The National Capital Region is the epicentre of a well-organised illegal organ trade. The Hindu reports on the web of criminals and their modus operandi

Months after the monsoon hit the small town of Saket Nagar in Kanpur last year, Sangeeta Kashyap*, 33, packed her bags for Delhi where she had been promised a good job. She was excited; she had never stepped out of Kanpur before.

“My husband’s friend had promised us ₹40 lakh. We dreamt of a ‘pakka’ house, a good education for our children, and even some savings to help us through illnesses. We also planned for old age,” says Sangeeta. On reaching the city that promised to fulfil her dreams, Sangeeta was given accommodation in a guest house in Ghaziabad. “The next day I was taken to a small clinic,” she says, unable to recall the location. “There, the doctors ran a series of tests on me. My husband’s friend told me that this was important because my employer wanted me to submit a medical clearance certificate before employing me as a maid and a cook. But then he took my Aadhaar card and told me that I have to assume a Muslim name and identity. I refused. I realised that something was amiss. Later during the week, when I was taken to a hospital, I overheard people describe me as a kidney donor. I panicked and raised a hue and cry at the hospital. I insisted that I be sent back home immediately. They packed me off to Kanpur and I thought the worst was over,” she recalls. But the nightmare had only begun.

“My husband’s friend came home and tried to convince me to sell my kidney,” says Sangeeta. “He told me that he has been living a good life after selling his. When I refused, he along with some other men threatened and assaulted me. They demanded that I pay them ₹50,000 as part of my travel and medical expenses. Frightened and broke, I approached the police. A senior officer asked me to file a complaint. An FIR was registered on February 1 against six persons in the Barra Police Station in Kanpur under Section 420 [cheating and dishonestly inducing delivery of property] of the Indian Penal Code and sections of the Human Organ Transplant Act.” Sangeeta was unaware that her complaint would blow the lid off a massive organ racket.

High demand, low supply

The epicentre of this massive illegal organ trade is the National Capital Region. The web of criminals includes police personnel, doctors, hospital administration staff, medical support staff, and kidney and liver donors — all catering to patients with end-stage kidney and liver failure. These patients can’t be treated with medicines or dialysis and therefore require a transplant.

A dozen leading private surgeons are under the scanner now. These include top urologists in Delhi who allegedly worked in nexus with some police personnel from the Uttar Pradesh Police as well as brokers (some of whom were previous donors themselves) to ensure a smoothly running profitable trade, the value of which some people peg at over a ₹100 crore.

So far, 15 people, including the CEO of Pushpawati Singhania Research Institute (PSRI), Deepak Shukla, have been arrested, and notices have been served to two leading doctors at Fortis Hospital in Delhi for violation of the Transplantation of Human Organs (and Tissue) Act, 1994. This legislation was brought in with the objective of “regulating the removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.”

These arrests and notices could prove to be only the tip of the iceberg. “Investigations against another leading hospital in central Delhi are currently under way and more arrests are likely,” says a senior Delhi police officer who is investigating the case.

“The industry is thriving despite several raids and laws against it because those who sell their organs are desperate for money. It is a trade that guarantees high profit. Plus, it’s easy to do business in India,” says a senior Health Ministry official who did not wish to come on record.

Impoverished donors are pushed into the trade as organ donations from cadavers and brain-dead patients in India are not enough to meet the requirement of over a lakh citizens annually who require a kidney transplant.

In 2016, in its reply to a Lok Sabha question, the Union Health Ministry noted that there is a huge gap between the demand and supply of human organs for transplant even though the precise numbers of premature deaths due to heart, liver, lung and pancreas failures have not been compiled. The Ministry noted that against the demand of 2 lakh kidneys, only 6,000 were available. Similarly, against the demand of 30,000 livers only 1,500 were available, and against the demand of 50,000 hearts merely 15 were available across the country. According to the Multi Organ Harvesting Aid Network Foundation (Mohan Foundation), a Chennai-based NGO working on organ donation, only about 3% of the demand is met.

