Kidney exchange in India: legal hurdles, and an app

An interesting story from The Tribune in Chandigarh, about kidney exchange in India, mentions  the legal hurdles that must be overcome to take part in kidney exchange there.  It also mentions that there is an app, for peer to peer kidney matching.

From sufferers to survivors, their tale is touching

The legal hurdles:
"Both Narinder and Pramod said the procedure was not easy. “First, we had to take police clearance from our respective districts. Then, we had to submit an affidavit before the tehsildar. We had to appear before a panel of doctors of the Punjab Government and submitted our case as the transplant was to be performed in a Punjab hospital. The entire exercise took nearly four months,” said the two."

The app:
"On the lines of matrimonial websites, a city-based kidney transplant surgeon has devised a mobile application to help renal failure patients.
“With this app, relatives of a kidney patient can find a right match and get the kidneys swapped with one of family members. Suppose, someone’s father has suffered a kidney failure and his son offers to donate his kidney, but the blood group and tissues do not match, then the person can look for a donor with the same blood group. This app will help needy families contact each other and get the kidney swapped,” said Dr Rajan.
Since 2009, the Paired Kidney Exchange (PKE) has been legalised under the amended Human Organ Transplant Act of India. The Incompatible Kidney App or ikidney will allow all such patients to come under one roof."
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Here it is on the apple app store:
iKidney By Pradeep Naangal

Open iTunes to buy and download apps.
 https://itunes.apple.com/us/app/ikidney/id1071816293?mt=8 

Mike Rees in India to help remove obstacles to kidney exchange

The Times of India reports:
Paired kidney donations may mitigate patients’ agonizing wait

"On Tuesday, at an event organized by Gift Your Organ Foundation, Dr Michael Rees, CEO, Alliance for Paired Kidney Donation, USA, and Dr Eric Velez, founder of ProRenal, a Mexico-based organization, discussed the possibilities of paired kidney transplants that can be a solution for Indian patients. The duo played key roles in making the world's first-ever global paired transplant possible.
...
"The US, in 2017, brought required amendments to its National Organ Transplant Act (NOTA) to allow paired donations. Alliance for Paired Kidney Donation has a transplant matching software that does the matching between donors and recipients.

"In Mexico, 1.2 lakh people suffer from end-stage renal disorder and only 2600-2800 patients undergo transplants every year, said Dr Eric Velez.

"Shalini Rajneesh, principal secretary, health and family welfare, said Alliance for Paired Kidney Donation agreed to share their software with the Jeeva Sarthakate Society of Karnataka (earlier known as ZCCK) for free. The state-owned society works on organ transplants and coordinates with patients awaiting organs through the registry. "The software does a perfect match between donors and recipients to allow the swap transplant," she said.

"Asked if the legal framework allows live kidney donation between unrelated donors, she said as a long-term plan, the government will look into the issues and bring in required amendments. The main barrier is people do not want to donate and there is a need to create awareness, she added.

"Currently, transplants among unrelated donors are put through a series of checks to ensure that it does not lead to kidney racket.

'Transplants between spouses getting tougher'

"Dr Sankaran Sundar, a nephrologist who has coordinated more than 2,500 transplants so far, said the existing legal framework makes it difficult for patients to pursue transplants among unrelated donors.

"Karnataka has seen only six swap kidney transplants. Even among the spousal donors (when the couple want to share a kidney), it's been difficult to get approval from the authorization committee. When the kidney transplant is between a father/mother and son/daughter, or between siblings, it's easy to establish relationship. But when it is between a couple, it's tough, as marriage certificate has also been found to have been doctored in many cases," said Dr Sankaran Sundar."
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Here's another account, from the Deccan Chronicle
Bengaluru: Path-breaking tech to facilitate kidney transplants

A transplant center in India has done 300 kidney exchange transplants

Here's the article, whose first author is Dr. Vivek Kute, of the Faculty of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences ,
(IKDRC-ITS) Ahmedabad , India

Transpl Int. 2017 Mar 20. doi: 10.1111/tri.12956. [Epub ahead of print]

Impact of Single-Centre Kidney Paired Donation Transplantation to Increase the Donor Pool in India.

