Global Nephrology: The Indian Inconvenient Marriage

Despite the best of intentions, governments in many low-to-middle income countries still cannot control the illegal sale of organs. The main reason is that there is a strong financial incentive for donating a kidney to a wealthy recipient. It seems that the system works as long as all of the components in the supply chain do what they need to do. It falls apart even when one link in the chain breaks. 

Take the example of the recent scandal in Bangalore India: a donor is identified in a village, he or she is made to say the right things about why they are donating - "because of affection to the recipient" to the transplant committee who in turn provide lax oversight. The surgeon performs the donor nephrectomy, the recipient surgeon transplants the kidney, and the nephrologist manages the post-transplant care. Everyone gains and everyone takes a cut of the money. Until it all goes wrong. Then the media coverage is intense and everyone claims to know nothing about it. 

The bottom-line is that aside from the unethical aspects of these inconvenient marriages, the pitiful part of all of this is the inequity it creates. Rich people buy kidneys from poor people taking advantage of their economic status. Only rich recipients benefit. In India and other developing countries where deceased donor transplantation is still a fledgling enterprise, poor people who have no living related donor available and who can't afford dialysis die because they can't afford to pay someone for a kidney.