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There has been much anguished discussion of late about the
“kidney sale racket” with the media “exposing” a three-fold
tragedy: “rapacious agents exploiting ignorant donors” with
doctors and the government turning a blind eye to the problem.
The present evolution is the active and illegal participation of
doctors in this racket.
Donors
I would like to raise a question about the “ignorance” of the
donors. Usually, donors know well what is happening in their
neighbourhood. Many of the other donors are personally known to
them and are often introduced by them to the agents.
We live in an information age where people gain instant access
to information ranging from current news to health issues to
crime trends. The penetration of television is likely to surpass
that of the radio and is certainly much higher than that of the
print media. The visual media thrives on controversy and
sensational news. The issue of kidney donation for money has
surfaced on numerous occasions over the years and has duly been
highlighted by all sections of the media, especially television.
Despite claims to the contrary, it is
difficult to accept the claim that the donors are truly ignorant
of what they are in for and what it entails. Many donors are
literate and live in or near urban centres. Few can claim the
disadvantages of illiteracy as well as ignorance of current
affairs.
Thus it is far from accurate to say that the
whole thing is one-sided, with marauding agents and colluding
doctors set against and the “poor and ignorant” donors, with the
government mostly indifferent.
There are negotiations over the price, cash
advances are made, the donors get admitted, usually to major
hospitals, and clearly know that they are going to be operated
upon to part with a vital organ of their body.
The Authorization Committee personally
interviews each donor and ascertains their willingness to donate
their kidney. The procedures involve the health implication in
future and the risks of the operation, both immediate and
long-term, and they are all explained to the prospective donor.
Everything is recorded and the donation authorised only if the
committee is satisfied that the donation is voluntary. (I can
hear strong voices that donation for money cannot be voluntary!
I shall come to that later).
The donors go through elaborate tests and
finally get hospitalised for weeks for the procedure. They are
routinely accompanied by a family member or relative. The whole
process takes several weeks if not a month or more. During all
this time, much informal but authentic information is easily
available to them from health workers and other patients.
Informed consent is obtained from the donors
for the operation. This is usually better done than for the
majority of surgical operations and other medical procedures.
The medical care for the donor during the process is also
usually very good, at least for the benefit and protection of
the donee and the reputation of the hospital and doctors
involved, if for nothing else.
In sum, the description of donors as
“ignorant” does not carry much substance.
Being paid for the donation
The next and certainly the more controversial
question is the role of money in the donation.
It is somehow generally considered that
getting something vital from a person by payment of money is
unethical, immoral and, often, illegal.
Since the law is changeable and usually
reflects the prevailing values and norms of a society, we shall
here confine our attention to the ethical and moral aspects.
It should first are foremost be clear that
putting one’s life and limb at risk for money or other valuable
consideration has been continuing since ancient times and, if
any, is more prevalent now.
Consider the example of adventure sports.
Examples include mountain climbing, skiing, rock climbing,
rappelling, ice hockey, Artic and Antarctic sledgeing, auto
racing and white water rafting. Many of these activities are
pushed to the limits by persons sponsored or paid to do so (the
two often start merging at extreme stages), and fatalities are
not uncommon. No one raises any issue about the commercialism
and the risks taken by the participants involved in these. In
fact, the activities often receive national, if not global
coverage and the persons become celebrities, at least till
someone overtakes them.
The next example will include persons in
security services such as the police, firemen, forest guards,
airline flight workers, security guards and personal guards for
VIPs. The last mentioned carry especially high risks of injury
or death. Are all these persons doing their jobs “only
voluntarily” and “purely out of love and affection”?
Can it be said that policemen and firemen
stay in their jobs not for their livelihood but purely out of a
wish to serve society, whatever the personal cost to them and
their families? Will not many of them choose an easier and
remunerative job if only it were available?
