Victims, Medical Professionals and Racketeers

The Human Cost of Organ Trafficking

Vinson Prakash*

“We had no funds for food after the Tsunami. We took a loan of Rs 100,000 for living expenses and to pay for the marriage of my oldest daughter. The money lender’s abuse to us was intolerable.”

“My main problem is severe poverty, not having our own land, own home and no money for my children’s education. All this made me to go for this act. I never wanted my wife to donate but everyone is having money from this, so [I thought] why can’t I?”

These are some testimonies given by victims of organ trade rackets that prey on India’s most vulnerable and financially disadvantaged population¹ . India’s organ market is plagued by a scarcity of organs and low donation rates. India’s deceased organ donation rate stands at 0.52 organs donated per million population, compared to the donation rate of other countries like the US at 39, Spain at 37.9, and Croatia at 24.5 per million, respectively² . Despite the fact that 1.8 lakh people experience renal (kidney system) failure every year, only 6,000 transplants are performed throughout the nation³ . The same trend is followed for other organs such as the liver, where 10-15 per cent of the 2 lakh patients who die from liver failure annually can be saved; and out of 50,000 people who suffer from heart failures annually, only 10 or 15 receive the required transplant⁴ .

The significant gap between the supply and demand of organs, coupled with a significant proportion of the country’s population living below the poverty line, has made India one of the most thriving markets in the world for illicit organ trade and illegal organ transplantations. A kidney is sold for about Rs 70 lakh to Rs 1 crore depending on the urgency of the transplant, according to a top Uttar Pradesh police official. However, neither the donor nor the sale of the organ (from a deceased person) can earn more than Rs 3 lakh⁵.

Historical Overview

How did India become a thriving market for illicit organ trade and illegal organ transplants? In the 1970s, renal transplantation in India became a successful endeavour. The following decade witnessed mastering of surgical techniques and the production of immuno-suppressant drugs that achieved better survival rates in transplant recipients . Pioneering transplant procedures, along with an unlimited source of poor donors, brought potential buyers of organs to India from several parts of the world, in so far that India became the ‘hub’ of organ trade in the 1980s. In the early 1990s, residents of Gulf states such as Kuwait, Saudi Arabia, Bahrain, Oman, and the UAE

Majority of studies on organ trade state poverty as the primary factor contributing towards organ sale. A World Bank report of 2024 states that approximately 129 million Indians are living in extreme poverty, earning less than Rs181 per day.

frequently travelled to India to obtain a kidney⁷.

This unscrupulous trade persisted unregulated for over three decades, up until the passing of the Transplant of Human Organs (THO) Act in 1994. This however pushed the organ trade underground, making it a much more lucrative business, owing to the shortening of supply and its illegality. Racketeers exploited Section 9(3) of the Act, which permitted an unrelated person to donate an organ out of affection or attachment⁸ . Donors were presented as people affectionate towards the recipient, making it business as usual. The THOA was later criticised for its limitations and especially its inability to curb the illegal organ trade.

India’s Illicit Organ Trade

The majority of studies on organ trade state poverty as the primary factor contributing towards organ sale. A report released by the World Bank in 2024 states that approximately 129 million Indians—almost 10 per cent of the country’s population-- are living in extreme poverty, earning less than $2.15 (Rs181) per day. Organs have thereby become a commodity, where people living in extreme poverty see it as a form of trade that may ameliorate them from their current living conditions.

Kidney transplants are one of the most common living-donor organ procedures, and the kidney is the most sought-after organ in the black market. Given that human beings can lead an active and healthy life with just one functioning kidney, selling the other one is perceived as a viable option. But, as studies consistently find, the sale of a kidney almost never helps the donor overcome poverty. On the contrary, it at times pushes them further into extreme poverty as

their physical capabilities are constrained, compromising their ability to generate an income.

Human trafficking for organ removal (HTOR) is a facet of the illicit organ trade and the victims of HTOR are predominately people living in extreme poverty. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, derived from a UN protocol, defines HTOR as “the recruitment, transportation, transfer, harbouring, or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability, or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of the removal of organs.” By definition, even if persons living in extreme poverty consent to the removal of an organ for commercial purposes, they are trafficked as they are defrauded, coerced (owing to their financial circumstances), and their position of vulnerability has been exploited by racketeers.

The Coalition for Organ Failure Solutions has thus far identified victims of HTOR in four areas of India. These include Erode and Chennai in Tamil Nadu, and villages/small town centres in West Bengal and Karnataka. In all these regions, extreme poverty was the factor that drove HTOR.

In Erode, the transition from handloom to electric loom created a significant employment gap that was effectively exploited by racketeers. In Chennai, the victims of HTOR are largely part of communities on the coast who lost their homes, belongings and livelihoods as a result of the Tsunami of December, 2004. Villivakkam, an area in Chennai which was affected by the Tsunami, was dubbed ‘Kidneyvakkam’ since most of the residents there sold their kidneys to sustain themselves⁹.

In West Bengal, particularly in the city of Raiganj and villages (Bajbindol, Balia, Jalipara) of the Uttar Dinajpur province, brokers are mostly individuals who have donated their own kidney and are now recruiting individuals for a kidney sale in Mumbai. In Karnataka, all the victims from the Mandya District, Mysore, Mangalore, Ulsoor and Udupi were farmers¹⁰.

Apart from the racketeers, medical professionals greatly abet the illicit organ trade. In 2016, 14 people were detained in Mumbai for engaging in illegal organ transplants. Out of these 14, five of them were medical professionals detained by the Maharashtra Directorate of Health Services after the discovery of discrepancies with kidney transplants carried out in their medical facility¹¹.

