Posts Tagged ‘Poor’

Commodifying Bodies.

3 February 2008

24th January, Thursday, Gurgaon police raided a house in an upscale colony that was in reality a state of the art facility racketeering in kidney transplants. Transplantation of Human Organs Act, 1994 (TOHA) was enacted specifically in the wake of similar rackets unearthed in early nineties. TOHA prohibits organ exchange between any persons with the sole exception of “near relatives” (parents, siblings, progeny, & spouse) & any related commercial transactions. Kingpin of the lucrative but obnoxious organ trade has been identified as Dr. Amit Kumar, who earlier went under the name of Dr. Santosh Raut, & had been arrested thrice previously in Delhi, Mumbai & Hyderabad and had been a focus of two sting operations by TV channels. There would be other fugitive operators like him, but it’s a small blessing that a habitual offender has been caught at it again probably indicating this malice hasn’t become pandemic yet. Though differences between touts have been sighted as the cause of a police tip off, what the outcome was of previous investigations against the suspects or why they were not under surveillance are issues worth close scrutiny. Complicity of the organs (pun unintended) of state is suspect.

This ‘Kidney Exchange’ is suspected to have put through between 400-500 ‘transactions’, where seller received INR 50,000 to 100,000 and the end user-buyer paid INR 1.5 to 2.5 million. Market intermediaries, like exchange administrator / doctors / touts, sucked up the difference. Buyers came mostly from USA, UK, Canada, Saudi Arabia & Greece, whereas sellers, mostly labourers with their bodies as the only tangible and tradable asset, came from Meerut, Moradabad, Gaziabad & Delhi. Why does kidney exchange command such premium lubrication? First answer suggests itself, the huge supply demand gap. Indian Medical Association estimates that about 200,000 individuals need organ transplants (about 80,000 of them Kidney transplants) in India. This probably is the observed demand that has surfaced on the buoyancy of economic resources at command of those who seek treatment. Latent demand that due to lack of money can not even dream of accessing the medical system could be much larger. Availability against this is about 4000 donors. Such large disparity is surely going to command a huge premium on the services rendered by providers. An unstoppable magnetic business proposition for a few criminally inclined. Only piece of this jigsaw is how to augment supply. Answer to this lies in the huge income disparity in our population where large swathes of it are barely eking out existence. Monetary allurements do entice some to trade their organs for a bit less burdensome existence. Some more may be netted through false promises or are simply duped into parting with their ‘assets’. Business carries on in complete disregard to what the law says so long as law enforcement does not walk its talk.

An economist has argued that nonsensical laws are responsible for such deviant behaviour. He advocates a theory popular among majority of economists, ‘Market knows best’
“Some part of this unmet demand certainly filters through to the illegal market. That’s inevitable, when one creates a mismatch between supply and demand through legislation that runs counter to market rules. If one doesn’t want to cite centrally planned economies of East Europe, there is the shortage economy of pre-1991 India. Laws counter to common sense will be violated. Enforcement is easiest when the law makes sense and is, therefore, almost self-enforcing. Nonsensical law is impossible to enforce. That proposition is almost tautological.”
Then he diagnoses what happens when law distorts the market.
“If a market is driven underground, it increases transaction costs, because it becomes unorganised. An unorganised market implies lack of efficient information flows, higher prices, a long chain of intermediaries (read brokers) and operations performed not by trained doctors, but by quacks, with adverse health implications for both donors and recipients. Not very different from what happens when abortion is illegal.”
The medicine he proposes is disarmingly benign & sensibly deceptive.
“Eventually, we recognised that if legislation created the shortage, the best course was to increase supply by amending the offensive law. Ditto for FERA (Foreign Exchange Regulation Act) and assorted economic legislation.”
Lastly he adds what he finds are counterproductive provisions of TOHA.
“Instead of controlling and banning organ transplants, the government would have been far better off (and donors and recipients too) had one tried to regulate it, by allowing non-related donor transplants, not just cadavers, and even commercialisation and foreign recipients. Had that been done, we might have been able to throw in insurance for donors, most of whom are poor.”