Kute VB1, Patel HV1, Shah PR1, Modi PR2, Shah VR3, Rizvi SJ2, Pal BC2, Shah PS1, Modi MP3, Butala BP3, Wakhare PS1, Varyani UT1, Shinde SG1, Ghodela VA1, Kasat GS1, Patil MV1, Patel JC1, Kumar DP1, Trivedi VB4, Patel MH4, Trivedi HL1.

Author information

Abstract

In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n=222), positive cross match (n=59) and better matching (n=19). A total of 124 two-way (n=248), 14 three-way (n=42), one 4-way (n=4) and one 6-way exchange (n=6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n=288) and 83.3% (n=250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3±3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist. This article is protected by copyright. All rights reserved.

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Here's a related recent article by Dr. Kute:

World J Transplant. 2017 Feb 24;7(1):64-69. doi: 10.5500/wjt.v7.i1.64.

International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India.

Kute VB1, Patel HV1, Shah PR1, Modi PR1, Shah VR1, Rizvi SJ1, Pal BC1, Shah PS1, Wakhare PS1, Shinde SG1, Ghodela VA1, Varyani UT1, Patel MH1, Trivedi VB1, Trivedi HL1.

Author information

Abstract

AIM:

To report the first international living related two way kidney paired donation (KPD) transplantation from India which occurred on 17th February 2015 after legal permission from authorization committee.

METHODS:

Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-match and donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD.

RESULTS:

Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/dL on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.

CONCLUSION:

International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.

A Catholic priest in Kerala India helps organize kidney transplant chains

Business of Kidneys: Kerala priest facilitates domino transplants for over fifty patients

"Nephrologists at New Delhi's All India Institute of Medical Sciences estimate that five lakh people live with failed kidneys in India at a time. A Lancet study revealed that just 10 per cent of patients suffering from kidney failure have access to dialysis, and 70 per cent of those starting dialysis die or discontinue treatment within the first three months due to the high cost of the treatment.
"The Catholic priest in Kerala's Thrissur district mooted a chain of kidney exchanges with a voluntary donor offering a kidney to a needy person, and a relative of this recipient in turn donating his/her kidney to another person, and so on. This system is known as 'Domino Transplant'. In the last five years, 56 people have been part of such kidney exchange chains, linking disparate people from industrialists to truck drivers in a chain. Two hundred others have pledged to join the chains when compatible donor-recipient pairings are established. Fr Davis Chiramel says the numbers could have been higher but for the poor medical infrastructure it could not."

More on kidney black markets in India

Top Indian Hospital Complicit In Lucrative Black Market for Human Organs

"Five doctors from one of India’s most distinguished hospitals were charged ... with performing illegal kidney transplants connected to an organ harvesting ring.

"The doctors, including a medical director and a chief executive, worked out of the prestigious L.H. Hiranandani Hospital in Mumbai. The trafficking racket was discovered in July after police were tipped off by poor villagers from Gujarat state who sold their kidneys.
...
"Unrelated donors can donate organs if the government confirms that no money has changed hands in the transaction. People can also source organs from cadavers or brain-dead patients, with the family’s permission, but these options are not common.
...
"A similar ring was broken up in June at the Indraprastha Apollo Hospital in New Delhi. Handlers at Indraprastha forged documents to show that recipients were related to donors. In reality, donors were paid about 300,000 Rupees (roughly $4,500) for their kidneys, which were then resold at a high profit.

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see earlier post:

Tuesday, June 21, 2016

Kidney black market arrests at Apollo hospital in Delhi

India considers a Surrogacy (Regulation) Bill, 2016 (banning commercial surrogacy, and restricting surrogacy to traditional couples)

Here's the government press release:
Cabinet approves introduction of the "Surrogacy (Regulation) Bill, 2016" 

"The Union Cabinet chaired by the Prime Minister Shri Narendra Modi has given its approval for introduction of the "Surrogacy (Regulation) Bill, 2016".

The Bill will regulate surrogacy in India by establishing National Surrogacy Board at the central level and State Surrogacy Boards and Appropriate Authorities in the State and Union Territories. The legislation will ensure effective regulation of surrogacy, prohibit commercial surrogacy and allow ethical surrogacy to the needy infertile couples. "

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Needless to say, there is lots of press reaction, on both sides, for multiple reasons. A sampling of headlines pro and con, with links:

The surrogacy bill is dangerous overreach

Ideological bias has trumped economic and ethical logic

Draft surrogacy bill violates fundamental right of people to choose modes of parenthood

Overseas Indians, foreigners, unmarried couples, single parents, live-in partners and gay couples are barred from commissioning the services of surrogate mothers.

