Selling a kidney fails to rescue Indians from poverty

Deborah Josefson Nebraska

Impoverished Indians who sell their kidneys in an effort to escape poverty suffer financially and medically in the long run, a new study has found (JAMA 2002;288:1589-93).

The study has broad ethical and social implications for the prospects of increasing the available organ transplant pool through organ sales, and suggests that financial incentives to increase the pool of donors may backfire.

India has a large population of patients with end stage renal disease, and dialysis is not widely available. It also has a chronic shortage of organs available for donation. Consequently, India harbours a thriving black market in organ trade.

Dr Mahdav Goyal and Dr Ravindra Mehta from the Geisinger Health System in Pennsylvania and colleagues from the Case Western Reserve University in Ohio and the University of California School of Medicine at San Diego conducted a cross sectional survey of people in India who had sold their kidneys.

The survey looked at the long term economic and health effects on the participants of selling a kidney and catalogued the underlying motivation for organ selling, the amount received from the sale, how the money was spent, changes in economic and health status in the six years after the sale, and what advice they would give to other people considering selling a kidney.

The survey was conducted in Chennai (Madras), Tamil Nadu. Because organ trade is illegal, the survey was conducted in a clandestine, door to door fashion by a team of eight Tamil speaking research assistants.

A total of 305 kidney donors were identified and participated in the study during February 2001. Nephrectomy was verified by presence of scars. The donors were paid 40 rupees (£0.53; $0.83; ¤0.84) for participating in the survey. Ninety five per cent of the men and 60% of the women worked in low paid jobs such as labourers or vendors.

Nearly all the participants sold a kidney for financial reasons, with 292 (96%) indicating that paying off debts was the prime motivating factor. Three per cent sold their kidneys to provide dowries and marriage expenses for their daughters, while 1% required cash to start a business. Seventy per cent sold their kidney through an intermediary and 30% directly to a clinic or individual.

The average payment for a kidney was $1070 (£638; ¤1090)--a third lower than the average amount promised--and the sums ranged from $450 to $2660.

Of the 292 participants who sold a kidney to pay off debts, 216 (74%) still had debts at the time of the survey.

The study found that 3% of people who sold their kidneys did so to pay dowries or marriage expenses for their daughters