10 August 2006
The illegal trade in human organs in India is thriving. Underlying such trade are improvements in medical technology which have enabled such procedures on a large scale and the desperate poverty of many who see the sale of an organ as a solution to their economic problems.
Research carried out by the London School of Hygiene and Tropical Medicine and the Indian Institute of Technology of Madras (Chennai) (members of the DFID-funded Consortium for Research on Equitable Health Systems) has highlighted the reasons why the regulations to stop the illegal organ trade have failed.
In short, it is because no one seemingly has a stake in seeing the laws enforced: -
- not the people requiring an organ,
- not the donors who sell theirs for cash,
- not the hospitals and health care providers and
- not the policy makers who should regulate the practice.
India’s 1994 Transplantation of Human Organs Act allows donations from a dead person, a living close relative, including a spouse, or a living unrelated donor who wants to donate "by reason of affection or attachment to the recipient". In the state of Tamil Nadu alone, around 1500 people donated organs to unrelated recipients in the two years prior to the study. Part of the problem is that the law has a number of loopholes – for instance its provision for donations from spouses has led to numerous cases of falsified marriages.
The commercial interests of service providers also play a major role in this illegal trade. At present, tissue matching and other tests that need to be conducted prior to transplant surgery are often carried out either in laboratories attached to hospitals where transplant operations take place, or in laboratories referred to by providers. This potential conflict of interest can encourage short cuts in proper tissue matching and quality control.
Against this background, regulatory authorities have numerous problems in enforcement – they have very little resources to monitor cases and no standardised procedure for conducting personal interviews with potential donors and recipients. Furthermore, such interviews often place the authorities under immense personal pressure to allow the procedure to take place.
In the wake of a workshop held by the study group, the Director General for Health for Tamil Nadu issued a Government order to close some of the loopholes in the Act, for instance by instituting mandatory third-party tissue matching. The impact of the project has been to highlight the potential abuses and exploitation associated with failures of the Act. These recent changes in policy made in the wake of the study may be effective in minimising harm to donors and organ recipients although in the longer term, broader ‘harm-reduction’ strategies could be considered involving a controlled trade where procurement and organ matching is carried out by a government agency.
A paper on these issues "The trade in human organs in Tamil Nadu: the anatomy of regulatory failure" can be found in the journal Health Economics, Policy and Law: Vol 1 Issue 1 pp 41-57.