Thursday, March 23
Next stop, Bangalore
Left San Francisco tonight in a whirlwind. I've been researching for this trip for the past several months and am eager to see what I'll find once I get to India. The trade in human kidneys has been an issue there since the 1970s, when the development of immunosuppressant drugs made organ transplantation possible. I've been told that would-be donors used to line up outside Indian hospitals waiting for the chance to sell. Practices changed in 1994 when the government introduced the Transplantation of Human Organs Act to try to regulate the trade.
After about 30 hours of traveling, with stops in Singapore and Hong Kong, I finally arrive in Bangalore. Stepping outside for the first time, the Indian air feels thick and heavy, even at 11 p.m. The mosquitoes are swarming around me -- I'm glad I've coated myself with Deet. As I leave the walkway, I'm herded into a narrow channel walled on both sides by a mass of human bodies, each one waving and yelling to offer me a ride or a place to stay.
Friday, March 24
Twenty cigarettes a day
I spend my first day in India trying to get adjusted. At Smart Bite, the restaurant next door to the hotel, I have my first taste of an Indian breakfast masala dosa -- lime juice and a dish of plain curd, a meal I'll come to know well.
By mid-morning, travel fatigue sets in and the incredibly polluted air begins to make me feel woozy. I had read in one of the guidebooks that breathing in Bangalore is the equivalent of smoking 20 cigarettes a day.
That evening I take an overnight train journey to Chennai in Tamil Nadu, about eight hours south of Bangalore. Chennai is a hub for the kidney trade.
Inside Chennai's slums, reporter Samantha Grant has little problem finding kidney donors willing to talk about their experiences.
Saturday, March 25
Today, with Bharathi, my translator, I go to Villivakkam, the Chennai slum where much of the organ trade activity takes place.
We arrived by auto-rickshaw, and I am greeted by surprised stares. Some children even gasp when they see me. Bharathi tells me they have likely never seen a white woman before. The neighborhood is bustling with activity -- women carrying stacks of bricks on their heads, naked children playing in the hot dust and a rowdy cricket match going on in the back streets.
We finally find the home of Koteeswari, the woman who will be our guide. She is wearing a blue and purple sari with a white stream of jasmine flowers woven into her long black braid. Koteeswari tells me that she knows of at least 50 families with a family member who has sold a kidney and that she can introduce me to as many of them as I need to meet. She says I will be expected to pay a modest fee of around US$2 for any interviews. Other journalists have paid this, so I must do so as well.
We make our way through the narrow walkways of the slum villages and start to film. Koteeswari introduces us to Rajathi, who leads us inside her dark, one-room shanty. She's wearing a vivid royal blue and turquoise sari and has a beautiful baby on her lap. She tells me she sold one of her kidneys 12 years ago.
As other villagers crowd around, I notice at least five other women who have the same scar that Rajathi showed me. I was shocked to see so many.
As other villagers crowd around, I notice at least five other women who have the same scar that Rajathi showed me. The scars are visible because of the way the women wear their saris. I was shocked to see so many.
My translator tells me she, too, is surprised by the experience. Everyone in India knows about the kidney trade, she tells me, but to see it with your own eyes is something else entirely.
Sunday, March 26
Selling a kidney -- woman's work
Today, we find Nirmala, another woman from the slums. She sold a kidney 17 years ago and is now in poor health. Still, she says, she would do it again because she has to feed her children and there's no other way to make money. Nirmala received half the money up front. She was given a donor card as proof that she did indeed donate a kidney and was told she would get the balance one month after the surgery. She shows us the original donor card, which she has been holding for 17 years, hoping to receive the rest of the money promised to her. But like many donors, Nirmala has never seen another penny. A photograph of her as a young woman is stapled inside her donor card. She says it's the only photograph she has of herself.
Among those interviewed is a woman who says she works as a kidney broker inside the Villivakkam slum.
We also want to talk to male donors about their experiences. We're told that there were four men from the slum who sold a kidney, but that two of them have already died, of related health problems. We find the other two, but neither of them is willing to go on camera to tell their story. Several of the local women explain that these men are deeply ashamed that they had to resort to selling their organs because selling a kidney is considered woman's work.
Sunday, March 26
Poverty and technology
Walking through the slums, I notice intricate chalk designs laid out in front of many of the doorsteps. My cameraman, Ranjan Kamath, tells me they are part of a ritual performed every morning to prepare the home for Lakshmi, the god of wealth, in case he happens to stop by the village. The hope is that his arrival will relieve them from a life of poverty.
Later on, Ranjan and I meet a friend of his for dinner. The friend asks to meet us at the food court inside a high-tech building in the heart of Chennai's IT [information technology] district. I've been told about the IT parks in India and how remarkably foreign they can look, but I am not prepared for such a bizarre contrast. Dirty polluted streets heaving with people give way to expansive carpets of lush grass upon which loom giant glass-and-steel monoliths. These compounds look as if they've been plucked from the hills of Mountain View, California. The only thing separating the IT sector from the rest of India is a thin gate and a checkpoint patrolled by a couple of security guards.
After dinner, we return to the friend's place to talk. He tells me that one of his relatives needed a kidney; they tried to buy one, but it didn't work out. It's amazing, he says, how quickly your outlook changes when someone you love is sick.
I've been told about the IT parks in India. Heaving polluted streets give way to carpets of lush grass and glass-and-steel monoliths that look as if they've been plucked from the hills of Mountain View, California.
