Kidneys For Sale: The Great Indian Scam

It was only in June this year that a massive kidney racket was unearthed in the capital city, at one of India’s top private hospitals – Indraprashta Apollo Hospital. Among those arrested were two personal secretaries of the doctors, along with the touts who allegedly managed the entire scam. This spurred investigations across hospitals in Delhi and around the country.

A month later, it was a case of déjà vu. Only this time, the kidney donation scandal rocked one of Mumbai’s top private hospitals, Hiranandani Hospital. The racket was exposed when the police were tipped off that a kidney transplant operation had been scheduled on July 14 at the Powai-based hospital, where the donor and the recipient were not related. The hospital’s chief executive officer, medical director, three doctors, the kidney donor, recipient, and agents were arrested by the Mumbai Police on the basis of a report by the Director of State Health Services Department.

Under Indian law, unrelated persons can only donate kidneys for transplantations after receiving the government’s approval. Related persons can do so if they are the recipient’s immediate family.

On August 18, the Andheri Metropolitan Magistrate’s court granted bail to the hospital’s CEO Surjit Chatterjee, medical director Anurag Naik and the accused doctors. The man who blew the lid off the racket is a senior leader of the Bahujan Samaj Party and a Mumbai-based activist, Mahesh Tanna.

At 9 pm on July 13, Tanna received a file from a man named Sundar Singh. The file, which BloombergQuint has reviewed, laid out details of an illegal kidney transplant which was scheduled to take place at Hiranandani Hospital the following morning. According to the file, the recipient Brijkishor Jaiswal had submitted forged paperwork, including a fake Aadhaar card and a marriage certificate to the hospital. It said the donor, Shobha Thakhur, was not his real wife but a poor villager from Gujarat. The complaint filed by Tanna with the Mumbai Police said she was being paid to pose as Jaiswal’s wife, Rekha. This was done to circumvent the law which permits a married couple to donate a kidney to a spouse as long as an authorisation committee vets the marriage certificates, photographs and all marriage-related proofs. The hospital-based authorisation committee is constituted by the state government and consists of the medical director, two senior doctors, two respectable members of society, the Health Services Director and the Health Secretary.

In this video filmed by Tanna’s associates, which BloombergQuint has not been able to verify, Tanna confronts the medical director at Hiranandani Hospital during the surgery.

Tanna says he informed the local police about the file and on July 14 at noon, he and his associates barged into the operation theatre along with two police marshals. “At 12:10 pm, we stopped the operation, which was already underway. The cuts had already been made, but we stopped it because we had proof that it was being carried out illegally. We thought the hospital didn’t know about this, but when we spoke with the hospital’s medical director Anurag Naik and with the CEO Sujit Chatterjee, we realised that everybody is involved in this,” he adds.

According to Tanna, illegal transplants were frequently carried out at the reputed Hiranandani Hospital and recipients would typically shell out nearly Rs 50 lakh for a kidney. He says he has proof of more than five such transplants which have taken place since March this year. He insists that not only can a paper trail be traced back to the hospital’s CEO and medical director via the transplant coordinator, but government departments, which give the requisite approvals, can also be implicated.

Currently, Hiranandani Hospital’s doctors, CEO, medical director and transplant coordinator Nilesh Kamble are out on bail, and investigations are underway.

The Curious Case of Sundar Singh

None of these revelations may have been possible if it wasn’t for Sundar Singh. Tanna says Singh, the whistleblower in this case, is a young man from Uttar Pradesh who had been a victim of a similar scam at the same hospital. In March, he had donated a kidney through an agent named Bhisen, who had promised him a hefty sum in return, which would help him clear his debts back home. Instead, he was given a measly amount after the transplant. Distraught and helpless, Singh started working for the cartel and was given accommodation in Mumbai. During this time, he learnt how the entire kidney racket functions and how agents target illiterate and indebted villagers, luring them to big cities like Mumbai as kidney donors.

Tanna and his associates pursued Singh for months until he finally agreed to turn whistleblower and handed the case file over to them.

Just (Not) What The Doctor Ordered?

The medical community seems startled by the way this case has panned out. One of Mumbai’s top nephrologists, Ashok Kirpalani says the regulations are antediluvian and tilt the balance against doctors in such cases. “This law puts too much burden on the doctor. It might have a facilitatory aspect, but it also has a punitive aspect. I would like to say that the punishments are out of proportion with the visibility of the crime,” he says.

The arrests were made under the amended Transplantation of Human Organs Act which says that doctors must not undertake transplants of any human organs unless they have communicated all possible ramifications, complications and threats involved in such a surgery. If the medical practitioners, in this case, are proven guilty, they could face a maximum of up to 10 years in jail along with a fine of up to Rs 1 crore.