Similarly, earlier this year, on July 9, 2024, a surgeon was among the seven arrested for operating an international organ trafficking racket in Delhi¹². This collusion of medical professionals is detrimental towards the trust people have in the healthcare system and the lack of trust is cited as one of the reasons for the slow evolvement of the deceased donation programme in the country.

The network and organisation of organ transplant rackets in India vary on a case-by-case basis. Some of the variations found through media reports are: the racket using a broker who was victimised by them to recruit more individuals from the broker’s hometown for kidney removal; the racket uses a quasi-medical professional such as a transplant coordinator in different hospitals where they identify patients in need of a kidney and then arrange for a commercial transplant¹³; or, the racket lures individuals from impoverished countries and transports them across borders using forged documents for kidney removal¹⁴.

The Way Ahead

Possible solutions to curb the illicit organ trade, recommended by literature on the subject, are either to implement the Iranian model of having a governmentregulated organ sale market; or, the state of Wisconsin’s (USA) model of giving organ donors tax breaks and medical allowances¹⁵. Both of these solutions are however not viable for the Indian context. In India, the primary problem is extreme poverty leading to organ sale.

Considering the Iranian model, the current exploitation of the poor will be exacerbated since this model cements the narrative that an organ can be used as a commodity to relieve a person’s debt. This can result in significant adverse effects on the poor people enrolling in this program, especially since the enrolment would be in enormous numbers from this proportion of the population. The elements of

coercion, exigent need for money, or lack of agency do not disappear under this model.

There needs to be a course of action that alleviates people from extreme poverty, imposes much harsher penalties on doctors who abet illegal transplantations, and improves the country’s organ donation rate. Rather than conceptualising illicit organ trade as a criminal issue, it should be conceptualised as a social issue.

Education Helps

After almost three decades, The National Education Policy 2020 is a step in the right direction in improving access to education for people from vulnerable social and financial backgrounds via the Gender Inclusion Fund and Special Education Zones. The impact of the implementation are yet to be seen since the policy is currently being implemented in “language and spirit” across India.

Obtaining a loan to meet living expenses is virtually impossible for people living in poverty. Most of them turn to local money lenders who charge exorbitant interest rates and quick repayment timelines that are impossible to fulfil. New schemes must be introduced for people living in extreme poverty, wherein they receive financial aid such as child maintenance allowances, housing assistance, medical allowances, and tax relief to meet their basic necessities, protect their fundamental Right Against Exploitation, and maintain their universal right to life, liberty, security, and standard of living.

Further, much harsher penalties must be imposed on medical professionals for abetting an illegal organ transplantation. These could include an extended prison sentence, an increased fine, removal of name for a period longer than three years from the register of the State Medical Council, and both permanent removal from the register and revocation of their educational qualifications (including degrees, diplomas, and certifications) for a subsequent offence, including barring them from taking up medical education in any other institution. Harsher penalties will deter medical professionals from engaging in illegal organ transplants and subsequently reduce such transplants since the racketeers will have a very limited supply of unscrupulous medical professionals to perform the transplant.

Increasing the Organ Donation Rate

To increase the country’s organ donation rate, a variation of the ‘presumed consent’ practice for organ donation can be implemented across the nation to encourage the donation of organs from the deceased. ‘Presumed consent’ works on the principle that the deceased person has consented to having their organs donated, unless a document states otherwise.

Brazil has an impressive organ donation count among developing countries, has managed to substantially reduce organ shortage, and increase the number of transplants done annually₁₆. Its ‘presumed consent’ law is primarily responsible for bringing about a commendable organ donation count. Following in Brazil’s footsteps, India too can implement a provision in the THOA that allows hospitals to harvest a deceased person’s organs, unless optedout by family members or if disapproved by the deceased prior to death.

A crime-fighting approach is simply not sufficient to curb and eliminate the illicit organ trade in India. There need to be legislative changes that ameliorate people from extreme poverty through access to quality education, financial assistance, and healthcare. A revival of THOA is needed with new amendments that can strike at the heart of the problem, including proper oversight of the Appropriate Authority to prevent abuse of Section 9(3) of THOA. India still has a long way to go before it can become a country where organs are not perceived as commodities, and a crackdown on illicit organ trade can truly be achieved.

References

Raja, K. R., Budiani-Saberi, D. A., & Findley, K. (2014). Human trafficking for organ removal in India: a victim-centered, evidence-based report. Coalition for Organ-Failure Solutions, 1-42.
Rana, M. S. (2022). Factors Responsible for Human Organ Trade in India. Part 2 Indian J. Integrated Rsch. L., 2, 1.
Ibid.
Ibid.
Ibid.
Chatterjee, S. (2021), The illegal trade in organs and poverty in India: A comparative analysis with Brazil and China. Handbook of BRICS and Emerging Economies. Oxford University Press (2021). © Oxford University Press. DOI: 10.1093/ oso/9780198827535.003.0022
Ibid.
Ibid.
Supra note 2
Supra note 1
Supra note 2
Statesman News Service. (2024a, July 9). Organ transplant racket busted in Delhi, surgeon among seven arrested. The Statesman. https://bit.ly/41OcXn9
Statesman News Service. (2024b, July 19). Delhi Police crime branch nabs 15 including Kingpin in Kidney Transplant Racket. The Statesman. https://bit.ly/40aCSEw
Manral, M. S., & M. , K. S. (2024, July 19). India-Bangladesh Kidney Racket: Another Apollo doctor, Clearance Committee under Police Scanner. The Indian Express. https://bit.ly/4iNgOXI
Bowden, J. (2013). Feeling empty: organ trafficking & trade: the black market for human organs. Intercultural Hum. Rts. L. Rev., 8, 451.
Supra note 6

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