Harvesting the Spare Parts

Many years ago, there used to be a minister in West Bengal Chief Minister Jyoti Basu’s cabinet by the name of Benoy Choudhury. He used to be the deputy chief minister at one point and was responsible for all the land reforms carried out in the early years of the Left Front government. An austere, honest and humble man in life, he stayed that way in death. When he died, there was neither cremation nor burial - he had donated his remains to the government medical college so that students might learn some anatomy by dissecting up his body.

Recently, A.K.Antony set another sort of precedent when he donated his organs as did celebrities Priyanka Chopra and cricketer Navjot Singh Sidhu. Preity Zinta has done this even earlier. This is great. For just as it is desirable to avoid ostentatious ness in the happier moments of life, so too in moments of grief – especially when there is a lot that could be done with our bodies even after we have passed on. As Priyanka Chopra put it quite well, in a symbolic sense, donating your organs enables you to live for ever.

But while such romantic notions of eternity are fine; there is a case to revisit the entire gamut of organ donation in the country. For on one side, there is a scarcity of vital organs so much so that there is a thriving black market in them and on the other side, every such organs are being consigned to the flames or buried six feet under.

As Scott Carney writes in Wired magazine,

“Scarcity has long been a key driver of the global kidney market, but in regions like India, Brazil, Pakistan and China, sellers are dealing with signs of a surplus. Operations that once set back patients tens of thousands of dollars on the black market can now be had for a fraction of the cost in some places.” and body brokers are now connecting wealthy patients with healthy but poor people willing to sell their organs for cash. The international market for human parts is thriving: A kidney goes for $25,000 in Russia, a heart for $290,000 in South Africa

In organ donation, the main taboos seem to be religious and here it does not seem to make much of a difference as to which religion one belongs to. But the taboos are clearly relative. The large numbers of donors who are poor and living on the edge who are selling of their organs for a pittance clearly are prepared to sell to survive another day. The presence of affluent doctors like Amit Kumar acting as racketeers and brokers proves that religious taboos are not too binding at the rich end of society either.

Not too long ago, blood donation was handicapped by similar taboos and myths. Now while it may be a little premature to claim that all the taboos have gone away, it goes without saying that we have come a long way indeed. Though fringes of commercialism still persist in the form of the “professional blood donors”, the voluntary blood donor movement – aided by strong social backing and helpful legislation has grown. Perhaps, we need to go the same route for harvesting our organs and who knows the large catchments of voluntary blood donors who already know what it means to gift life through donating blood may become the bulwark of another movement – those who donate blood in life…. And their body parts in death…

Reverse Mortgage in Health

India's premier medical institute, the All-India Institute of Medical Sciences, is still grappling with an acute shortage of corneas. Dr. Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS currently has a waiting list of 250 to 300 top priority patients this month who are blind in both eyes and are young. Similarly, over three million people in India suffer from end-stage renal disease, yet only 2,500 people receive kidney transplants every year. Experts who held a brainstorming session on Saturday to find ways to bridge this yawning gap, found a two-pronged solution: a dose of awareness in the community and suitable amendments to the law governing human organ transplants.

The severe shortages which happen due to several reasons including religious belief and superstition leads to at least three things. Firstly it means that many people who need organ transplants, be it corneas or kidneys or any other suffer the consequences, be it perpetual blindness or a chronic death. Secondly, for those who receive transplants, the costs are prohibitive. Thirdly, because of shortages, rackets thrive in organs, especially kidneys for which India, among other is notorious.

Health care in India and globally is daily growing more expensive and it has always been a challenge to deal with these rising costs. Insurance has not penetrated large sections of the population and will not in the foreseeable further even if the industry expands and then not every one is insurable any way. Those who do not have insurance and fall sick. Lack of access to quality public health services and a rapidly growing unregulated private sector have led to a situation where an increasing number of people are getting trapped in debts or slipping into deeper poverty due to the expenses of hospitals. At the national level, at least 25% of hospitalized people are falling below the poverty line only as a result of hospital-related expenses.

Considering that insurance is not going to be the complete answer and that meeting hospital expenses from out of pocket are increasingly pushing people into debt, it is time to do things differently. Considering that so much of health care is getting commercialized any way, it is time to adopt a practice that has just been introduced in India in a small way- the concept of reverse mortgage. Can reverse mortgage, which has thus far been introduced to provide a safe haven of housing for senior citizens be adapted to health. Yes.

Reverse mortgage contracts in health can work for health care institutions, possibly corporate ones in the first place as they are usually the early adaptors. Such institutions can provide free or subsidized health care for individuals, who stipulate that on their death, they would donate their organs for transplant to those who would need it. This could be particularly tried out among senior citizens who are usually not insurable and to ensure that hospitals and clinics are not tied up by contracting to provide treatment to the young for decades. Of course adequate ethical and systems checks and guidelines need in place to ensure that clinical care is not compromised in the race to harvest organs for transplantation but with adequate regulation in place, reverse mortgage can provide a viable health care financing option for those who are not insurable and who would typically find the costs of treatment to be high. Such a route would provide health care for senior citizens; a regular supply of organs for transplant and some what ease the organ racket. An idea worth exploring and whose idea has come!