EDITORIAL: Disclosures of illegal kidney transplants highlight the need for tougher controls

KATHMANDU (The Kathmandu Post/ANN) - For this case to have occurred in the heart of the country, in a private hospital, shows the seriousness of the issue.

It has been reported that five people were arrested on October 16 for their alleged involvement in illegal kidney trade. The case is a bizarre one, where everyone involved seems to be in the wrong and could face up to five years in jail. The case highlights the height of immorality and corruption prevalent in the system set up to prevent such illegal trade in the first place. It also shows how doctors, supposed to be in the profession to care for people, can also forget their many oaths, to serve and to protect, for personal gains. It points to cases where poor Nepalis can be duped into selling their organs for much-needed cash. This not only puts their health at risk but also ultimately puts them on the wrong side of the law. It is, after all, as illegal to sell a kidney as it is to buy one. Lastly, this case highlights the need for stricter regulation of kidney donations, and a change in the law to allow for a kidney ‘swap’ programme to mitigate incentives to trade illegally.

In the present case, the five people arrested include three personnel attached to Nidan Hospital in Lalitpur. They also include a section officer of the District Administration Office in Lalitpur and the kidney recipient himself. Alarmingly, every one of the accused and arrested, besides the patient, is a member of Nidan’s Kidney Transplantation Approval Committee. All hospitals offering kidney transplant services are required by law to set up such panels to check the authenticity of the donors and recipients.

Nepal’s law states that only close relatives are allowed to donate organs to those that are in need. The exception to the rule is when the donor and recipient are not related, but the donor is willing to provide the organ free of duress and without any compensation; the immediate family members of both parties have to sign a release. It seems that the transplant approval committee first consented to let the patient receive a kidney donated by his nephew. However, on the day of the surgery, the family brought in an impostor, the victim, with falsified documents identifying him as the nephew.

When suspicions arose and a complaint reached Nidan’s management, the transplant committee stood by the forged documents and assured the hospital that the donor was an authentic one. The surgery went through as planned on August 8, and it took the police some time to find the real donor and build a case against members of the committee and the recipient.

This is not the first time such an incident has occurred in Nepal. In fact, the Daily Mail in 2015 exposed that the entire population of a village in Kavre had sold their kidneys on the black market to buy land and build houses. The victim in this case, too, was a man from Kavre living in ‘abject poverty’ in Bhaktapur who had been a patient at Nidan before the transplant. When people are living in poverty and lack credible information, it is easy to dupe them into selling one of their kidneys illegally to make some money, no matter the risk. And with the need for kidneys growing--a 2012 estimate puts the number of illegal transplants per year at over 10,000, or more than one every hour--the problem will only grow.

For this case to have occurred in the heart of the Capital, in a private hospital, shows the seriousness of the issue. This very instant, there may be many poor patients across the country being approached by hospital personnel and being pressured to sell their organs. The thought is chilling. The need of the hour is stronger regulation of the kidney transplant committees. There is further need to research and implement kidney exchange markets, such as those designed by economist Alvin Roth and implemented all across the US, which allows for a safe, ethical and money-free exchange of kidneys.

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