~ Allegations over sale of kidney raises serious concerns about organ transplant
The verbal “agreement” was simple. “Give us a kidney and we’ll give you a million rupees, was the ‘agreement’,” alleges Anoma* from a southern town, who nearly two years after the donation has filed a complaint of wanchawa (cheating), in what is believed to be an unprecedented incident in the country.
“Not only did they promise me that amount but also assured me that they would buy me a few juki machines to start my own sewing business,” she claims in a complaint made to the police of the southern town, who in turn have forwarded it to the Special Crime Investigation Bureau (SCIB) of the Mount Lavinia Police, as the couple against whom the complaint had been made had lived in this area. Although in Anoma’s mind it is an open-and-shut issue, this “simple verbal agreement” brings out crucial aspects with regard to organ donation that the authorities need to address immediately.
|‘Anoma’ at home
Anoma’s story begins in 2005. Widowed in 1993, she had the task of bringing up two teenage children. She worked at a rubber factory near her home, but it did not bring in a regular income.
One day, in 2005, she caught a bus to Colombo and got off at Mount Lavinia, asked trishaw drivers whether they knew of any homes needing domestic help and was directed to one and got hired immediately.
Her job was to cook for an elderly couple, clean house and see to the domestic chores. “I was promised Rs. 5,000,” she told The Sunday Times when we met her in her humble home. However, a few days into her new job, the couple came up with a suggestion, which according to her, was irresistible.
It was the big break she had been looking for to snap the trap of poverty she and her children were caught in, says 42-year-old Anoma.
The conditions were simple – the couple requested her earnestly to donate a kidney, as the “lady of the house” was very ill and in return they would remunerate her handsomely. “Laksha dahayak mage pothe danawa kivva,” says Anoma, explaining that they promised to give her Rs. 10 lakhs in addition to buying her the juki machines.
The urine and other tests were done quickly in Colombo, all in private hospitals, the tissues matched and the kidney transplant performed on October 15, 2005 in a private hospital in an outstation town.
Adding a different dimension is the fact that the name on the bedhead ticket is alleged to be different to that of Anoma.
Anoma is claiming that the couple who requested the donation allegedly forged an identity card for her but did not let her keep it in her possession, while the other side is claiming that Anoma herself came with an identity card that was in the bogus name, says Sub-inspector Pannilage Siripala of the SCIB who is conducting investigations into the complaint of cheating. The National ID Card bearing the bogus name, meanwhile, is missing.
Soon after the transplant, Rs. 340,000 was put into her savings book, according to Anoma, of which now not a cent is left. Many were the times she went to their home, requesting the alleged balance money.
When The Sunday Times contacted the donee’s family, they declined to comment.
After the many futile visits, Anoma says, relatives directed her to the Rural Women’s Front in her area, who advised her to make a complaint to the police.
That was how the file ended up on SI Siripala’s desk. The “lady of the house” who received the kidney had died three months after the operation, discloses SI Siripala.
SI Siripala in attempts to establish the authenticity of the claim that Anoma did in fact donate a kidney has advised her that she should be ready to be produced before the Judicial Medical Officer of the Kalubowila Hospital, which suggestion has been rejected by her.
There are many issues the SCIB is endeavouring to unravel. Can a value be placed on an organ such as a kidney? In the absence of a written agreement between the two parties, how can one establish the veracity of claims made by both parties?
SI Siripala is putting together a file to send to the Attorney General’s Department for advice.
With more and more appeals in the newspapers from desperate relatives seeking organs, particularly kidneys, for their loved ones, important factors that come up are whether the Transplantation of Human Tissues Act No. 48 of 1987 needs to be amended to suit present times. While the Act stipulates the need for consent in writing from the donor and also prohibits the sale of organs, with more transplantations taking place both in state and private hospitals, who ensures its implementation?
“I think there is an Authorization Committee to screen donors to ensure that no illegal activities take place,” said a senior doctor, while another doctor said this was suggested to the Health Ministry but was not implemented.
However, The Sunday Times learns that there is an unwritten understanding that organ donations should strictly be between relatives, while this has been slightly expanded to cover those who are willing to donate an organ due to an “altruistic motive” as in the cases of monks and priests, to cut out exploitation or commercialization. This throws light on the alleged ID forgery, which may have been done to establish a relationship.
Dubbing these as ethical issues, Dr. Chula Herath, Consultant Nephrologist of the Sri Jayewardenepura Hospital says before they perform a transplantation, they request production of documentary proof such as birth certificates and marriage certificates to ascertain whether the donor and donee are related. “This is to prevent money changing hands because the sale of organs is illegal in Sri Lanka,” he says.
When asked whether it was ethical to sell organs, another consultant explained that in many countries, the sale of human organs is illegal. But there is provision for those receiving a donation of an organ to pay for such things as loss of employment during confinement to bed, for travel connected with such donation and also for nutrition during the period of donation. It is understood, of course, that all medical expenses would be met by the person getting the donation.
Meanwhile, as in the case of more demand and less supply, organ transplantations, while giving life and hope to many, also create a minefield about which the authorities need to be aware and take action immediately. “This would be in the interest of both the donor and the donee,” another doctor said.
The biggest danger, The Sunday Times understands, is commercialization with its gamut of middlemen which in turn could lead to organ sale rackets. Reports indicate that India is already grappling with such issues.
Is the consent for an organ donation taken without financial inducement? How will the medical team carrying out the transplantation ensure that no money and big money at that changes hands? Should not a regulatory mechanism be put in place soon to keep a close eye on all human organ transplantations?
These are the glaring issues that come out in this unprecedented complaint, indicating the urgent need for pre-emptive action by the authorities.
In the public interest, not only to protect the person who receives the organ but also the person who gives an organ, the authorities should act right now, not in a month, a year or a few years, like the country usually sees with the lumbering bureaucracy.
(“Name has been changed to protect identity)
Amend Transplantation Act
We proposed certain crucial amendments to the Transplantation of Human Tissues Act in 2001, but they never saw the light of day, says Dr. A.M.L. Beligaswatte, who was the then Director-General of Health Services, with regret.
Among the amendments recommended was the opening up of potential donors from relatives to anyone unrelated, but with strict screening by an independent National Committee, he told The Sunday Times.
With the demand, especially for kidneys, seeing a drastic rise, there was a need to widen the donor category. Many of us at that time including active names in the field of kidney transplantations proposed this amendment, as it is difficult for kidney patients to find relatives who would donate a kidney.
“We proposed the setting up of a National Committee comprising medical and non-medical persons, without any vested interests in transplantations, to screen each and every donor to ensure that no financial transaction has taken place for the kidney,” he explained.
Currently, monks and priests are also allowed to donate kidneys as a form of dana in addition to relatives.
Urging that amendments are essential to the Act, Dr. Beligaswatte also said the harvesting of organs from cadavers should also be expanded, but once again under strict guidelines.
Voicing serious reservations about a committee screening potential donors, Dr. A.L.M. Nazar, Consultant Nephrologist of the National Hospital in Colombo, queried about "undue influence" on such members.
Pointing out that there were recent moves by a private hospital in Colombo which carries out kidney transplantations to set up such a consultative committee, Dr. Nazar cited the example of India where such committee members had given into undue influence coming in different forms.
"I think, we at the NHSL, have very strict screening of donors to prevent corruption and money transactions," he added.
Meanwhile, the Kidney Transplant Support Foundation is attempting to set up a database for doners and donees all over the country, to ensure that everyone is on a list and the most urgent transplantation is done first. “This will also cut out the need for relatives to go on a frantic search on their own for a donor,” says Ajith Perera of the KTSF.