Why the Surrogacy Bill is necessary

No more rent-a-womb: Why India needs to regulate surrogacy

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Update: and here's the bill: Surrogacy (Regulation) Bill, 2016

Kidney black market arrests at Apollo hospital in Delhi

Each morning when I manage this blog I erase spam comments, and many of them relate to kidney sales. You can see typical ones on the Google+ page of the (apparently mis-spelled) Appollo Hospital in India.
So I noted with interest this recent story about arrests connected to that hospital.


Kidney Racket: At Least 3 Recipients, 5 Donors Traced
Delhi | Press Trust of India |

"NEW DELHI:  Delhi Police have traced at least three recipients and five donors in connection with the international kidney racket linked to Apollo Hospitals in Delhi, even as the investigators sought legal opinion regarding slapping charges on them.

Five persons, including two personal secretaries of a nephrologist in Apollo Hospital, have been arrested in connection with the kidney racket which is believed to have its ramifications in countries including Sri Lanka and Indonesia, an official privy to the investigation said.

Till this afternoon, three of the recipients were traced in Kolhapur, Jammu and Kashmir and Ghaziabad.

Prima facie the recipients shelled out over Rs. 40 lakh for each transplant, of which not even 10 per cent reached the donor, the official said.

He further said, the police have traced over five donors, including three women, who are presently admitted in a hospital in Delhi.

During investigation it came to light that the gang members used to prepare forged papers to establish the relationship between donors and recipients, to adhere to the law.

The police have come across five cases in Apollo Hospital, in which the donors were shown as wife, brother, father or brother-in-law (2 cases) of recipients, the official said, adding that while average time of hospital stay for the donors was six days, for the recipients it was 12 days.

Meanwhile, the police have sought legal opinion in slapping charges on the donors and recipients under relevant provisions of law. Lawyers have been consulted for the purpose, the official said.

The accused arrested so far in the case include Aditya Singh and Shailesh Saxena, who worked as personal secretaries of Apollo Hospital doctors for 3-4 years, and three touts identified as Aseem Sikdar, Satya Prakash and Devashish Moulik.

The touts used to lure financially poor people from West Bengal, Uttar Pradesh and other parts of the country for donating kidney. Mr Moulik landed in the police net following a fight with his wife, whose kidney he had sold off.

Medical tests of recipient and donor were conducted and once the compatibility match was done, operations were conducted at Apollo Hospital in southeast Delhi.

"We are cooperating and providing all information required to help the police in their investigation pertaining to the alleged kidney sale racket," said a press statement by Indraprastha Apollo Hospital."

77 Kidney Exchange transplants in 2015 at one transplant center in India

I received the following cheerful news from Dr. Vivek Kute at the Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences ,
(IKDRC-ITS) Ahmedabad , India

 Kidney Paired Donation (KPD) Transplantation Activity At Single Center In Institute Of Kidney Diseases And Research Center And Dr. H L Trivedi Institute Of Transplantation Sciences , (IKDRC-ITS) Ahmedabad , India

Kute VB , Patel HV, Shah PR, Vanikar AV, Modi PR, Shah VR , Varyani UT, Wakhare PS ,  Shinde  SG,  Godhela VA, Shah PS , MK Shah , Gattani VS ,Shah JH, Wadhai KG , Trivedi VB, Patel MH, Trivedi HL.

1) We have performed the largest number of KPD Transplantations (77 patients from 1 Jan 2015 to 1 Jan 2016) in our single center and to the best of our knowledge this is largest number for KPD transplants in single center in one year in the World. KPD constitutes 25% of living donor kidney transplant (LDKT) in 2015.

2) We have performed 274 KPD Transplantations in Our Single Center from Year 2000- 2015 and total 231 KPD Transplantations from Year 2011-2015

3) We Have Performed First Non-Simultaneous Domino Chain Transplant of 6 ESRD Patients and 6 Donors in Single Center in August 2015.

4) We Have Performed First International KPD Transplant on 17 Feb 2015.

5) In The Year 2013, we have performed 56 Kidney Paired Donation Transplantations in our single center. KPD constitutes 15.8% of LDKT in 2013.

6) In The Year 2014, we have performed 56 Kidney Paired Donation Transplantations in our single center. KPD constitutes 18.1% of LDKT in 2014.

