Written by:
Anoushka Pinto
In theory, organ donation is widely regarded as a noble and selfless act, one that can truly save lives and provide hope for those desperately awaiting transplants. Yet, when it comes to taking that crucial step, many individuals in India find themselves hesitating. This reluctance is largely fueled by deep-seated fears and misconceptions, particularly concerning the integrity of the process and the potential for fraudulent activities or scams.
Even though there are legal frameworks designed to oversee organ transplants, a shadow of doubt still hangs over the issue. People often worry about the risk of being misled, the perceived violation of their bodies, and the irreversible nature of becoming a registered donor. These anxieties are not entirely baseless, especially in light of the numerous organ donation scams that have surfaced in India.
Why are organ donation scams so widespread in India?
The combination of extensive internet access, economic hardships, and the temptation of quick cash has created an environment ripe for organ donation scams in India. Despite the existence of governing laws, exploitation persists, fueled by poverty and facilitated by social media platforms. The rise of social media as a widely used platform has turned it into an unregulated marketplace for a variety of goods, including human organs. In their desperation, both buyers and sellers seek hope on this platform, but unfortunately, many scammers take advantage of their vulnerable situations.
Prior to the explosion of social media and the availability of low-cost internet, illegal kidney sales primarily occurred through informal networks. The aftermath of the catastrophic 2004 tsunami, which plunged many survivors into poverty, significantly intensified the organ trade. In those dire times, numerous impoverished individuals resorted to selling their kidneys for immediate financial relief, giving rise to the phenomenon known as “Kidneyvakkam” in Tamil Nadu.
A detailed article by Al Jazeera highlights how the COVID-19 pandemic exacerbated this issue. As many lost their jobs and faced dwindling incomes, the desperation to sell organs increased. Scammers, masquerading as doctors or hospital staff, established Facebook pages and groups to lure in desperate sellers. They charged fees for dubious “donor cards” or “registration,” leaving many in an even worse financial situation.
While regulations have been implemented to oversee organ transplants, scammers have adeptly found ways to circumvent these laws. With nearly half of India’s population—around 1.4 billion people—now online, these fraudsters exploit social media platforms to promote their schemes. Desperate individuals living in poverty often fall victim to these scams, believing that selling an organ might lift their financial burden. Tragically, many end up losing money to fraudulent intermediaries, deepening their struggles.
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India's illicit organ trading network
In the 1980s, India experienced a surge of patients from West Asia, especially from Saudi Arabia, who were in dire need of treatment for kidney failure. Private hospitals in Mumbai began conducting transplants, but these procedures were often shrouded in secrecy. Most of the donors were individuals living in poverty, driven by a desperate need to support their families or settle debts. Many figures in these murky operations would recruit donors through a network of so-called “agents.” These agents frequented temples, hid under bridges, and loitered around slums, targeting vulnerable people such as beggars, rickshaw drivers, and migrant workers with the lure of quick cash, typically between $300 and $1,000.
In the absence of strict laws, makeshift nursing homes began popping up in cities throughout India. These establishments advertised “safe and painless kidney removal” in their newspaper ads, yet they often lacked the qualified medical personnel necessary to safely perform such surgeries. The illegal nature of this trade rendered it exceptionally lucrative. Much like drug dealing or flesh peddling, organ trafficking boasted high profit margins and limited competition. It wasn’t uncommon to see gross margins of 90% on kidney matches.
Organ trafficking stands as a profitable yet often overlooked aspect of human trafficking, overshadowed by more visible forms such as sex and labour trafficking. Despite its relative secrecy, it remains a pressing issue. The World Health Organization indicates that India has become the leading exporter of kidneys, with over 2,000 kidneys sold legally each year, primarily to affluent foreigners. The illegal organ trade is believed to be exponentially larger than this official figure. Ironically, around 300,000 patients within India are currently awaiting cadaver donations, emphasising the stark difference between demand and supply.
