快猫短视频

INDIA has a flourishing, and illegal, trade in human organs. And the legislation designed to prevent it is failing. That is because no one feels they benefit from the laws that govern organ transplants, be they people requiring a new kidney, donors who sell theirs for cash, or even the hospitals and policy makers who should regulate the practice.

That鈥檚 the conclusion of the first investigation into why India鈥檚 1994 Transplantation of Human Organs Act, which banned commercial transplants, is not working. It says the law could be tightened up to remove ambiguities and loopholes. Or the government might wish to take the pragmatic approach and legalise the trade once more, and control it.

The act as it stands permits donations from a dead person, a living close relative, including a spouse, or a living unrelated donor who wishes to donate 鈥渂y reason of affection or attachment to the recipient鈥�. Donations in this third category have to be approved by a local authorising committee, which is supposed to ensure that the organ is not bought or sold.

But that hasn鈥檛 stopped an illegal trade in organs from flourishing. Estimating its scale is difficult, but around 1800 people donated organs to unrelated recipients over the past two years in the state of Tamil Nadu alone, according to the investigation by Stephen Jan of the George Institute for International Health in Sydney, Australia, and Vangal Muraleedharan and Ram Prasad at the Indian Institute of Technology in Madras. Almost all the organs were probably donated for money.

The team interviewed donors, recipients, representatives of hospitals, transplant surgeons and others involved. The unrelated donors were generally open about receiving money for their kidneys, the team reports in a paper accepted by the journal Health Economics, Policy and Law.

They found numerous cases of female donors pretending to be recipients鈥� spouses in return for cash, and other paid donors who faked an 鈥渁ttachment鈥� to the patient. Middlemen seem to drive the trade, operating apparently freely in hospitals, which also receive money for the transplants. The hospitals were also allowed to tissue-type potential donors and recipients themselves.

Yet the trade is bad news for the health of both donors and recipients. Though donors in Tamil Nadu receive on average $1070 for a kidney, more than twice the average annual income, 86 per cent of one group in another survey said that their health had subsequently deteriorated. This meant that they couldn鈥檛 earn as much money at work and so ended up poorer than before.

Also, more people die after receiving organs from living, unrelated donors, than from relatives. That suggests tissue matching is often poorly done, and the hospitals鈥� commercial interests might also be driving the boom in the trade, says Jan.

Even policy makers tacitly support the sale of organs. One former member of an authorising committee told the researchers that he did not feel he should stop a patient in a life-or-death situation receiving a kidney from an unrelated donor, even if the donor was being paid. Other policy makers shared this view, the team reports.

Changes to the law could help, they say. Making it mandatory for a third party to do tissue-typing rather than the hospital carrying out the transplant would at least avoid a possible conflict of interest. The provision for donations on the basis of 鈥渁ffection or attachment鈥� could also be removed.

鈥淏ut as they exist, the regulations don鈥檛 seem to be workable, and the regulators are facing an uphill battle to keep a lid on any sort of trade,鈥� says Jan. 鈥淚f you take that objective, and recognise that the trade will occur even if we don鈥檛 like it, what we should be doing as regulators is trying to protect the donors as well as the recipients.鈥�

And that could mean legalising the trade, with the government acting as the go-between, giving set payments for organs and enforcing third-party tissue testing, the team suggests.