Seeking sensible points in this argument, one finds that law-drafters did indeed go overboard when they defined too narrowly legal transplants by restricting donors to cadavers & near relatives. Many recipients may find a willing donor acting purely out of humanitarian consideration from among relatives excluded by law & even friends. Today this category cannot donate. Probably fear weighed on them that a commercial transaction may be disguised as a humanitarian & they were anxious to plug this anticipated loophole. But in doing so they threw out the baby with the bath water. This provision certainly needs to be reworked so that genuine donations pass through while sells are weeded out.

Enacting laws by themselves, however majestic, does not eliminate crimes. When statutes on record are enforced firmly, unexceptionally & transparently without fear or favour, then most will comply – either because they believe in principals that laws uphold or they fear the punishment transgression invokes – though a few may always fall foul them. This has been true in all times & climes. Laws also need to be fair & should not militate against innate sense of what is right or just, or otherwise they may face mass defiance. But when laws are ill enforced, crime detection & investigation are lax or are ready to work in cahoots with criminals, then holding laws responsible for the failure to achieve stated aims is patently disingenuous. When in most parts of the country police complain of severe shortage of manpower, there is always a huge posse ready for VIP security duties. If priorities are set right, then enforcement can improve within existing budgets.

Permitting commerce in organ transplants needs to be approached far more gingerly & needs an open debate. Our economist has wrote in a cavalier way on this, where he almost adds as an afterthought, “…we might have been able to throw in insurance for donors, most of whom are poor”, as if doing a favour to a beggar by chucking a coin at him. His point may be based on the notion of “Free choice” similar to other modern values of Liberty, Equality, right to life, etc. If there is a transaction between two individuals conducted of their own free will without coercion, then why others should object so long as no one else is harmed. In theory it sounds unexceptionable, but will it be so in practice. Is it sensible in practice? First unspoken assumption that it’s a transaction between equals, at least who stand on equal footing or to use a more popular expression, have a level playing field, breaks down in practice. It is violated on account of disparities in wealth, education, information, opportunities, access, etc. When level playing field is held sacrosanct in business, then why shouldn’t it be so in organ trade? Second tacit assumption is that all or most individuals in need are reasonably affluent to afford commercially procured organs. What happens to those who at least have the gumption to seek organs but can’t afford it? Or are rights to health or life to be treated as abridged by capacity to pay? Thirdly, it has been argued that if “organ exchanges” become legal, then that would drive down transaction costs and make organs more affordable. When buyer is willing to pay, should not seller, better informed somehow through some suitable mechanism that market theorist will undoubtedly devise, get to keep most of those millions? Donor can wait for a suitable price, recipient can’t. Markets are unforgiving – aren’t we told?

Economics besides, most would not like to shortchange moral & ethical dimension of life. Planned economies have failed people in 20th century. Market economies have served people well in quite a few countries. So the argument goes that markets are the best arbitrators of not only economy but human life & destiny. Such blanket pronouncements are highly risky. Pedophilia exists even if it is illegal almost everywhere. Why not apply the market principle here by creating an exchange where pedophiles may legally procure children? May be the children or parents of children will fetch a good value that way, whereas both are defrauded presently. Many would react in horror to this suggestion. But come to think of it, before early twentieth century it was common for mature men to marry girls who were barely pubescent, hardly 11 or 12 years old. It was not so because of markets. Social mores didn’t see it as immoral or unethical. Then the life expectancy at birth too was in late thirties to early forties. Even with these inputs about their ancestors, people would find the idea of pedophile-exchange morally repugnant. Similarly, unless the anomalies stated above and may be yet others that an open forum will throw up are comprehensively redressed, it would be hard to avoid a sense of outrage one feels. Everything in life cannot be commodified. It shouldn’t be. Everything in life cannot be monetized. It shouldn’t be.