7) We Have Performed Ten KPD Transplantations on World Kidney Day 2013 in Single Day in Our Single Center on 14 March 2013.

8) We Have Performed Successful Three-Way KPD Transplantation: First Time in India on 13 February 2013.

9) We Have Performed Successful Three-Way KPD Transplantation in Combination with Desensitization Protocol: First Time in India on 6 May 2014.

Under Mentorship of Prof. HL Trivedi, Vivek Kute is mainly focused on expanding donor pool and kidney-paired donation (KPD) transplantation. 

Correspondence Address

Dr.Vivek Kute. 

MBBS, MD, FCPS, DM Nephrology (Gold Medalist), FASN

Associate Professor , Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences , (IKDRC-ITS) Ahmedabad , India

(M) : +919099927543  

Email: drvivekkute@rediffmail.com  

Website : www.ikdrc-its.org

The real estate broker cartel is tough in India

Here's a report of real estate brokers in India roughing up the employees of a company that seeks to help buyers and sellers manage without realtors:
Sign of things to come? Property brokers rough up NoBroker.in CEO and employees
Property brokers in Bengaluru resorted to physical assault to shut NoBroker.in.

"Bengaluru-based online real estate startup NoBroker.in claimed that its office was “attacked” by local agents and brokers on Tuesday. As the name suggests, the startup helps customers to save money paid as brokerage, something which would worry traditional property brokers."

HT: Sangram Kadam

Deceased organ donation in India

The Times of India has the story:  Many pledge, but long way to harvest

"Almost one lakh people have signed up for organ donation dur ing the annual organ donation day campaign of the Times of India, over the last three years. That could translate into several lakhs of lives transformed or saved if all the pledged organs could be retrieved. However, the organ donation process is yet to be streamlined and not all donors are able to donate their organs because of the lack of infrastructure and adequate awareness.

"Thousands have registered as donors in a span of a fortnight. But experience has shown that of thousands of people who pledge, only a few are likely to convert into donations after brain death.
...
"One of the most glaring inadequacies in the organ donation programmes is the lack of a national registry for organ donation, a centralised registry in the form of an electronic database, readily available to personnel involved in organ donation. Some states like Tamil Nadu and Kerala which have successful organ donation programmes in place have taken the initiative to set up their own centralised registry for organ donation, but a national-level database is still missing more than two decades after the Transplantation of Human Organs Act was enacted in 1994. In 2011, the 1994 law was amended to mandate various kinds of registries to track the organ transplantation system.The rules to implement the amendments were framed in March last year. Servicing large national-level registries would need support and financial commitment from the government. But almost Rs 150 crore allocated for it remained unutilized.
...
"Several people working to boost organ donation have pointed out that along with a registry for donors, there is the need for a recipients' registry too. The concept of cadaveric organ donation is built upon public trust which expects a system in place to ensure fair distribution of the organs donated. A centralized registry for recipients helps to build this trust as it guarantees fair allocation of organs for transplant. Lot more people would be willing to donate if they knew that there are strict rules dictating how transplant surgeons and coordinators determined who should be placed on the waiting list for organs and if the system was fully transparent, stated volunteers who work on campaigns for organ donation.
...
"Transplantation procedures are restricted almost entirely to private hospitals and thus remain beyond the poor and middle classes' reach. Even in public hospitals, where transplantations are infrequent, a liver transplant costs about Rs 12 lakh.With post-transplant costs of around Rs 10,000 a month, for immunosuppressive drugs to prevent rejection of the new organ, such procedures remain inaccessible for the poor. If no system is put in place by the government to help fund the cost of transplants, India's organ transplant programme would become one accessible only for a small section of those rich enough to afford the surgery and treatment costs. There is an urgent need for the government to come up with financial support to make transplant surgeries accessible for all who need them, even the poor."

Tourism pricing at the Jaipur observatory

Here's the price list...

And well worth it, to see a sculpture garden of assorted sundials of varying sophistication:

Bollywood support for organ-donor registration in India

A Bollywood film and its cast promote deceased organ donation: Ship of Theseus carries message about organ donation

Read more: http://www.thenational.ae/arts-culture/film/ship-of-theseus-carries-message-about-organ-donation#ixzz2cfAO6go9
Follow us: @TheNationalUAE on Twitter | thenational.ae on Facebook

"The film Ship of Theseus, India’s latest art-house sensation, aims to make the audience leave the cinema quietly resolving to sign a pledge donating all their organs.