Kirpalani is not the only one who has concerns with the regulations. Following the racket at Hiranandani Hospital, a group of Mumbai’s senior nephrologists and urologists decided to put on hold fresh kidney transplant cases till the government intervenes and clarifies some of the procedural intricacies involved in such surgeries.

Shrirang Bicchu, a nephrologist at Bombay Hospital in South Mumbai who is also a member of Mumbai Nephrologists group told PTI, “We are very afraid (to carry out transplants) after the development. It’s not a protest but it’s out of fear. Just because there is no clarity on the donor’s transplant, we have stopped taking fresh transplant cases.” Pending cases at different hospitals across the city, however, will be taken care of, he added. “If our reservations are not considered seriously by the government, we will stop performing transplant procedures completely,” said another nephrologist, requesting anonymity.

Under the existing law, the doctor must satisfy himself of the medical and the psychiatric condition of the patient and the mental and physical fitness of the donor. The doctor also needs to reassure himself of the identity of the donor and recipient. But medical and legal practitioners say that the process of establishing identity in India is very loose. Initially, medical practitioners used to rely on Tehsildar certificates and marriage photographs to confirm that the couple was married but marriage certificates and Aadhaar cards have proven to be easy to forge. That’s why doctors have increasingly begun to rely on the due diligence done by the hospital’s transplant coordinators. According to Tanna, the transplant coordinator at Hiranandani Hospital, Kamble, has been managing the entire operation all along. Recently, Rs 8 lakh were recovered from Kamble’s house by the Powai police, Tanna says. When BloombergQuint reached out to the Mumbai Police, they refused to confirm this and said investigations were underway.

Kirpalani insists, “If there is a transplant coordinator, then I have to accept that he is an honest person appointed by my hospital and if he brings a husband and wife to me, then I have to accept they are married… Just because we (doctors) are high profile people, we are portrayed as big crooks because we save lives? I feel very disgusted about that.”

The Heart of The (Kidney) Problem

While some might dismiss the laws relating to organ donations as archaic and others might blame it on a corrupt system, these might just be part of a much bigger Indian problem. India has often been infamously dubbed as the “diabetes capital of the world”. The International Diabetes Federation estimates that India is home to over 60 million diabetics. Diabetes is a major reason for kidney failure. Kamal D Shah, co-founder of NephroPlus, India’s largest dialysis centre network said in a telephonic interview, “India today faces a huge shortage of organs. Though about 1.5 lakh people in India need a kidney transplant, barely 5,000 kidney transplants happen every year.”

Under Indian law, unrelated persons can only donate kidneys for transplantations after receiving government approval to ensure that no money was exchanged. This process is known to be arduous and lengthy and is hence, not the most popular among Indians. Doctors say that it had become commonplace for affluent Indians to fly down to Singapore to get a kidney transplant from a “legally unrelated” donor. That’s cause the city-state allows such transplants between unrelated parties. Sri Lanka was another such transplant destination, but earlier this year, the government suspended kidney transplants for foreigners.

The Tip of The Iceberg

Transplantation tourism is one concern, but the bigger problem seems to be brewing closer back home. Recent events suggest that the kidney scam transcends state boundaries and that the Hiranandani Hospital case might just be the tip of the iceberg. A couple of weeks ago, the alleged kingpin of the kidney racket Santosh Raut was arrested in Delhi, but according to a report in The Indian Express, he escaped from custody while being escorted back to Anand from Delhi. Raut was convicted for a 2008 kidney racket in Mumbai and was allegedly involved in over 1,500 kidney surgeries, some of which continued through his agents, while he was still on bail, the report says.

Bombay Hospital was rocked by a kidney transplant scandal in 2004 when leading nephrologist Dr Trivedi was arrested.

After the Apollo Hospital kidney scam erupted in Delhi, the government set up a probe panel to investigate the matter. The Maharashtra government also responded promptly and decided to soon lay down a set of Standard Operating Procedures to help identify both organ donors and recipients who would be linked via Aadhaar cards. State Health Minister Deepak Sawant told PTI, “After the Hiranandani (Hospital) racket was busted, I had a meeting with the Chief Minister in which it was decided to finalise SOPs on a priority basis. This will help authorise both donors and recipients.” Certain discrepancies in the law will be addressed once the SOPs are finalised, he added.

Sawant said that in the future, both donors and recipients will be shown an informative video explaining the implications, complications and hazards of kidney transplants. He added, “The whole process will be video recorded and later a declaration form will have to be filled by both, saying that they understand and agree to a kidney transplant.”

Kidneys For Sale

It’s uncanny how the news of the Hiranandani Hospital scam, the Apollo Hospital scam and Sanjay Raut’s arrest, came just days before August 13 – World Organ Donation Day. If there was ever a sign that India’s ailing organ donation system needed to be cured, then this has to be it.

BloombergQuint reached out to Apollo Hospitals Delhi and Hiranandani Hospital on email but neither responded to our queries.