Namakkal kidney racket exposes gaps in Tamil Nadu’s transplant regulation

The recent exposure of the Namakkal kidney sale racket may have shocked the state, but it is not the first time a private hospital has come under the scrutiny of the Directorate of Medical and Rural Health Services. In several past cases, action was initiated, but many hospitals managed to evade serious consequences, either by paying fines or temporarily suspending specific services, only to resume operations shortly thereafter.

In August 2024, Pride Super Speciality Hospital’s registration was cancelled over allegations of illegal kidney transplants and organ trade. The hospital's licences, including its transplant licence, were suspended, and it was ordered to shut down all operations, including outpatient services, and transfer all patients to other facilities. However, the hospital has since resumed regular services. The donor from Pallipalayam in Namakkal, the same place currently in the spotlight due to the recent case, had alleged that he was not paid the promised sum for kidney donation.

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In another case in Erode, the police were unable to take action over an alleged organ sale because the donor, who was offered Rs 5 lakh to sell his kidney at a hospital in Kerala, did not file a complaint.

Not restricted to TN

Such incidents are not confined to Tamil Nadu; similar cases have been reported in other states, often involving individuals from Tamil Nadu. In one incident in May this year, two Chennai-based individuals were arrested in Hyderabad for their involvement in human organ trafficking. The Crime Investigation Department, which made the arrests, revealed that the suspects lured poor individuals from Tamil Nadu to Hyderabad with false job promises and then offered them money in exchange for a kidney.

A 2006 study titled “The Trade in Human Organs in Tamil Nadu: The Anatomy of Regulatory Failure” identified four key obstacles to the effective implementation of the Act: the commercial interests of middlemen and service providers, ambiguities and loopholes within the legislation, limited monitoring capacity of regulatory authorities, and the pressure and responsibilities placed on the authorising committees.

In a case of organ trafficking investigated in Kochi in June 2024, recipients were found to have links to Iran, while the donors were impoverished individuals from rural areas of Tamil Nadu. According to health experts, small towns and villages remain vulnerable targets for middlemen. Though such incidents continue to surface periodically, authorities rarely take decisive action, such as shutting down the hospitals involved or holding the culprits accountable.

More hospitals involved?

In the Namakkal case, health department officials suspect that certain private hospitals in Erode, Trichy, Thanjavur, and Perambalur may be linked to the organ trafficking racket, not just due to their proximity, but because tier-two and tier-three cities often serve as easy targets for those engaged in such illegal activities.

While the investigation is underway and the key accused, who brokered the organ donation, remains at large, it is evident that organ trafficking networks are preying on vulnerable individuals burdened by debt. In many of these areas, people who are unable to access bank loans due to a lack of proper documentation often turn to microfinance lenders, making them easy targets for middlemen involved in the illicit trade.

Easy prey for middlemen

“Tamil Nadu, though a developed state with a strong presence of small and medium-sized industries across its towns, sees many factory workers and daily wage labourers fall into debt traps when industries shut down or they suffer financial losses. This makes them easy targets for middlemen linked to hospitals. Unable to repay these loans, they tend to go to microfinance lenders. The middlemen involved in organ trafficking are often informed by microfinance lenders to identify desperate individuals willing to sell organs, such as kidneys, without scrutiny, ensuring a steady supply for illegal transplants,” Dr R Shanthi, National Secretary of the Doctors’ Association for Social Equality, told The Federal.

While the Transplantation of Human Organs Act outlines various provisions for action in such cases, there are significant loopholes, particularly in identifying the individuals responsible, gathering concrete evidence, and the absence of a complainant, which hinder effective enforcement.

“In the Namakkal kidney sale racket, forged documents were used in five out of six cases, complicating efforts to identify those responsible. The issue surfaced due to a conflict when the donor was not paid the promised amount, exposing the role of middlemen collaborating with hospitals. To curb such malpractices, improving infrastructure in government medical college hospitals is crucial. Establishing multi-specialty hospitals in southern Tamil Nadu could reduce reliance on private hospitals, where these illegal practices often occur, ensuring safer and more ethical healthcare access,” she added.

Exploiting legal loopholes

Health experts point out that several legal loopholes enable the involvement of middlemen in illegal organ donations and transplants. In many cases, no action is taken due to the absence of a designated authority to initiate proceedings and gaps in the existing legal framework.

Speaking to The Federal, Dr J Amalorpavanathan, convenor of the Tamil Nadu Cadaver Transplant Programme, says that the rural areas are usually targeted because hospitals engaging in such practices and even middlemen involved are aware that they can find the vulnerable individuals who would be willing to donate the organs in such places.

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“There may have been hundreds of such cases since the Act came into force in 1994, yet very few have resulted in punishment. A key reason is that only an appropriate authority is empowered to initiate action, and they must involve the police for investigation. If an individual medical officer files a complaint and the case proceeds without the authority’s involvement, the court is likely to dismiss it, even in cases involving serious malpractices in organ donation and transplants,” explains Dr Amalorpavanathan.

In 2024, the Union Health Ministry, in an advisory to all the states, had pointed out that some states are not compiling living and deceased donors’ data, which were essential to monitor the implementation of the organ transplantation programme and prevent commercial dealings in organs.

National registry of donors

While the National Organ and Tissue Transplant Organisation (NOTTO), established under the Transplantation of Human Organs and Tissues Act (THOTA), 1994, is tasked with maintaining a national registry of organ and tissue donors and recipients, including living donors, there are critical gaps in implementation. Private hospitals are expected to link both living and deceased organ donations to NOTTO to ensure data is shared for the national registry. However, the state health department currently lacks a system to collect and track data on living donors.

The Transplant Authority of Tamil Nadu (TRANSTAN) currently monitors only cadaver donations and facilitates related transplants in the state. However, incidents of malpractice in living donor transplants highlight the urgent need for a dedicated regulatory body to oversee living donor transplants, beyond merely granting approvals for organ donations.

“There are authorisation committees in place to grant permissions and oversee living organ donations and transplants in the state. These committees operate in Chennai, Madurai, Dharmapuri, and Coimbatore, and are responsible for approving living organ transplants across Tamil Nadu. However, despite these safeguards, some miscreants manage to exploit the system by forging documents and bypassing required criteria, as seen in the Namakkal case,” said Dr N Gopalakrishnan, Member Secretary, TRANSTAN.