The arrest of Amit Kumar, and the revelations that followed of the buying and selling of kidneys in Gurgaon, blew away the fig leaf of respectability on this sordid practice. The Human Organs Transplant Act 1994 had provided a loophole for sale of organs by allowing a person not related to the donor, to give an organ on the basis of love and affection. The only difference between what Amit Kumar did and what is happening in many states under cover of the “authorization committees” for organ transplant is that Amit Kumar did not bother to fake the documents that make it possible for a person with money to buy the kidney of a person desperate enough to sell.

The background

Technological advances in medicine have made it possible to transplant a number of organs from one human being to another. This is done when the organ is damaged beyond repair. The usual source of such organs worldwide, are people who are brain dead. This means that the person’s brain has suffered irreversible damage. The heart continues to function normally. Such persons can only be maintained alive on ventilators, machines which breathe for them. Usually, heart activity will stop within a few days.

The presence of two kidneys, and the fact that only one is required to maintain life, has made it possible to take a kidney from a living donor. It is also possible to remove part of the liver from a living donor. All other organs can only be taken from the brain dead.

It must be remembered that organ transplant does not end with the transfer of the organ. The recipient requires medicines life long to prevent the organ from being rejected. These medicines are very expensive. In the absence of a government programme to provide these medicines, organ transplantation can be an option only for the well-off, not merely because of the capital cost of the procedure, but because of the recurrent cost of the immuno-suppresive medicines.

The situation in India

End-stage kidney failure is quite common in India. The exact figures for this condition are not available, as the government of India, in spite of an enviable statistical apparatus, has never bothered to collect data on the prevalence of various diseases. In the 1970’s, dialysis (using an artificial kidney), and then transplant, was started in a small way in some government hospitals. Certain kinds of kidney failure require dialysis only for a limited time till the kidney regains its function. By and large the government hospitals began to restrict themselves to these conditions, because dialysis time was limited. People with chronic kidney failure were certain to die. Growing technological sophistication in the private sector medical care made it possible for the small section of people with money to access the option of dialysis and organ transplant there.

Unlike certain developed countries, there is very little planning on the deployment of new technologies in medicine in India, and these are usually done in an ad hoc manner. The same was true of kidney transplant. Live donation started off within families, and only in a very few centres. It was not long before “medical entrepreneurs” saw an opportunity, and so began the sordid saga of extracting organs from the poor.

Ethics and social sanction in the age of neoliberalism

The advocates of the market as the solution to all human dilemmas and arbiter of humankind’s fate proclaim that there is nothing wrong with selling kidneys. They say that it is a “win-win” situation. The buyer needs the organ, and the seller needs the cash. The only ethical problem, if any, is the middleman. Therefore, their spokespersons shout from every platform that what is needed is to make it legal to trade organs! Such a position is simply anathema as it reduces the human being to the sum of his parts. Old slavery sold the human being whole. Twenty-first century slavery seeks to sell him piece-meal.

But let us examine this argument on the terms of the neoliberal discourse.

Scientifically, the repeated assertion that one kidney is enough, hides a basic truth. It is enough if one is very healthy. It is very clear who the sellers are – they are very poor people for whom this is a last resort. Therefore their health status is not likely to be of optimum standard. The morbidity among the sellers is likely to be much higher than the population as a whole, and certainly their general health condition is likely to be far worse than that of the social class to which the buyers belong. Having a kidney removed is likely to have far more serious effects on them. It is curious also, that all those who advocate selling are quite unwilling to give one of their own kidneys!

Markets are always subject to distortions. What shall be a fair price for an organ? Will the law prevent the unscrupulous from forcibly removing organs as Amit Kumar’s team in Gurgaon and Dr. Palani Ravichandran’s team in Chennai has done? Obviously, the proponents of selling only wish to remove the existing impediments for the buyer. They have no concern at all for the seller, who are poor and therefore “non-people.”

Medical Care in India – Chaos of the Market

In a caring society, one expects the optimum allocation of resources. In medical care this would mean a careful mapping of the disease profile in India, and deployment of resources in a way to prevent preventable diseases and manage the others. Nothing of the sort exists. There is a clear dichotomy between the public and private sectors. The public sectors provide the barest minimum of services that will prevent an uprising among the people. In teaching hospitals, some cutting edge technology is available, more as the personal effort of individual doctors, some of whom are concerned to provide all that is possible, and others, with less noble motives, who wish to learn the technology on the uncomplaining poor before moving on to the private sector.

The private sector provides everything that is profitable. Thus diseases of the poor in which little profit can be expected are completely ignored. On the other hand, there is competition for the high profit interventions, such that procedures will be done not for the patient’s benefit but purely for his money. The neoliberalists are not happy with this and complain bitterly, but such is the logic of their market! Profit isn’t everything, it’s the only thing! Why complain that your omnipotent god, the market, is unfair?

Health care as a political imperative

It is quite striking that in spite of a very poor health infrastructure, health is not an important part of the political programme of any of the bourgeois parties. Since 1992, after the World Bank issued its document “Investing in Health” and suggested what the priorities for the Indian government should be, we have seen a focus on specific diseases like polio, without any attempt to develop the overall health infrastructure. These focused programmes are a great favourite of bourgeois governments because they give the illusion of much activity without any need to address the socio-economic determinants of illness. They may reduce the mortality and morbidity from a specific disease, but will make no impact on the overall health situation as the focus illnesses will be replaced by other illnesses. Illness is a part of the social situation, and an organization of society into classes, invariably carries with it diseases of classes.

The neoliberal apologists put forth the specious argument that there will never be enough money for all that science has made possible. Our argument is, let the people decide what the priorities are, and let this be available to all. This is the only position possible for a civilized human society. From each according to his ability, to each according to his need.