The Indian Transplant Registry notes that live transplants account for the majority of kidney transplants in India; cadaver transplants account for a very small number. “In India, [the] deceased organ donation programme is largely restricted to big institutions and the private sector which makes it less accessible for all. The deceased donation rate in 2013 was 0.26/million population and this went up to 0.36/million population in 2014,” it says.

Modus operandi

In the case that the police is investigating at the moment, patients who needed transplants were admitted in large and well-known private hospitals that are protected by a battery of lawyers and administrators, says a senior Delhi police official.

“Donors, all of whom are from very poor families, are brought to these hospitals for initial testing and matching with patients,” explains Lucknow-based Vardhan, a prime witness in the case. “We are then trained to face the interview board of the competent authority [which evaluates transplant of organs between near relatives related genetically] or the Authorisation Committee [which evaluates transplant of organs between those related emotionally and where the donor’s intentions are altruistic] of the hospital for clearance for donation. Then we are housed in guest houses in Delhi. There we are tutored to tell the hospital board that we are relatives of the patients we are donating organs to. At this point, the payment too is partially made.”

Like Sangeeta, Vardhan’s story began around August last year. He desperately needed money to pay for the operation of his two-and-a-half-year-old child who was born with a hole in the heart. He decided to sell one of his kidneys.

“An old friend told me about this offer. He made it out to be a noble deed. He said I would get ₹2 lakh — enough to pay for my child’s surgery and for setting up a small shop for myself. It seemed like a good option. I thought God has given the poor two organs as personal insurance against bad times,” he says. He breaks down while showing large surgery scars on his abdomen.

Following the surgery, Vardhan has one kidney and no child. He is without a job. And to make matters worse, he has been receiving death threats from those in the illegal organ trade.

“Life has become unbearable. The hospital administration’s goons took back the money I got from my kidney sale after I refused to work with the gang. My child died without treatment. And my wife, who I married against the wishes of our parents, left me as she was frightened by the death threats. No one is willing to employ me in Lucknow because they think I am involved in something illegal. I used to repair watches. I have become a nervous wreck following the investigation,” he says.

His only mistake, he says, was his refusal to become a headhunter himself. “They call me daily to tell me that I will be ‘accidentally’ killed in an accident soon. They stole my money after I refused to work with them,” he says.

Attractive to the poor

“While there are many layers of control to prevent exploitation, the fact that there are a negligible number of organ donations makes finding a matching donor for the patients a tough task,” notes the Mohan Foundation. Under the law, only those related to the patient are allowed to donate organs. This further reduces the number of prospective organ donors.

In 2013, the medical journal, Indian Journal of Anesthesia, stated that of the 205 patients declared brain-dead at AIIMS in Delhi in the trauma centre over the last five years, only 10 were potential organ donors. The reasons were varied. There was lack of awareness about organ donation among family members. Many believed that donating a person’s organs after death would affect the person in his or her ‘next life’. And processes were simply not in place to help such donations.

“Indian organs are being sold thanks to advertising by word of mouth. We are dealing with an underground mafia of organ traders. In this case, the gang managed to create fake identities. And with the help of medical persons, they managed to manipulate medical tests and documents,” says a senior official from the Uttar Pradesh police who is involved in inter-State investigation.

“Those in the business had created a large database of those who were ready to donate their kidneys and livers. These people were then recruited into the business to find more sellers. And with every new racket being busted, we also find that the age of the donors/sellers is rapidly falling. Younger men are being recruited or are coming forward to donate their kidney or liver. This is really worrying,” says a Delhi police officer.

A witness in the case, Sonu*, admits that he is only 18-20 years old. “According to my official papers, I am much older though,” he says. “I decided to sell my organ to help my family which was on the verge of starving to death. But today, even after selling my kidney, my life is no better. Policemen and laws don’t understand that we sell our organs just to ensure that we are able to stay alive.”

