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Complex nexus of demand, poverty, and regulatory gaps makes South Asia the hub of illegal kidney transplants.

The Delhi Police Crime Branch recently put an end to a suspected international kidney transplant scam that operated within the National Capital Region (NCR) and Delhi. The operation resulted in the apprehending of seven individuals. including a doctor and her assistant. Dr. D. Vijaya Rajakumari, a well-known female doctor from Delhi, was among those charged with arranging illicit kidney transplants with donors and recipients primarily from Bangladesh.

Approximately fifteen Bangladeshi nationals had procedures performed by Dr. Rajakumari, a fee-for-service practitioner at a Delhi hospital, in a Noida hospital from 2021 to 2023, according to authorities.

According to media reports, falsified medical records and 23 forgeries of stamps belonging to doctors and notary publics were among the evidence found during the search.

The renal patients in Bangladesh, who were mostly from low-income families, were the primary targets of the scam, which enticed them to India with promises of employment. To undergo kidney transplants in India, a legal requirement, they had to fabricate ties between donors and patients, and upon their arrival, the authorities confiscated their passports.

Vikram Singh, who was Dr. Rajakumari's personal assistant and dealt with patient files and affidavits, and Md. Sharique, who helped arrange appointments and medical tests, were integral parts of the well-coordinated racket. All donors received meagre payments, ranging from 20,000 to 60,000 rupees per patient.

The operation's major figure, Rasel, a native of Bangladesh, earned commissions of up to Rs 25–30 lakh per transplant for facilitating transactions between donors and patients. The scheme also implicated members of his inner circle. including Rokon, who oversaw pathology testing, and Sumon Miya, who drafted forgeries.

A number of variables contribute to the pervasiveness and severity of illegal kidney trafficking in South Asia, making it more than just one incidence.

There is a significant gap between South Asia's legal supply of kidneys and the high demand for transplantation. Due to the long wait times for legal transplants, patients with end-stage renal illness often resort to unlawful means to receive a transplant.

On top of that, acute poverty in the region, despite robust GDP figures, creates an environment of desperation among donors, leaving them financially abused and medically exposed.

Moreover, South Asian organ transplant regulations are frequently both weak and inadequately implemented. Law enforcement and medical practitioners' corrupt practices make efforts to prevent illicit practices even more complicated.

Illegal kidney transplants, which are the second-most profitable organised crime globally, are the most commonly trafficked organs. Estimates suggest that the global market for kidneys alone may involve tens of thousands of illegal transplants annually, generating revenues in the billions of dollars. Transplants can occur across international borders, making it more challenging for law enforcement to combat this issue. Experts express concern that, in order to avoid discovery and take advantage of legal gaps, organised crime networks traverse international borders.

Organ transplants and other expensive medical procedures are drawing patients from more affluent countries to South Asia, where a growing medical tourism sector caters to their needs. Despite the obvious ethical and health concerns, the area is appealing because kidneys are available on the illicit market.

Two landmark global initiatives that have tackled moral and legal issues surrounding organ trafficking are the Lancet Kidney Campaign and the Declaration of Istanbul. These campaigns are calling for strict rules and standards to stop transplant tourism and ensure transparent and ethical organ donation.

The Lancet Kidney Campaign and the Declaration of Istanbul are two significant initiatives that aim to address the ethical issues surrounding organ transplantation, combat organ trafficking, and transplant tourism. The Lancet Kidney Campaign focuses on improving kidney health outcomes, raising awareness about kidney diseases, advocating for policy change, supporting research and innovation, and fostering collaboration and partnerships. On the other hand, the Declaration of Istanbul establishes ethical guidelines for organ donation and transplantation, prohibits organ trafficking and transplant tourism, protects vulnerable populations, and promotes international cooperation. These initiatives have had a significant impact, as global endorsement of the Declaration of Istanbul has sparked legislative reforms and policy initiatives. However, challenges remain, including inadequate enforcement of laws, insufficient resources for monitoring transplant practices, and disparities in access to legal transplantation services. Despite these challenges, the Lancet Kidney Campaign and the Declaration of Istanbul play crucial roles in promoting ethical practices and protecting the rights of donors and recipients in organ transplantation. Continued collaboration and commitment are necessary to address the complex challenges associated with organ transplantation and ensure equitable access to life-saving treatments worldwide.

Moreover, the Council of Europe Convention against Trafficking in Human Organs is urging lawmakers to make it illegal to take organs from living donors without their consent or for financial gain. Despite these global initiatives, problems persist, and places like South Asia are thriving centres for the illicit organ trade.

Due to high demand, poverty, and regulatory inadequacies, illegal kidney trafficking in South Asia continues to be a lucrative but dangerous operation. Strong international collaboration, strict legislation, and heightened initiatives to encourage ethical organ donation procedures are necessary to fight this trade.

To ensure ethical standards in healthcare procedures worldwide and to protect the rights and health of vulnerable populations, it is essential to address the causes of illegal organ trafficking.

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