"In fact, the film’s cast, as well as the filmmaker Kiran Rao and her husband, the Bollywood actor Aamir Khan, attended a function in Mumbai last week to pledge their organs.

“We had discussed it before but after seeing Ship of Theseus, we realised that it was something we had to do – give the gift of life and use our bodies to change the life of not just one person but several,” said Rao.

"The central question of Ship of Theseus derives from a question posed by Plutarch: if you replace all the decayed planks of a ship, does it remain the original ship?"

HT: Seema Arora

Ten kidney exchange transplants on World Kidney Day in Ahmedabad, India

Here's the link:

Clinical Studies

Ten kidney paired donation transplantation on World Kidney Day 2013: raising awareness and time to take action to increase donor pool

Posted online on August 12, 2013. (doi:10.3109/0886022X.2013.823997)

Vivek B. Kute¹, Aruna V. Vanikar², Pankaj R. Shah¹, Manoj R. Gumber¹, Himanshu V. Patel¹, Divyesh P. Engineer¹, Pranjal R. Modi³, S.J. Rizvi³, Veena R. Shah⁴, Manisha P. Modi⁴, Kamal V. Kanodia², and Hargovind L. Trivedi¹

¹Department of Nephrology and Clinical Transplantation,

²Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology,

³Department of Urology and Transplantation, and

⁴Anesthesia and Critical Care, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS),

Ahmedabad

, India

Address correspondence to

Dr. Vivek Kute

, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases & Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC- ITS), Civil Hospital Campus,

Ahmedabad 380016, Gujarat

, India. Tel.: +91 79 22687000; Fax: +91 79 2268 5454; E-mail: drvivekkute@rediffmail.com

Abstract

Background: Kidney paired donation (KPD) is feasible for any center that performs living related donor renal transplantation (LRDRTx). Lack of awareness, counseling and participation are important hurdles in KPD patients with incompatible donors. Materials and methods: This is an institutional review board approved study of 10 ESRD patients who consented to participate in the KPD transplantation at our center. All the surgeries were carried out on the same day at the same center on the occasion of World Kidney Day (WKD) (14 March 2013). All recipients had anatomic, functional and immunological similar donors. Results: KPD were performed to avoid blood group incompatibility (n = 8) or to avoid a positive crossmatch (n = 2). None of the patients experienced delayed graft function and surgical complications. At 3 month follow-up, median serum creatinine was 1 (range 0.6 to 1.25) mg/dL and two patients developed allograft biopsy-proven acute rejection and responded to antirejection therapy. Due to impact of our awareness activity, 20 more KPD patients are medically fit for transplantation and waiting for permission from the authorization committee before transplantation. Conclusion: This is a report of 10 simultaneous KPD transplantations in a single day in a single centre on WKD raising awareness of KPD. KPD is viable, legal and rapidly growing modality for facilitating LRDRTx for patients who are incompatible with their healthy, willing LRD.

Read More: http://informahealthcare.com/doi/abs/10.3109/0886022X.2013.823997

Farmers in India petition to be allowed to sell organs

I (would like to) assume that this story from India only concerns sale of live kidneys for transplantation, but it isn't completely clear to me, given the mention of suicides due to debt:

Allow us to sell our organs to repay our debts, farmers tell PM

"Unable to repay bank loans and to highlight their miserable plight, a group of farmers from Haryana have sought permission from Prime Minister Manmohan Singh to allow them to sell their vital organs.

"The farmers' group who held a rally at Kurukshetra on Monday under the aegis of Bharat Kisan Union (Tikait), held placards displaying a rate list of their organs.

"Later, 33 farmers handed over a letter to the Kurukshetra Tehsildar to be forwarded to the Prime Minister, BKU's state unit chief Gurnam Singh said on Tuesday.

"We are left with no other option, but to sell our vital organs. Over 20,000 farmers have ended their lives across the country due to debt burden. At least, selling our organs would enable us to repay the debt and live for a few years more and feed our families," he said."

HT: Sangram Kadam

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We'll be traveling in India in the coming days, so at least some of my blog posts will be from inventory...

Kidney exchange chain in India

Kidney exchange makes some progress in India: the story is here.

