The Flipside of Medical Tourism: Organ Transplant Rackets

Why in News?

• Newspapers carry frequent stories of acts of spontaneous solidarity by ordinary Indians donating organs.
• Simultaneously, there is news of scandals, often involving the buying of organs from the vulnerable. 
• Every news on organ transplantation poses difficult questions and tests us collectively and therefore it becomes imperative to understand the flipside of medical tourism and challenges in tackling organ transplant rackets.

The Paradox of Organ Transplant System in India

• Inspiring Stories of Solidarity and Scientific Progress
  • Newspapers frequently share heartwarming accounts of ordinary Indians selflessly donating organs from deceased family members, reflecting acts of spontaneous solidarity.
  • Instances of parents donating their brain-dead babies' organs amid unimaginable grief showcase the altruistic nature of organ donation.
  • Scientific breakthroughs in transplantation highlight the positive impact of collaboration, teamwork, and advancements in healthcare.
• Simultaneous Scandals and Unethical Practices
  • Amidst the uplifting stories, there are disheartening instances of organ trafficking scandals, often involving the vulnerable.
  • Recently, a Kolkata hospital was investigated for luring Nepalese street children as kidney donors.
  • A recent Myanmar-based ring was exposed for arranging paid kidney donors, leading to transplants in a prominent Delhi hospital through forged documents.
  • Despite being illegal globally, the buying and selling of human organs persist due to high demand and normalisation of body commodification.
  • Also, unethical transplantation requires the collusion of expert doctors whose professional oaths condemn organ trading.

Strange Dichotomy of Medical Tourism in India in the Context of Organ Transplant

• Expansion of Transplantation Technology in India
  • The growth of transplantation in India, largely in the private sector, has been exponential, focusing on tertiary care.
  • Transplants need well-trained personnel, technology, advanced intensive care and an institutional drive for good outcomes.
  • These conditions were met in an expanding private sector, especially corporate hospitals.
  • Corporate hospitals, driven by an institutional push for positive outcomes, have facilitated access to transplants beyond kidneys for a section of Indians who previously lacked such accessibility.
  • Medical tourism, leveraging India's healthcare expertise, seems beneficial in a globalised world, with patients from other countries seeking treatment and India earning revenue.
  • The assumption is that profits from the private sector are reinvested, contributing to the country's economic growth.
• Yet, it is Costly for Indians
  • Recognising the revenue potential in medical tourism, the corporate health sector in India has actively engaged in transplantation.
  • They attract patients from South Asia, Central Asia, and Africa.
  • Transplantation is relatively inexpensive for foreigners in India compared to the global average.
  • The whole scenario of medical tourism and revenue generation creates a peculiar dichotomy where it remains costly for ordinary Indians.

Challenges/Complexities in Transplantation Medical Tourism

• Complex Patient Dynamics
  • Transplantation medical tourism involves very sick patients navigating a foreign country with a different language and culture.
  • Post-operative care for both donors and recipients extends beyond the operation, raising questions about the effectiveness of follow-up care upon their return.
• Establishing Relationships and Distinguishing Donations
  • The challenge lies in establishing a relationship between donor and recipient when they travel across borders.
  • Differentiating between paid and voluntary donations becomes crucial, requiring a robust system to prevent exploitation and coercion.
• Issues with Due Diligence and Certificates
  • Embassies are tasked with issuing certificates ruling out coercion or payment, but due diligence in this regard appears lacking.
  • Experience suggests that there may be gaps in the verification process, compromising the authenticity of these certificates.
• Impartiality of Authorisation Committees
  • Authorisation Committees in India are entrusted with ruling out organ trade, but conflicts of interest may compromise their impartiality.
  • Hospitals, driven by the pursuit of numbers and revenue, may inadvertently contribute to ethical lapses.
• Informal Referrals and Monetary Commissions
  • In the absence of a well-organised mechanism, informal referrals based on monetary commissions are prevalent.
  • Most foreign patients are recruited through agents who handle travel logistics and paperwork, potentially introducing vulnerabilities.
• Questions on Transplant Doctors' Awareness
  • Questions arise about whether transplant doctors are aware of or misled by forged paperwork, raising concerns about their role in detecting subterfuge.
  • While doctors claim it is not their responsibility to detect deceit, professional oaths place an ethical obligation on them to uphold the integrity of the medical profession.
• Impact on Trust in Healthcare
  • In a country where trust in healthcare is already under threat, news of a substantial number of foreigners receiving transplants poses a double-edged challenge
  • Trust is crucial for the success of the deceased donation after death project, and previous incidents of foreigners receiving heart transplants resulted in a significant drop in donations.
• Revenue Generation Model of Private Hospitals
  • Private hospitals, equipped with the capacity to perform transplants, are positioned to meet the demand swiftly, contributing to revenue generation.
  • The monetised health system is prone to seizing opportunities, whether legitimate or, if necessary, through illegitimate means to meet the demands of patients seeking transplants.
• Global Disparities
  • Global disparities in the availability of organ transplants lead patients to seek solutions abroad, often in countries like India where medical tourism is thriving.
  • The ability to pay for transplantation services becomes a crucial factor, further highlighting the economic dimensions of healthcare access.

Actions to Be Taken to Make Organ Transplantation Transparent in India

• Address the Debate of Solidarity and Scandal
  • The world has demonstrated that the future of organ transplantation lies in donation after death, emphasising the importance of deceased organ donation.
  • In India, continuous appeals are made to ordinary citizens to donate organs after death, with support from the government, including the Prime Minister's involvement.
  • The effectiveness of organ donation campaigns is contingent on the selflessness of citizens, but scandals in the transplantation system may erode trust.
  • Citizens may be hesitant to participate in donation efforts if they perceive a scandalous environment or if they question the fairness of the system.
• Address Fairness and Affordability Concerns
  • A pressing ethical concern arises from the disparity between encouraging citizens to donate organs and the inability of many to afford transplants when needed.
  • The fairness of urging altruism while failing to address the financial barriers to transplantation raises difficult questions about the equity of the healthcare system.

Conclusion

• The dilemmas associated with organ transplantation highlight the complex interplay of scientific progress, economic interests, etc., to address challenges in healthcare access and organ donation.
• Balancing these challenges and concerns of healthcare requires a careful and collaborative approach.

Q1) What is the meaning of medical tourism?

Medical tourism (also called medical travel, health tourism or global healthcare) is a term used to describe the rapidly-growing practice of travelling across international borders to seek healthcare services. Services typically sought by travellers include elective procedures as well as complex surgeries, etc.

Q2) What is the contribution of medical tourism in India?

This has the capability to generate an additional $9 billion in patient inflow to India. To maximise the industry's potential, the government is pulling out all its aces. The aim is to make India the number one Destination for Medical Tourism in the world, tripling its revenue to $13 billion within 4 years.

Source: The Indian Express