Does anyone even consider how they stake
their lives for an income? Even more, does anyone object? Very
few of these are likely to be insured for their risks of injury
and death. It is more probable that insurance companies, being
more realistic than romantic, either refuse insurance or add
additional premium for these workers to cover their risks! This
is especially true for hazardous sports which are usually
included only in the exclusion criteria! In fact, especially
abroad, the event is likely to be better covered by insurance
than its participants!
And lastly, what about our armed forces? Are
all, even most of their members, purely in it for patriotism
alone? No one objects that they have to defend our country on a
salary basis. In fact, it is encouraged. Since, of late, fewer
people come to join them, salary and other benefits are being
enhanced and highlighted to attract more and better persons to
the armed forces. Can it be said that they are not exploited for
our safety?
Somehow, society takes a “high moral stand”,
verily hypocritical, when it comes to transaction of money in
donation of body parts. But it expects paid health and
sanitation workers to accept hazardous work dealing with
dangerous diseases and medical waste material.
Will society tell the dogcatcher, “Do your
job only if you are voluntarily willing to risk rabies and not
for the sake of your salary, rather, even without salary”?
Will our VVIPs advise their guards to protect
them only “out of love and affection”, with no payments
involved?
Will we accept leaving our banks and borders
unprotected because it involves risk of life to those to guard
it as a means of livelihood?
Then why alone should donation of body parts
and fluids, that too, dispensable, for payment be condemned?
In fact, the risks faced by donors of kidney,
blood, bone marrow, semen, egg, etc., are far less than what is
borne by those mentioned above. They often receive better health
care, too, at least during the process. Monetary compensation
does not change this. Altruistic satisfaction, if any, is an
additional benefit.
Question of human rights
The last but not the least question is of
human rights. It is a major accusation that commercial kidney
donation is against human rights. Whose human rights? What about
the right of the donor to do what he wishes with his body or
life? Also, what about the patients with terminal kidney
failure? Are they condemned to die a lingering and miserable
death because they have no one to “voluntarily” donate kidneys
for them and because “buying” a kidney is prohibited by a
“humane” society?
How does society decide that it is
praiseworthy to risk one’s life for money in some instances but
not in others? When some are allowed, even encouraged, to put
their life at risk for money, among other considerations, why
not kidney donors?
What right does society have to decide what a
person does to his or her life? In fact, even suicide is viewed
as more of a personal and social issue than criminal.
This is like the meat eaters in the West
condemning Asians who eat horse, dog and cat meat, just because
the former love these animals, often spending more on them than
they would on fellow human beings, and cannot imagine them as
food.
Not dishonourable
Finally, comparisons may be odious, but is
selling a kidney more dishonourable or exploitative than is
prostitution? The world’s oldest profession has even been
legalised in many Western countries! In our own country, while
the law remains in the statute books, the enforcement agencies
mostly turn a blind eye to it, except for booking cases for
statistics or for collecting mamool.
Social workers and agencies like National
AIDS Control Organisation openly recognise “sex work”, as it is
now called, as a legitimate profession and work for their health
protection, often without going too much into issues of
exploitation and bondage.
The focus of both government and voluntary
agencies is now more on preventing the health hazards to sex
workers and their clients, and less on how to end prostitution
or the associated commercial exploitation. Cannot society, which
condones and even indirectly encourages sex workers, similarly
allow and protect kidney sellers?
Finally, it is one thing to condemn
exploitation, cheating and inadequate health care for kidney
donors, it is quite another to condemn those who are involved in
it for commercial motives. Can the Armed Forces Recruitment
Board, whose situation is not very different, be accused thus?
Cannot one perform a life-saving act for payment?
It will be more sensible, honest, not
hypocritical but fair to all concerned to make the entire
process transparent, improve health education so that the donors
are not exploited but know full well what they are doing, ensure
they are well cared-for, and adequately recompensed.
Dr T R Suresh
Send in your comments to:
Email:
sureshtr57@yahoo.co.uk
Website:
www.drssureshprabalkumari.com
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