HT: Seema Arora

Kidney exchange in India

Outcome of kidney paired donation transplantation to increase donor pool and to prevent commercial transplantation: a single-center experience from a developing country.

Kute VB, Gumber MR, Patel HV, Shah PR, Vanikar AV, Modi PR, Shah VR, Patel MP, Trivedi HL.

Source

Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India, drvivekkute@rediffmail.com.

Abstract

BACKGROUND:

Economic constraints in operating an effective maintenance dialysis program leaves renal transplantation as the only viable option for end-stage renal disease patients in India. Kidney paired donation (KPD) is a rapidly growing modality for facilitating living donor (LD) transplantation for patients who are incompatible with their healthy, willing LD.

MATERIALS AND METHODS:

The aim of our study was to report a single-center feasibilities and outcomes of KPD transplantation between 2000 and 2012. We performed KPD transplants in 70 recipients to avoid blood group incompatibility (n = 56) or to avoid a positive crossmatch (n = 14).

RESULTS:

Over a mean follow-up of 2.72 ± 2.96 years, one-, five- and ten-year patient survival were 94.6, 81, 81 %, and death-censored graft survival was 96.4, 90.2, 90.2 %, respectively. Ten percent of patients were lost, mainly due to infections (n = 4). There was 14.2 % biopsy-proven acute rejection, and 5.7 % interstitial fibrosis with tubular atrophy eventually leading to graft loss.

CONCLUSION:

The incidences of acute rejection, patient/graft survival rates were acceptable in our KPD program and, therefore, we believe it should be encouraged. These findings are valuable for encouraging participation of KPD pairs and transplant centers in national KPD program. It should be promoted in centers with low-deceased donor transplantation. Our study findings are relevant in the context of Indian government amending the Transplantation of Human Organs Act to encourage national KPD program. To our knowledge, it is largest single-center report from India.

Kidney exchange in India

This story of kidney exchange in India reminds me of the early days in the U.S., before there was a thick marketplace. (In addition it sounds as if Indian laws make exchange difficult, no doubt with the intention of making difficult the cash-for-kidneys black market...)

""Both the patients had approached us separately. They had come along with came individually with their respective wives as probable donors. But the transplants could not take place at that time as the blood groups of the patients and that of their respective wives did not match," said Dr Deepak Shankar Ray, the head of nephrology at RTIICS.

"Later, while scanning through the list of renal failure patients with renal failures and their prospective donors (related) who had come to the hospital, Ray happened to stumbled upon the fact that Manoj Kumar's blood group which is A +matched that of Umesh Prasad.

"Gupta's wife's, while Gupta's blood group was the same as which is B + matched that of Kumar's wife. While Nandarani and Gupta are B+, Kumar and Reena are both A+. The doctor then acted as a link between the two parties informing them that the transplants could happen if their wives were ready to donate their kidneys to someone else.
...
"Armed with no-objection certificates from the health department of their respective states (mandatory under the Organ Transplant Act), the patients came back returned to Kolkata a few weeks back.

"In Kolkata, advocate Subhomoy Samajddar filed affidavits at Alipore court that is required for unrelated donor transplant. The court has granted permission and we will forward all documents to the state health department next week that will complete all the legal formalities," said Sumato Ghosh, the legal manager at RTIICS."

Indian surrogates bearing British babies

The Telgraph reports: how more and more Britons are paying Indian women to become surrogate mothers.

"There are now up to 1,000 clinics, all entirely unregulated, in the country, many specialising in helping Britons become parents.

"Couples and single people are paying an average of £25,000 a time to have children, getting around rules in the UK which make commercial surrogacy illegal.

"It is estimated that 2,000 births to surrogate mothers took place in the country last year, with most experts agreeing that Britain is the biggest single source of people who want to become parents in this way. Britain may account for as many as 1,000 births last year in India. In contrast there were 100 surrogate births recorded in Britain last year.
...
"Dr Sharma has chaired a committee which has drawn up proposals for industry standard. It would guarantee safety standards for the first time, outlaw sex selection, forbid women capable of childbirth making use of surrogacy and set up the first register of clinics, with a regime of inspections and sanctions for those which fail them.
...
"However the legislation has yet to be considered by India’s parliament and it could be many years before it becomes law. Dr Sharma’s committee has called for urgent action.
...
"Clinics in India offer fertility treatments which would-be parents in Britain would either be unable to have for legal reasons, or would face lengthy waits on the NHS to obtain.
...
"One clinic in New Delhi, The Birthplace of Joy, said that their patients were “100 per cent foreign” and estimated that as many as half of them were homosexual couples wanting to become parents."

