The backstory: Looking for an organ donor

It was March. Mumbai had already started to boil with humidity. Outside Dadar station, I looked for Ravi – not his real name, but let’s get to that later.

We had never met before. On the phone, he had asked me to look for a tall guy near a juice shop. Sure enough, it was easy to spot him. His tall built distinguished him from the crowd.

We had juice, and over a straw, he narrated how his schedule was “very tight”. “I just dropped my daughter off at school. In a few hours I have to go pick her up again,” he said. “Then drop her off for tuition.”

I noted the dark circles underneath his eyes. He looked dishevelled. It felt like he had not slept at all.

In his forties, Ravi does odd jobs of servicing vehicles, both two-wheelers and cars. I was introduced to him by another journalist whose vehicle he often serviced. Ravi wanted to get in touch with someone who reported on health. I had no clue why. I was soon to find out.

Not far from the station, he walked us down to a charitable dialysis centre. Fifteen beds lay facing each other in a long ward. All occupied by silent, bored-looking, patients.

Ravi said he hated visiting the centre, even though he was a regular. His left upper arm was proof to go by. As he rolled up his cotton shirt’s sleeve, I saw a fistula attached to his forearm. The surgical vessel connects a vein and an artery to create a large and strong passage for blood to drain into an external tube at high speed. This blood then flows into a machine to get purified – ordinarily the job of kidneys that are supposed to remove toxins from the blood – before it is channeled back into the body through a second tube into the fistula.

When a patient has a fistula attached to their arm, it is usually a mark of kidney failure. Over time, the blood vessel grows so thick that the arm begins to bulge.

Ravi’s arm, because of the fistula, looked like a toned bicep. He said he underwent blood dialysis for four hours late at night twice a week. During the day, he worked and spent time with his family. “At night when they sleep, I come here for dialysis,” he said.

The routine was taking a toll on him, he said. He suffered from lack of sleep, and a general frustration with the life-long dependency on machines. Besides, the frequent dialysis meant a heightened risk of infection through the fistula.

We met a few other patients at the centre. Some of them had come from outside the city, drawn by the relatively cheaper cost of dialysis at the centre – Rs 250 per cycle against Rs 1,500 to Rs 4,000 in other private establishments.

For these patients, the only escape from this cycle of misery lay in securing a kidney transplant, either from a living family member or friend, or from a deceased donor who had suffered from a brain death. Many patients said they had been on the government waitlist for a kidney donation for over a decade.

Ravi had registered on the waitlist in 2021. “I don’t want to rely on dialysis my entire life,” he said, as he eyed the tiny white machines silently working at the centre. But he knew, looking at the other patients, that the wait will be long. And so he has been looking for other solutions – like buying a kidney.

For this, Ravi has started saving money. Apart from the cost of the kidney transplant procedure (about Rs 12 lakh), he needs another Rs 4 lakh to 5 lakh to pay a donor. He has made trips to Kolkata and Bangalore to meet “agents”. He has heard Sri Lanka is a popular base for kidney transplants, but he hasn’t saved enough to travel that far.

“Bas ek donor mil jaye” – all I need is a donor, he told me. “There are many people, you know, willing to sell.” By that he meant those poor and in need of money.

Ravi knows kidney donation in exchange of money is illegal in India. But no one in his family is medically compatible with him to donate their kidney . “Rich people do it all the time,” he said. “Why can’t a poor person do it to save his life?”

I advised him to stick to the government waitlist. He would surely find a brain-dead donor one day, I reasoned.

“Will I be alive till then?” he laughed at my suggestion.

“The system is so skewed, it forces us to do what is illegal,” he said.

Ravi wanted me to write about the problems poor patients face in getting kidney donations, and how the rich, almost always, get away with illegalities. Over the years, he said he had collected evidence of government and private doctors taking bribes to do illegal organ transplants. He wanted me to bring that out. “I have made friends in different hospitals,” he said. “They told me all about it.”

I knew that the word of hospital staffers wouldn’t be enough to establish any wrongdoing. But I did end up writing a piece on the skewed nature of organ donation in India, where wealth determines a kidney patient’s fate.

I did not mention Ravi in my piece.

A few days ago, when a report surfaced of an alleged kidney racket in Delhi’s Apollo hospital, involving donors from Myanmar, Ravi called me to ask: “Did you read about the kidney donors from Myanmar?”

I asked him whether he had found anyone. “Still struggling,” he said.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.