When financial desperation drives organ donation, it often entails invasive surgical procedures that come with considerable risks. Many individuals resort to selling their organs to settle debts, only to find themselves trapped in a cycle of poverty and suffering from health complications post-surgery. Furthermore, this trade takes advantage of impoverished individuals to meet the medical needs of the wealthy, further deepening global health inequalities.
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Each year, India records approximately 1.5 lakh cases of brain death; however, only 1,028 cadaver organ donations occurred in 2023, facilitating over 3,000 transplants. (Source: TOI). This represents less than 17% of all organ transplants in the nation. Superstitions, religious beliefs, lack of awareness, and insufficient medical facilities contribute to the tragic loss of life-saving opportunities through organ donation. Government-run hospitals participate minimally in transplant procedures, while private hospitals impose fees that are often unaffordable for the average citizen. This inequitable system forces many impoverished individuals to either donate or illegally sell their organs, while wealthier patients receive transplants in upscale medical facilities.
Global Financial Integrity estimates that 10% of all organ transplants—including lungs, hearts, and livers—involve trafficked organs. Kidneys are the most commonly traded, with an estimated 10,000 kidneys exchanged on the black market each year.
The Transplantation of Human Organs Act (THO), 1994
The Transplantation of Human Organs Act, enacted in 1994, aims to create a robust framework for ethical organ donation and transplantation in India. Its main goals are to oversee the removal, preservation, and transplantation of human organs for medical purposes while also combating illegal trade in human organs.
State jurisdiction
Organ transplantation falls under the jurisdiction of individual states. Initially, the Act was adopted by Maharashtra, Himachal Pradesh, and Goa, but it has now been embraced by all states with the exception of Andhra Pradesh and Jammu & Kashmir.
Key provisions
Brain death certification
The Act legally recognizes brain death, establishing clear criteria and processes for certification (Form 10).
Organ donation
It permits organ and tissue transplants from both living donors and deceased individuals, following either cardiac or brain death.
Regulatory and advisory bodies
Appropriate Authority (AA)
Responsible for inspecting and granting registration to transplant hospitals, ensuring compliance with standards, conducting inspections, and addressing complaints. The AA possesses civil court powers to summon individuals, request documents, and issue search warrants.
Advisory Committee
Composed of experts who provide guidance to the AA.
Authorization Committee (AC)
Oversees living donor transplants to prevent exploitation and illegal transactions. All proceedings are recorded on video, and decisions are communicated within 24 hours. Appeals can be made to either state or central authorities.
Medical board (Brain Death Committee)
A panel of medical professionals responsible for certifying brain death. If a neurologist or neurosurgeon is unavailable, any qualified surgeon, physician, anaesthetist, or intensivist can fulfil this role.
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Donor classification
Near relatives
Includes spouses, children, grandchildren, siblings, parents, and grandparents. Permission from the transplant centre’s physician is required.
Non-related donors
Authorization must be obtained from the state’s Authorization Committee.
Swap transplantation
The Act allows for paired organ exchanges between incompatible donor-recipient pairs, facilitating more successful transplant outcomes.
Authorization for organ donation after brain death
Prior authorization
Individuals may provide consent for organ donation before passing away.
Posthumous authorization
Consent can be granted by the individual legally responsible for the deceased’s body. ICU doctors must check for prior authorization and inform relatives about donation options.
Unclaimed bodies
A specific authorization process is established for donations from unclaimed bodies.
Hospital registration for organ retrieval
Hospitals equipped with ICU facilities may register as organ retrieval centres, provided they meet the necessary standards for organ diagnosis, maintenance, and temporary storage.
Cost allocation
The financial responsibilities for donor management, organ retrieval, transportation, and preservation fall upon the recipient, the institution, the government, NGOs, or community organisations—not the family of the donor.
Medico-legal cases
Procedures are clearly defined to ensure that organ donation does not impede investigations into the cause of death.
