India's Black Market Organ ScandalBy SIMON ROBINSON/NEW DELHI

Shocked but not surprised.
That might be the best way to sum upIndia's reaction to the revelation this week that a black market organtransplant ring had been harvesting kidneys from poor Indian laborers,sometimes against their wishes, and using them in foreigners desperatefor transplants. Police who busted the ring last week say doctors paidas little as $1000 for the kidneys and then sold them for as much as$37,500. The racket, based in Gurgaon, a business center close to thecapital, New Delhi, drew victims from as many as eight Indian statesand lasted for almost a decade. Police say the black market doctorsmay have illegally transplanted as many as 500 kidneys. The ring,according to the police, was run by two Indian brothers, neither ofwhom had any medical training but who oversaw the surgery. One of thebrothers has been arrested in Mumbai, but the other, Amit Kumar, whopolice say was the racket's kingpin, is now the focus of aninternational manhunt and may have fled to Canada.But while the details of this particular case are appalling, and thescam is the first — or at least first to be exposed — involvingforeigners from as far away as the U.S. and U.K flying in fortransplants, Indians are sadly all too familiar with organ rackets. In2007, police in southern India uncovered an illegal kidney tradeinvolving fishermen whose jobs had been destroyed by the Indian Oceantsunami. A massive transplant ring in Punjab was also uncovered in2003. Police there believe at least 30 of the donors, who as in thislatest case were poor, illiterate workers promised riches for theirorgans and bused in to be operated on, died, despite promises thatthey would receive excellent post-operation medical care and that theyhad nothing to worry about.India's illegal organ trade is driven in part by the incredibleimbalance between supply and demand for legal organs. The Indiangovernment banned the sale of kidneys for commercial gain in 1994;lawbreakers can be jailed for up to five years. But legal organdonations remain rare in India. The Multi Organ Harvesting Aid Network(MOHAN), a Chennai-based non-government group that promotes legalorgan donation, puts donation rates in India at well under 1 permillion, compared to rates of more than 20 per million in places suchas Spain, the U.S. and France. The group's head Dr Sunil Shroffrejects the idea that Indian culture or religion is behind the lowdonation rates. "The reason is we haven't got our act togetherbasically," he says. "The infrastructure is not there. The generalperception is lacking."The Indian government has encouraged more people to donate, and a fewyears ago began a campaign to increase the rate of cornea donations totry to fix the country's huge problems with blindness. But despitesome success — the high-profile cricketer Anil Kumble and Bollywoodactress Aishwarya Rai both promised to donate their eyes when they die— a 2003 study in the Indian Journal of Opthamology found thatilliteracy and rural residence (read poverty) meant that only half ofthose persons interviewed "had knowledge of eye donation, 20% knewabout corneal transplantation and only 4.34% of them knew when todonate their eyes."Dodgy doctors exploit those same factors — illiteracy and poverty — tobuy cheap organs on the black markets. There are millions of pooryoung men in India, desperate for a job and only too ready to travelto India's big cities at the promise of a quick buck. And even ifthey're not willing, they're still potential fodder. The AssociatedPress reported that while some donors sold their kidneys willingly,some were forcibly brought to clinics, held at gunpoint and thenforced to undergo operations that they didn't want. "India is not sucha literate population," says a spokeswoman from the National HumanRights Commission. "That's the main thing. There are a lot of peoplewho are easy to take advantage of."Shroff and his colleagues at MOHAN argue that if India can push itslegal donation rates up "then we can take care of the shortage andstop these kind of horror stories." But encouraging families to donatethe organs of their recently deceased after this week's terriblerevelations is no easy task. "For the next month or two it's going tobe extremely hard to get a family to donate because they think it'ssome big scam," says Shroff. "That's the wider damage this type ofstory does."