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Feature Organ donation

Has Tamil Nadu turned the tide on the transplant trade?

BMJ 2013; 346 doi: (Published 12 April 2013) Cite this as: BMJ 2013;346:f2155
  1. Sandhya Srinivasan, freelance journalist and researcher, Mumbai; consulting editor, Indian Journal of Medical Ethics; consulting editor, public health, Infochange News and Features
  1. sandhya_srinivasan{at}

A programme to encourage harvesting of organs from cadavers might show other states a way to reduce commercial organ trafficking, writes Sandhya Srinivasan

India is a world leader in the commercial kidney trade. An estimated 3200 transplants put India second only to the United States (with 6435) in 2006,1 but national data are not reliable, and estimates range from 3000 to 6000 live donor transplant operations (commercial and non-commercial) a year.

The transplant industry is highly profitable, and private hospitals, which conduct most transplant operations, are subject to little regulation.2 3 Regulation improved in 2008 after the arrest of doctors running a transplant business in Gurgaon, near Delhi, who had transplanted 600 kidneys removed from poor people without consent. They were convicted on 22 March 2013 and sentenced to prison. Still, paid-for transplants are thought to make up a considerable proportion of live transplants in India.

The Transplantation of Human Organs Act 1994 bans the buying and selling of organs,4 but clause 9 of chapter II permits live donation by an unrelated donor “by reason of affection or attachment towards the recipient.” Authorisation committees have often turned a blind eye when there has been reason to suspect that the “donor” is being paid.3 This has left medical professionals free to exploit desperate patients with renal failure and desperate poor people ready to sell a kidney to pay their debts.

The commercial transplant business thrives in the absence of strong transplant programmes that harvest organs from dead donors. Each year in India 134 000 people die in road traffic incidents.5 Some 70% are declared brain dead and are potential sources of organs for transplantation.6 Deaths from snakebite and brain haemorrhage also give rise to potential donors. Yet organs from fewer than 200 cadavers are transplanted each …

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