Medicine December 2008

Caveat Donor

A street brawl in India brings down a global kidney-transplant ring.
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Manan Vatsyayana/AFP/Getty Images

In a country where 300 million people live on less than a dollar a day, Amit Kumar—nicknamed “Dr. Horror” by the Indian media after his arrest last winter for heading an illicit global kidney-transplant ring—had little trouble finding homegrown organ donors. One favorite hunting ground was a strip of restaurants, shops, and hovels near an Islamic shrine, or dargah, in Mahim, a predominantly Muslim precinct of Mumbai. Devotees of the dargah, which attracts people of all faiths, donate money to restaurants to help feed the beggars who cluster there. Last June, walking past one such restaurant whose kitchen extends to the sidewalk, I saw a dozen or so men huddled within scorching distance of giant cauldrons in which meat and potatoes simmered. Expressions glazed and clothing in tatters, the men watched, motionless and silent, their patience unwavering. I felt as if I were looking at a still photo.

Kumar, who’s now on trial, has told officials that he sent his agents to offer such men anywhere from $500 to $2,500 for a kidney. Elsewhere, in the fast-growing towns of states like Haryāna and Uttar Pradesh, Kumar’s ring also went after newly arrived migrant workers seeking jobs.

Most donors were keen to trade their kidneys for cash. Some were professional blood donors, such as Mahesh, who worked at a tea stall near a century-old clock tower with a shattered dial that rises above Meerut, a city in Uttar Pradesh, near Delhi. He, in turn, told me about Shahid, a rickshaw puller who joined Kumar’s group after having made a career out of finding men who would sell their blood to nursing homes. Leveraging his knowledge of blood sellers, Shahid became one of Kumar’s most successful kidney hunters. Then there was Gyasuddin, a boyish-looking migrant worker with a shock of hair who sold his kidney for $1,000 and became another node in Kumar’s Meerut network.

Wandering through Meerut’s narrow streets, amid hundreds of cyclists, rickshaw pullers, three-wheelers, cars, and pedestrians, I asked shop owners and lemonade vendors where I could find other people who had sold their kidneys. They pointed me toward a rundown building across from the tower. Behind a tall iron gate, groups of men were playing cards in the shade of a tree, among them Rakesh, Mahesh, and Om Prakash—all of whom would later raise their shirts to show me long scars above the waist.

Thin as a rail, with some of his front teeth missing and the rest stained brown by tobacco, Prakash paints for a living. “I took the day off today,” he said as we sat down on an empty cart to talk. Nearby, Rakesh toasted a pellet of hash in a matchstick flame.

Sharing a joint, the two men told me that they were paid $1,000 after their kidneys were taken, in 2006. Prakash said he had been lured by a man posing as a contractor who offered him a month-long painting job for $4 a day. He was put up in a high-rise apartment in nearby Gurgaon with other workers. The next day, he was taken for an ultra­sound and a blood test—and even though he found this puzzling, he went along for fear of losing the job. He was then tempted with more cash in exchange for his kidney. The surgery took place nine days later. With a sheepish grin, Prakash said he had spent all the money on alcohol and prostitutes.

The Indian government’s case against Kumar includes complaints from seven men who allege that they were cheated out of their kidneys. Their stories are similar: Gyasuddin or other agents of Kumar took them to Gurgaon on the pretext of employment as masons, waiters, or cooks. They were kept at safe houses and medically tested. Some were forced to undergo surgery; others were falsely diagnosed with ailments like gall stones that required surgical treatment.

Dozens of other victims had been willing donors but they weren’t paid what they had been promised. Because Kumar’s agents had to pay for the ultrasound and other tests needed to match each donor to a recipient, they shortchanged many donors. The result was a bunch of disgruntled kidney sellers, some of whom complained to police in Jaipur and Mumbai.

On the morning of January 24, a climactic fight broke out between two men near a busy street-crossing in Morādābād, a town in Uttar Pradesh. A crowd gathered, and the already slow traffic of cars, scooters, and cycle-rickshaws came to a halt. One of the men was Gyasuddin, the donor-turned-agent from Meerut. The other was Vidya Prakash, who was accusing Gyasuddin of having stolen his kidney. A constable on street duty found the allegation so odd that instead of letting the men off with a warning, he took them to a nearby police station. And thus did Amit Kumar, India’s self-taught and self-made kidney king, with clients from Europe, Asia, the United States, and the Middle East, and with homes and properties in Mumbai, Toronto, Hong Kong, and Australia, end up in a Haryāna prison.

Yudhijit Bhattacharjee is a writer at Science magazine.
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