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Hospital requirements
The Act specifies the standards required for hospitals to be registered as transplant centers, including infrastructure, equipment, and staff qualifications.
Tissue banks
Guidelines are provided for the operation of tissue banks, detailing necessary infrastructure and standard operating procedures.
Transplant coordinators
All transplant centres are mandated to appoint qualified transplant coordinators.
NGO and society registration
Non-governmental organisations, registered societies, and trusts involved in organ or tissue transplantation are required to register.
National network establishment
The central government is tasked with establishing the National Organ & Tissue Transplant Organization (NOTTO), along with Regional (ROTTO) and State (SOTTO) Organ & Tissue Transplant Organizations to oversee the networks for organ and tissue removal and storage.
Donor and recipient registry
A comprehensive registry of organ and tissue donors and recipients is maintained by the central government.
Penalties
The Act imposes strict penalties for unauthorised organ removal, illegal transactions, and other violations.
Forms
A variety of forms are outlined for consent, authorization, registration, and certification, ensuring compliance with the Act’s provisions.
(Source: Organ India)
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Case studies: Organ transplant scams, malpractices and trafficking in India
In February 2020, Surya found herself in a dire situation. With ₹5 lakh in debt after her husband lost his job and unable to work herself due to an accident, she contemplated selling a kidney to make ends meet. Although she knew that selling organs is illegal in India, desperation drove her to post her phone number on a Facebook group. Just a few days later, she received a call from Dr. Sandy, who claimed to represent a medical centre in Ghaziabad. He offered her a staggering ₹1 crore for her kidney, but only if she first paid ₹8,000 for a donor card. Fortunately, before taking any further steps, Surya came across the MOHAN Foundation, a non-profit that advocates for legal organ donations. They informed her that donor cards are actually free, helping her realise she was on the brink of being scammed.
In April 2017, Jaideep Sharma, a 23-year-old MBA student from Pune, found himself deeply troubled by the mysterious disappearance of his 24-year-old classmate, who had previously talked about kidney donation. Concerned for his friend, Jaideep decided to take matters into his own hands and infiltrate a kidney trafficking ring by pretending to be a potential donor. Teaming up with a news reporter and the crime branch of the Delhi police, Jaideep meticulously devised a sting operation. He reached out to the traffickers, who offered him a staggering ₹4 lakh for his kidney.
The traffickers made him transform his appearance, changed his name to Polepeddy Snayna Podma Phanikumar, and crafted fake documents to prove his relationship with the family requiring his kidney. They even went as far as to photoshop pictures provided by the family to include him.
On May 25, just one hour before the planned surgery, the police raided the hospital, armed with 200 hours of video evidence provided by Jaideep. This investigation unveiled a deep-rooted trafficking network involving prominent Delhi hospitals, where recipients were charged between ₹30 and ₹40 lakh for a kidney, while the donors received a mere 10% of the promised amount, with the traffickers pocketing the rest.
In late 2023, authorities uncovered a covert operation in Jaipur where counterfeit no-objection certificates (NOCs) were used for organ transplants. 3 prominent private hospitals were implicated for conducting a staggering 184 transplants based on these fake documents, since 2021. Nearly half of the donors and recipients were discovered to be from Bangladesh.
The scandal came to light when an assistant administrative officer of one of the hospitals was arrested by the Anti Corruption Bureau for accepting a bribe of ₹70,000 to issue a bogus NOC. This led to further arrests, including hospital coordinators of the other implicated hospitals. In response, the Rajasthan health department swiftly revoked the transplantation licences of the 3 hospitals.
As the investigation deepened, authorities apprehended two individuals from West Bengal connected to a company that facilitated organ donations. The alleged mastermind behind the operation, managed to evade capture after relocating five patients to a guest house in Gurugram. Additionally, four Bangladeshi nationals were arrested, revealing they were paid ₹2 lakh per kidney, while recipients were charged ₹10 lakh.
