Print version ISSN 0042-9686
Bull World Health Organ vol.81 n.7 Genebra Jan. 2003
Nepalis question the law against selling human organs
Hari Narayan Lama, who made a living from finding donors for patients with kidney failure, was taken into police custody on 4 May. He is charged with selling human organs for transplant, a crime according a Nepali law enacted in 1998. If found guilty, he will face up to five years in prison and a fine of up to half a million Nepali rupees (US$ 6667).
A kidney donor himself, Narayan confessed to police that he had persuaded more than 50 people to sell one of their own kidneys for transplant. A recipient pays the broker between US$ 2000 and US$ 3500, but the donor, being poor, is often satisfied with much less than this, so an able broker can get rich. Narayan, having been a donor himself and in good health, could easily persuade others to part with a kidney without fear of disablement.
One of his clients is Dr Sunil Chakradhar, a Nepali physician whose transplant was carried out in India. Chakradhar says there are 50 hospitals in India that are equipped for transplant surgery, and they compete for patients to cover their operating costs, offering commissions to brokers to find patients. This in turn encourages "transplant tourism", as the operation is more readily available and cheaper in India than in many other countries. In India too, however, it is a punishable offence to buy or sell human organs, and so the arrangements are made to a large extent unofficially except where the donor is a close relative.
No Nepali hospital is equipped for organ transplantation, but dialysis is available in some, including the National Kidney Centre. As dialysis costs nearly US$ 7000 a year, the Centre urges patients to arrange for a transplant in India as soon as they can. The Director of the Centre is Dr Rishi Kumar Kafle, who is Nepal's top kidney specialist. Thanks to a German donation, his centre has recently increased its number of dialysis machines from five to fifteen.
He believes the current law on transplants is too harsh, and puts transplant surgeons in danger of being criminalized for saving lives. Chakhradar is also against this law, arguing that he is still young, and if it had been enforced he would probably have been dead some time ago. His solution would be to provide more protection to donors against grasping middlemen.
The trial of Hari Narayan Lama will be a test of official and public opinion in Nepal. On the one hand organizing organ donations can save lives and perhaps solve a personal financial problem; on the other it puts pressure on the poor to sell their own living flesh to the rich.