surgeon in this country is a crime. However Dr Nagpal should also know that such falsification of Donor ID does happen with the explicit knowledge of Nephrologist and transplant surgeon.

However I do agree with Dr Nagpal that when such cases are exposed, why only members of transplant team are targeted. Actually as per TOHA 1994, every one involved is liable to punishment that means it include the Organ Recepient as well who pays to the donor in other words purchases the organ, and thus commits an act which is punishable under TOHA1994 as ammended in 2011. Then why in all these Kidney Scams never ever recepients are arrested or punished. Only possible reason is because most of such recepients of organs from fake relatives are influential people.

 
Comment by Dr Neeraj Nagpal
2013-12-11 08:48:37

Dear Dr Mathur
If the nephrologist and transplant surgeon are party to falsification of Donor ID they deserve punishment as prescribed under the Act. Mostly patients are undergoing dialysis in different states, are advised transplant , refused transplant due to one reason or the other, then go to a different state with paid donor and fake IDs, register with a new centre and get transplantation done based on papers made in another state screened by appropriate transplant authorization committee.

The transplant surgeon comes into the picture after the fake IDs, financial transaction is done. If he refuses to transplant even after authorization committee approvals I am sure he will be prosecuted under CPA, Criminal negligence, and in Medical Council.

By Law authorization committee is comprised of people other than transplant team. What happens is a witch hunt. As per Section 19 A of the Act the donor has also participated in recieving money for organ. Why is he as well as the recipient not prosecuted.

Fact is Press, Public and Police view transplant as a crime. Since the anesthetist is participating in the surgery even without any role in the organ procurement so he , assistants, residents all should also be punished. Also it is masala news that “kidney stolen”, “Doctor arrested”. Given the gravity of the situation doctors become easy targets for arm twisting by the police and forced to pay hefty bribes.

 
Comment by prof RS Ahlawat
2013-12-12 23:04:06

things are not that simple as they are said, at first patient is last to be blamed, he is already victim of the circumstances, he wants freedom from end stage renal disease by some medical treatment and in no way like to die in sufferings. next come the medical team, if they have done the act in good faith then why they should be punished? now who should be blamed ? is it not the corrupt system through which the patient has reached the renal transplant center and hence it is the moral duty of the administration and the judiciary to keep the system clean and doctors in India should work in the field of medical research to find out any alternative treatment of this end stage disease. as pool of the live donors is also quite limed we should widen this pool through cadaver donors .

 
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