We also talk about what he calls the Indian "and" factor. From his perspective, India is a country of "ands," not "ors." India is rich AND poor. Hot AND cold. Dry AND wet. Hindu AND Muslim. Progressive AND traditional. He says that to live in India, you have to learn to accept the contrasts -- but the danger is that once you accept these contrasts, you become desensitized and it's harder to stay motivated to change anything.
Monday, March 27
Cadavers and context
After morning coffee and dosa, Ranjan and I race over to the MOHAN [Multi-Organ Harvesting Aid Network] Foundation to interview its founder, Dr. Sunil Shroff. MOHAN is a nonprofit that is working to promote cadaveric transplants rather than live donor transplants. The idea is that if there are more organs available from cadavers -- a lot of them from the high incidence of auto accidents -- the demand for living organ donors will drop.
According to Dr. Shroff, there are so many auto accidents in India that if MOHAN were able to harvest all the organs from these cadavers, they would be able to supply all the organs needed in India, wipe out the waiting lists and even supply organs to other countries. The biggest obstacle to the program's success is convincing people to sign up as organ donors. Many Indians are afraid that if they become involved in an accident and have signed up as an organ donor, doctors will be less inclined to save their life in order to harvest their organs.
Wednesday, March 29
The official government response: "We're only human..."
In order to put the final pieces of the story together, I head back to Bangalore to find out what the government response is to the organ trade.
D'Souza Robinson,out-going chairman of the government's Authorization Committee at his office in Bangalore.
We find D'Souza Robinson, the out-going chairman of the government committee responsible for overseeing donor cases, sitting behind piles of paperwork. It quickly becomes clear that Robinson has mixed feelings about the government's role in determining whether an organ donation should be permitted. Currently, both the prospective donor and the recipient must appear before members of the committee to plead their case. They must convince the committee that the donor is truly motivated by altruism and that no money has changed hands. If the donor and the recipient can sufficiently prove that the donation is an act of love, the committee rubber-stamps the operation. If there is any suspicion of commerce, the operation is denied.
Robinson tells us the story of one man whose health was so poor he couldn't make it up the stairs to the Authorization Committee to plead his case. He tells of another donor who was mentally ill, leaving the committee with a tough ethical decision to make. Robinson is conflicted by some of the approvals that have gone through, but he also feels that it would be wrong to outlaw donation to non-family members because it does help some people who are truly motivated by love. When I ask him about the fact that some illegal operations have slipped through, he responds that members of the committee are also human, and it's impossible to stop every operation.
If the donor and the recipient can sufficiently prove that the donation is an act of love, the committee rubber-stamps the operation. If there is any suspicion of commerce, the operation is denied.
Friday, March 31
Controversial doctors and conflicted government officials
Dr. Ajit Huilgol is a transplant surgeon in Bangalore rumored to be in favor of regulating rather than outlawing the kidney trade. We agree to meet at his office inside one of Bangalore's major transplant hospitals.
Inside the nephrology unit, we find several patients quietly waiting on wooden benches to go into surgery. Huilgol tells us that he has performed more than 1,400 kidney transplants. He points out that the large number of diabetics in India and around the world means demand for kidneys will only rise in the next few decades. He says that now is the time to find a viable solution.
Huilgol believes the current system is wholly inappropriate for India. The Transplantation of Human Organs Act of 1994 was lifted straight from the British law books with little thought to the cultural differences that exist. The law permits organ donation only between immediate family members or between unrelated members if they can prove that they are going through the donation for love and not money. Huilgol says, unlike in England, bonds between extended family members in India are just as strong as bonds between immediate family members and therefore extended family members should be legally permitted to donate to other extended family members if they so choose.
He also believes the organ trade should be organized and regulated rather than outlawed entirely. Poor people need a way to make money, and they are going to sell their kidneys whether the trade is outlawed or not. As long as it's outlawed, Huilgol tells us, the donors will fall victim to unscrupulous brokers who pocket large portions of the fee for themselves. Also, the donors will receive no follow-up care. Huilgol suggests that if the trade were more controlled, the donors would be protected by third-party organizations that could ensure the donors actually get the money they deserve.
After meeting with Huilgol, we make our way to our final interview in Bangalore with the government's Appropriate Authority. The Appropriate Authority is charged with regulating the transplant surgeons and the hospitals that are given licenses to perform the surgeries approved by the Authorization Committee. After an elaborate runaround from the chairman's secretary and the chairman himself, we finally meet a Mr. Basavaraju. He greets us with a politician's handshake and a fresh cup of coffee, then buzzes his assistant to bring in a copy of the Transplantation of Human Organs Act.
Basavaraju begins thumbing through the document and asks me what kinds of questions I will be asking him. I tell him I am looking specifically for information about how the Appropriate Authority operates. At this, Basavaraju becomes flustered and calls in another assistant to help him with the interview. We begin directing questions at Basavaraju, but he refers each question to his assistant. Five minutes into this, we decide it would be more productive to interview the assistant instead.
The act states that the Appropriate Authority is responsible for reviewing the licenses issued to doctors and hospitals involved in the transplant trade and to investigate any claims of illegal behavior. I want to know how closely the Appropriate Authority monitors both doctors and hospitals and exactly how many of the licenses have been revoked since the law was introduced in 1994. At first, the assistant dances around the question, but I keep pushing. Eventually, he reveals that not a single license has been suspended or cancelled in the 12 years since the act came into law.