This is the third part of a series on organ donation. Click to read the first and second parts.

The police often say that organ trafficking is difficult to track because even the victims refuse to lodge a complaint. The claim falls flat when we consider years-old cases that have gone cold for a variety of reasons.

A 23-year-old man from Moovattupuzha met with an accident in Kothamangalam in December 2009. Admitted to a private hospital in Kochi, he was eventually pronounced brain-dead. The police surgeon who conducted post-mortem on the body was shocked. The liver and kidneys had been surgically removed. The police registered a suo motu case even though no one lodged a complaint. The probe went nowhere though. The district medical board exonerated the doctors.

The police decided to reopen the case in 2016. A doctor, who was a member of the medical board at the time of the incident, testified that his sign was forged in the report. He had not even taken part in the meeting. The investigation from the police crime branch has been pending before the state medical board.

Two remote villages near Thodupuzha were visited by organ traffickers 19 years ago. Poomala and Methotti villages in the Velliyamattam panchayat had many people who struggled to make both ends meet. They were offered lakhs of rupees in exchange of their kidneys. Eight villagers, desperate for money, travelled to Kozhikode to sell their kidneys.

Once the villagers signed the consent papers, the agent showed his true colours. He said that the recipients of the kidneys were in a financial crisis and they could only give Rs 50,000. The villagers backtracked but they were threatened by the agent. They were warned with a huge fine and rigorous imprisonment for asking money for kidneys and false representation before the authorisation committee. The villagers had no other option but to budge.

One of them later filed a complaint before the medical education director. Another complaint spurred a magistrate in Kozhikode to direct the Nadakkav police to launch an investigation. There was no headway in the case. The probe was handed over to the crime branch in 2012. Shockingly, the police made the complainant an accused along with the agent, for selling the kidney. The court rejected the chargesheet and the crime branch is preparing another one.

The crime branch has failed to identify the accused in many cases of organ trafficking. A report submitted by crime branch inspector general S Sreejith to the state police chief says most of the cases involved kidney harvesting. The accused could not be identified even though the report pointed to the involvement of government officials.

An FIR registered by the crime branch on October 22 reads: “A group of unknown people conspired to illegal organ transplants in the past two years. Most of them were kidney transplants.” Who are these unknown people? That’s the million dollar question.

Elusive reforms

The Kerala government received a report in 2018, recommending the formation of a state-level authority to monitor and encourage organ donation. The report, prepared by Dr Luke Noel, in consultation with doctors working in the public and private hospitals where organ transplants are done, has not been acted upon yet even though the government itself had commissioned the study.

The only recommendation to be implemented was to clarify a 2017 government order laying out the guidelines for confirming brain death. There were more recommendations, including the setting up of a Kerala Organ-Tissue Donation and Transplantation Authority, the preparation of a register of patients in need of organs and possible organ donors, coordination between government and private hospitals, public funding of organ transplant and the introduction of organ transplant in school curriculum.

The formation of a society to monitor organ donations and transplants in the state would also mean that the authority would be in charge of granting recognition to hospitals to conduct organ transplants, monitoring the expenses of the surgeries and ensuring the well-being of the donors.

Even if a patient has relatives willing to donate organs, their organs may not be a match for the patient. In such cases, anyone in the proposed registry could donate organs. The existing Kerala Network of Organ Sharing (Mritasanjeevani) will be merged into the new society.

These reforms could lead to a situation in which organ donations are more transparent and devoid of unscrupulous agents.

Kerala’s kidney racket was centered on Idukki, Thrissur and Kozhikode two decades ago. Most of the organ stealing cases in the past two years were reported from Thrissur, according to a crime branch report. Kochi has also emerged as a hub of organ traffic. Residents of some of the colonies in west Kochi have been found to have donated kidneys in some of the city hospitals. These colonies are frequented by agents offering money to the indebted poor. People who have lost their jobs due to the COVID-19 pandemic are specifically targeted. The shocking revelation about six women from the Santhome Colony in Mundamveli selling their kidneys in the past five months led the district collector to order a police investigation. The police, however, are yet to act on the direction.

A woman from Kasipalayam in Tamil Nadu’s Erode district lodged a complaint before the district administration three years ago. She said her husband had been taken to Kerala to harvest his kidney. The police were just in time to save the man from a private hospital in Kochi. He was about to lose his kidney. He was offered Rs 5 lakh for a kidney. He was one of the four men from Tamil Nadu taken to Kerala to harvest a kidney on the same day. The police dropped the case after the complaints were withdrawn. This was just one instance of the working of a racket that operated in Erode, Salem, Namakkal and Tiruppur in Tamil Nadu.

Two years ago, two men from Meenakshipuram in Palakkad died in a road accident in Salem. Their organs were surgically removed at the hospital they were taken to. The hospital had offered to write off the treatment bill in exchange for the organs. The case is pending before a court in Salem.

Only a tenth of the total organ transplants in Kerala are held in government hospitals. The Government Medical College Hospital in Thiruvananthapuram, the only government hospital to have a licence to conduct liver transplant surgeries, has conducted only one such surgery in the last five years. The hospital has a liver transplant unit which cost Rs 12 crore. At the same time, many people suffer without the funds to go to a private hospital.

There is another side to the story, as highlighted by former health department officer, Dr V K Subhadra, in a letter she wrote a few days ahead of her death. Her application for permission to receive a transplanted liver had just been rejected by the ethics committee of the government. She had identified a donor because none of the relatives had a matching organ.

"I know well the rigours of the legal system. If you do not approve of this donor, I will have to look for another one. The same problems will be presented even then. I agreed to this transplant only after being satisfied about the motives and the honesty of the donor. I cannot wait for the liver of a person who died in an accident. It will be cruel to wish for such an occasion," she wrote in the letter.

She was a member of the committee formed by the government to enquire about the organ traffic in the Malabar area.

Creating awareness about organ donation is a major part of the strategy. Very few people agree to donate the organs of their relatives who had been declared brain-dead. Between 38,000 and 42,000 road accidents are reported in Kerala every year, the traffic police reported. They result in 3,800-4,400 deaths. If organs can be harvested from all the patients who are pronounced brain-dead, it will save a lot of lives.

In 2016, as many as 76 accident victims’ relatives agreed to donate the organs. That year, 4,196 people died in accidents across Kerala. In 2019, consent was given for organ harvesting in only 19 of the 4,400 cases of accidental deaths. This year, up to September, relatives of 18 accident victims have agreed to donate organs.

(Reporting by Jayan Menon, Santhosh John Thooval, A S Ullas, S V Rajesh and Vinod Gopi; Complied by Jaison Parakkatt)