Kaushik Basu on India

Kaushik Basu, Currently on leave from Cornell as Chief Economic Adviser, Government of India, gives a wide ranging interview.

On Indian bureaucrats and bureaucracy:
"But one of my big surprises when I joined the government of India was to see the quality of the top civil servants in India. They really are very talented people, because it is a highly competitive system of recruitment. But the efficiency of the bureaucracy leaves so much to be desired. It’s like getting a bunch of ace drivers and then getting caught up in a traffic jam and leaving them there. There is something in the system which makes it go very slowly and sluggishly. I’ve felt this frustration as an ordinary citizen before I joined government, and I feel it now because I feel that if we can do better then India’s economy can really take off.

"There are two major things that can hold back an economy. One is the physical infrastructure, and the other is this soft infrastructure, which is the bureaucracy. On the physical infrastructure, I’m very optimistic that India is going to change. Even within the next four to five years, you’ll see the change. There is investment happening, the government is putting in money, and it will improve. On the bureaucratic side, it’s very tough. Everyone frets about it, but you don’t quite know where to begin. I’m less hopeful on that. However, the economy has done well despite that because, mercifully, one big difference with China is that India’s government, despite the inefficiency, doesn’t quite have the power of the Chinese government."
...

"Now to my policymaking work. In our everyday life, we have to practice what I call normal economics. You have to recognise and respect the laws of the market, allow individual enterprise to flourish, international trade has to be open, and all the regular things economists say I would also repeat. At the same time we must not blight our chances of a more idealistic world. My book is based on two views of the invisible hand. For Adam Smith, the invisible hand was the little minions going about their everyday life, unwittingly creating order. That’s true in many domains, and its discovery was a major scientific breakthrough. But I contrast it with Kafka’s view, drawing on The Trial and The Castle, where little minions are going about their everyday chores without thinking about the larger implications of their actions and they create a horrific world. The book argues that both these visions have a role to play. Economists have given complete predominance and priority to the Smithian view, but we should be aware of the Kafkaesque view of what can happen and take guard against such a predicament.

Have you been able to move that into the policy world in your current job?

"No. My work as a policymaker is to attend to everyday life. This is what I meant by normal economics. What I do now is normal economics. I have to make sure that prices don’t rise too fast, interest rates don’t fluctuate too much, India’s economic growth is rapid and sustained, and unemployment is low. There is a lot of standard economics that addresses these matters. We need to apply this accumulated wisdom well and that’s what I try to do my best with. To reject all standard economic theory as conspiracy, as some do, is a big mistake. It can only lead to policy failure. But, at the same time, we must not abandon the somewhat utopian project of creating a distinctly better world some day. This needs a lot of analysis and research. The possibility of such a world is what my book is about.

The Red Market: from grave robbers to organ brokers in India

Laura Miller at Salon reviews "The Red Market: On the Trail of the World's Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers"

"It includes vivid, on-the-spot reports from Indian "bone farms," where remains looted from graveyards are processed into skeletons for Western anatomy students (hundreds of reeking bones left out to bleach in the sun) and tsunami refugee camps where most of the residents bear the scars of kidney "donations."
...
"Poor people supply human flesh in various forms for rich people, while a well-meaning ethical system of anonymity and mandated "altruism" allows middlemen to siphon off most of the profits.

      "When the supply isn't sufficient to the demand, some enterprising individuals take it upon themselves to even things up.
...
"Carney argues that the inequities of the red market were only exacerbated by regulations like the National Organ Transplant Act of 1984, which prohibited the sale of human organs and tissue and was championed by then-Sen. Al Gore as a way to make sure that the human body could not be treated as "a mere assemblage of spare parts." Although Carney is no fan of the market philosophy that would reduce our bodies to salable "widgets," he thinks we need to face up to the fact that altruistic donation will never provide as much of these precious materials as we desire. "As a society we neither want to accept open trade in human tissue, nor do we want to reduce our access to life-extending treatments. In other words, we want to have our cake and eat it, too."


HT: Steve Leider (who knows something about repugnant markets)

And here's the NY Times review.