In today’s Finshots, we explore the really troubling allegations against Apollo Hospitals and the larger issue around organ trafficking in India.

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The Story

There could be a massive kidney transplant scam unfolding in India’s capital city. And this might be taking place at one of India’s largest hospital groups — Apollo Hospitals!

At least that’s what the British media house The Telegraph revealed on Sunday.

What’s going on, you ask?

Well, it begins with our neighbour Myanmar. See, organ transplants in Myanmar can only happen between relatives. So when someone’s kidneys fail, that person can’t really take out an advertisement asking for donors and promise they’ll pay for a kidney. They have to find a relative. Or, they could find some random individual willing to do it out of the goodness of their heart. It’s the same rule in India. Now apparently, wealthy Myanma are flying across the border to India for organ transplants. And they’re finding poor villagers from their country to donate kidneys.

But what about the relationship status?

That can be fixed by some forged documents, of course. The middlemen or the agents who connect the donor with the recipient will take care of all the dirty work — they’ll create a family tree, fake household documents showing family ties, drum up a marriage certificate if needed, stage a photo op to show the two people visiting a temple or taking a holiday, and then cook up a false story.

Oh yeah, they need a false story too. Because you can’t just waltz into a hospital and say, “I’m the donor. Take my kidney.” Oh, no. In many cases, there could be an interview with a transplant authorisation committee. The ones who make up this committee are officials from the hospital and even a member appointed by the government. These folks need to believe the documents. They need to buy into the story. And only then will they sign off on the transplant.

So yeah, there’s definitely a process in place. And if the documents and story seem genuine enough, it could be quite easy to fool this committee too.

Now the big question is — was Apollo’s top brass involved in this scam too?

Well, the hospital has vehemently denied any knowledge of course (We've added a statement from the Group at the end of this article). And maybe the rot is just limited to its Myanmar office. Because when the Telegraph’s reporter posed as a relative of someone who needed a kidney transplant, they were told by a Dr Htet Htet Myint Wai from the Apollo office, “It’s easy to find a donor.”

So yeah, it could be a case of a few dubious individuals trying to make a quick buck.

But here’s the thing…

Apollo’s been embroiled in a kidney scam before. Back in 2016, similar accusations were leveled against the hospital. And at that time, the donors and recipients in the picture were all Indians. People from poor parts of Uttar Pradesh would be paid ₹3–4 lakhs for a kidney. And again, documents would be forged.

But Apollo said that it was “a victim of a well-orchestrated operation to cheat patients and the hospital”. Apparently, the traffickers managed to fool the committee into believing these fake relationship statuses.

So it could be a similar story playing out again.

But the question is — despite knowing that organ trafficking was rampant, and having been on the receiving end before, what did Apollo do to tighten the screws?

We imagine that Apollo will probably have to answer this sooner or later.

And in the meanwhile, it also raises a few other questions regarding organ trafficking.

You see, India is one of the epicentres of commercial organ trafficking. Sure, we have a law in place. The Transplantation of Human Organs and Tissues Act came into effect in 1994. But if you go by media reports, it's still quite easy for unscrupulous people to get around it.

Now there might be a couple of reasons why organ trafficking is so rampant here.

Firstly, there’s massive income disparity in the country. So when the poor get desperate for money, they resort to whatever means necessary to hold on to their life. For instance, in 2001, 305 people in Chennai who had sold their kidney were asked why they did it. And 96% of them said it was to pay off debts. They had no other way out. Now sure, that survey is over two decades old but the inequality in the country has only been expanding since then. So it’s not hard to imagine that the situation could be even worse than before.

The other problem is a demand-supply gap. In India, there’s a need for 200,000 kidney transplants each year. But just 10,000 transplants are conducted. And whenever there is a mismatch of this magnitude, it opens the doors for the black market. The illegal business thrives.

So how do we solve this problem, you ask?

Well, for starters, the simple answer is that we need more organ donors. Currently, the organ donation rate among the dead is just 1 per million people. Experts say we need to get the ratio higher to around 65 per million. And one method to improve this is to train ICU hospital staff on recognising when the organs of a deceased can be used and counsel families for donation.

But you can imagine that’s not a frictionless ploy. Getting people, who’re dealing with loss, to consider donating organs of their loved ones is a tall order.

So maybe the other way is to move from an opt-in model for organ donation to an opt-out model.

What do we mean?

Well, this means that the default state is that as soon as you’re born, you become an organ donor. You don’t need to take the effort and sign up to be one. Rather, if you decide that you don’t want to donate your organs, and that you want to opt-out, that’s when you actually have to fill up a form. And this system seems to work. A decade or so ago, researchers looked at some data in Europe. They found that in Germany, which had an opt-in policy, only 12% of people registered as organ donors. Whereas in Austria where it was an opt-out policy, 99% of people were organ donors.

Sure, the idea might be a bit controversial. Giving away one’s organs, even if it’s after death, might make people squeamish. But you could justify it on the as-judged-by-themselves” principle. In simpler terms, what will you want if you were struggling to get a transplant for a loved one? We’re guessing you’d be hoping more people are organ donors, no?

And it seems like Indian authorities are mulling over using the opt-out system as well.

Now we don’t know how it’ll all turn out. But we do need to do something to put a full stop to illegal trafficking of organs. We need to stop the exploitation of vulnerable people. And we need hospitals like Apollo to be more accountable for what goes on behind closed doors. No?

Until then…fingers crossed.

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PS: The company spokesperson for Indraprastha Medical Corporation Limited (IMCL) that's part of the Apollo Hospital group, shared the below statement with us today.

“The allegations made in the recent  international media against IMCL are absolutely false, ill-informed and  misleading, All the facts were shared in detail with the concerned  journalist. To be clear, IMCL complies with every legal and  ethical requirement for the transplant procedures including all  guidelines laid down by the government as well as our own extensive  internal processes that exceed compliance requirements. For example,  IMCL requires every donor to provide Form 21 notarised  by the appropriate ministry in their country. This form is a  certification from the foreign government that the donor and recipient  are indeed related. The government appointed  transplant authorisation  committee at IMCL reviews documents for each case including  this certification and interviews the donor and the recipient. It  further re-validates the documents with the concerned embassy of the  country. The patients and donors undergo several medical tests,  including genetic testing.  These and many more steps far  exceed any compliance requirements for a transplant procedure and  ensure that donor and recipient are indeed related as per applicable  laws. IMCL remains committed to the highest standards of ethics and to  delivering on our mission to bring the best healthcare  to all."

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