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How to avoid organ transplant scams
When it comes to avoiding organ transplant scams in India, vigilance is key. Here are several essential guidelines to help you navigate this critical area:
Verify hospital credentials
Check accreditation
Confirm that the hospital holds accreditation from recognized medical and health authorities, like the National Accreditation Board for Hospitals & Healthcare Providers (NABH).
Research reputation
Investigate the hospital’s reputation by looking for reviews and ratings from trustworthy sources regarding its transplant program.
Consult with registered specialists
Seek qualified doctors
Make sure to consult licensed transplant surgeons, nephrologists, or hepatologists who are well-regarded in their field.
Verify credentials
Always check the qualifications and experience of the medical professionals you engage with.
Understand the legal framework
Know the regulations
Familiarise yourself with the Transplantation of Human Organs (THO) Act, 1994, alongside other pertinent regulations governing organ donation and transplantation in India.
Ensure compliance
Confirm that all procedures align with these legal stipulations.
Avoid unofficial channels
Steer clear of middlemen
Refrain from interacting with intermediaries or brokers who propose quick or unofficial transplant arrangements.
Ignore promises of immediate availability
Be wary of offers that guarantee immediate organ availability or miraculous outcomes.
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Verify donor source
Request documentation
Make sure that the organ is sourced from a legally recognized deceased or living donor, with all necessary documentation and consent forms properly in order.
Check donor registration
Verify that the donor was officially registered and that the donation process adhered to established channels.
Scrutinise financial transactions
Avoid unusual payments
Be cautious of any requests for upfront payments or extra fees that lack clear explanations.
Use transparent payment methods
Ensure that all financial transactions are conducted through official and transparent means.
Seek second opinions
Get multiple opinions
Before committing to a transplant, seek second opinions from various experts to validate the necessity and legitimacy of the procedure.
Consult independent medical boards
Reach out to independent medical boards or associations for further verification.
Report suspicious activity
If you encounter any suspicious activities or fraudulent practices, report them to the relevant authorities, including hospital administration, medical boards, or law enforcement.
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Credible organisations working in the domain of organ transplants in India
The National Organ and Tissue Transplant Organization (NOTTO) is a central agency operating under India’s Ministry of Health and Family Welfare. Its main role is to coordinate and oversee all activities related to organ and tissue transplantation throughout the nation.
The Regional Organ and Tissue Transplant Organization (ROTTO) consists of regional bodies that work under NOTTO. They play an essential role in facilitating and monitoring transplantation efforts within their areas, ensuring that national policies are effectively put into practice.
The MOHAN Foundation, or Multi-Organ Harvesting Aid Network, is a non-profit organisation in India dedicated to promoting organ donation. They achieve this through awareness campaigns, training programs, and providing support services for transplant coordination.
Organ India, an initiative of the Parashar Foundation, focuses on increasing awareness about organ donation. They offer information and support to both donors and recipients while advocating for better policies to enhance the organ donation landscape in India.
Gift Your Organ Foundation is dedicated to fostering deceased organ donation across India. They maintain a national registry in partnership with Karnataka’s Zonal Coordination Committee for Transplantation. The foundation’s mission is to close the gap between the government and the public, eliminate misconceptions surrounding organ donation, and provide education through online platforms and a network of enthusiastic volunteers.
Shatayu’s primary goal is to raise awareness about organ donation in India. Shatayu encourages people to register as organ donors, offers donor cards, and stresses the importance of discussing donation preferences with family members. The initiative champions both deceased and living donations, emphasising the life-saving potential of these generous acts.
The Apex Kidney Foundation is a charitable trust committed to kidney health, education, and promoting organ donation. They run educational programs and provide subsidised treatments for patients battling kidney disease. The foundation actively advocates for kidney donation, motivates individuals to register as organ donors, and collaborates on initiatives like the ASTRA registry for swap transplants, all while contributing to vital kidney disease research.
For any queries or doubts about organ transplants, or to report scams or fraud, please reach out to these organisations.
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