In April 2018, kidney transplants in India made news when former finance minister Arun Jaitley underwent one at the All India Institute of Medical Sciences in Delhi. Apart from the politician's health issues, there was some criticism about how he had “jumped the queue” for a transplant—at the time, at least 400 patients, who had also managed a live donor, were on the waiting list of the premier hospital. Going by the need for organs—especially kidneys—transplants in India, and the long waiting lists for getting a procedure done at AIIMS, that number might not have changed significantly even more than an year later.
At the heart of renowned nephrologist and Padma Bhushan awardee Dr Ramesh Kumar's book, Kidney Transplants and Scams: India's Troublesome Legacy is this skewed demand and supply ratio of those who need one, and those who are fit to 'donate' one. Kumar, a pioneer in the field of nephrology, performed the first 'living related' kidney transplant in 1973. In his book, he traces the history of transplants in India, the pitfalls of lack of regulations, as well as the challenges that lie ahead given the huge need for patients requiring a spare kidney.
Kumar, who is also credited with introducing the procedure of chronic ambulatory peritoneal dialysis (for those over 65 years, patients with poor cardiac function, limitation of vascular access and some patients who do not want maintenance dialysis and kidney transplant) in the same year while working at AIIMS, also details the events that led to a law regulating organ transplants in India, before which only a related donor could give away his kidney to the ailing. Kumar details how in the absence of the law (that came well in 1993), the country had become a haven for illegal harvesting and transplants, the poor were duped and India became a 'kidney bazar'. The law, he recounts, was a turning point in the history of organ transplants in India, as it recognised “brain death” for the first time, and allowed doctors to harvest and transplant organs from a cadaver, for a living recipient.
Besides details of the kidney scams that flourished in the 70s and 80s and even now, the book also provides insights into prevailing social biases. The rich could buy themselves a kidney, the need of boys for a kidney was privileged to that of their sisters', and kidneys of wives were sold by husbands to make-up for dowry. The book also has several other touching anecdotes—of mothers getting cold feet just before they were to donate a kidney for a child, and of the tragic series of deaths in a family, set off by a young man's death in an accident while on way to donate the organ for his brother. As the brother waits for his donor to arrive, the family learns of their other son and donor's death in an accident, and his wife kills herself upon hearing of her husband's death—a case that haunts Kumar even now.
In the end, Kumar raises the issue of harvesting organs from those who die unfortunately in accidents, and raising awareness on organ transplants so that some of the huge demand-supply gap can be bridged. One can only hope that the government, doctors and hospital managements will pay heed to Kumar's timely and pertinent advice.
Title: Kidney Transplants and Scams: India's Troublesome Legacy
By Dr Ramesh Kumar
Publisher: Sage Publications
Rs 495; 227 pages