Sonu and Vardhan were admitted in the same hospital at the same time for kidney removal. Like Vardhan, Sonu too was cheated by middlemen, who only gave him a portion of the promised sum of ₹2 lakh.

“When I close my eyes, I dream of blotches of blood. The cops tell us that they will catch those who exploited us. But will we get our entire promised money or the organs we sold? No one is ready to answer these questions,” he says.

The investigating agencies claim that they are fully aware of the reasons that compel people to sell or donate organs. “A kidney is sold for anything between ₹70 lakh and ₹1 crore depending on how urgent the need is. The donor/seller never gets over ₹3 lakh. The rest of the amount is distributed among those who run the business,” says a senior official officer from the Uttar Pradesh Police.

Expanding the web

It was when a police team from Kanpur approached the Delhi police regarding a kidney racket that they stumbled on T. Rajkumar Rao, 40, alleged to be the kingpin of an international kidney racket.

Rao himself was a donor. But unlike other donors, Rao was ambitious and built his own empire. He had been arrested before and sent to prison. But after being released, he resumed his activities and changed his base from West Bengal and its neighbouring States to central India. He got donors and sellers from Unnao, Kanpur, Lucknow and Fatehpur.

A police officer who once interrogated him recalls Rao as being very sharp and knowing how to influence donors and later make them part of his racket.

“There were around 12 permanent members in the gang. They would prepare fake documents, coordinate with hospitals and donors, transfer money and prepare donors for interviews,” he says.

Rao used to keep a large portion of the money for himself in every deal. The rest was shared among the others, including the donor. “He never paid the promised amount to the donor. And when the donor asked for it, Rao would urge him/her to bring more donors with the promise of more money. Regardless of the deal, the donors get only between ₹2 lakh and ₹4 lakh of the promised ₹5 lakh,” says the officer. Donors who refused to co-operate were threatened with legal cases of cheating.

Suresh Singh* got a kidney transplant in 2016, and was chargesheeted for demanding money for it. “After a prolonged kidney treatment my doctor recommended a kidney transplant. He told me that my kidney would stop functioning soon,” he says. “I discussed it with the personal staff of the doctor and offered to pay for a kidney if I could get a donor. I got a call from the doctor’s secretary, who gave my family members the contact of a man who could arrange a donor for me. After several rounds of negotiations, the deal was fixed at ₹20 lakh.”

Suresh was asked to pay immediately, he says, while the paperwork was taken care of by the ‘staff member’. “I paid the amount before the operation and it went off smoothly. I met the donor only once during the interview. I was introduced as his elder brother to the hospital,” he says. He explains that a major part of the payment was made through cash and rest was transferred to a bank account.

Rajesh Yadav, Superintendent of Police (Crime), Kanpur Police, says that a Special Investigation Team has been formed to investigate the case. “Till now we have arrested 15 people in the case including doctors and middlemen. We are in touch with the Delhi and Faridabad Police to get information regarding the whereabouts of other suspects,” says Yadav.

“To make this a watertight case we have ensured that the donors and recipients are prime witnesses and not the accused. During the investigation, we found that the hospitals and middlemen had prepared a fake profile of donors. The coordinators at PSRI hospital had forged DNA reports to present the donors as blood relatives of the recipient. We are also looking at how the organ transplant clearance committee of hospitals ignored all the facts and never cross-examined donors and recipients,” says a police officer who is part of the SIT team and did not wish to be identified.

A 2003 report in the Indian Journal of Medical Ethics is a chilling postscript to the story. “If the organ trade is not controlled, disappearances, especially among street children [and] kidnapping rackets may flourish along with the theft of organs of executed criminals in future. The people may lose trust in the medical community and may suspect their involvement in the premature declaration of death on seeing a signed donor card.”

*Names have been changed to protect identities