The news that numerous unrelated donor renal transplants are being permitted in Bangalore will surprise no one. It is near axiomatic that whenever anything is in short supply, as kidneys are, and when a few people are given discretion on the allotment of the scarce commodity, as the authorisation committee is, the ground has been prepared for misuse of power. A similar situation (and no less important) exists in the field of medical education. The abandon with which different states are rushing to permit private medical colleges, which charge exorbitant amounts for seats, is cause for serious concern. Unfortunately, those who should be advising the government on such matters are themselves using these avenues for their children and as post-retirement sinecures.
The harmful effects of this kind of subversion of the system will be felt widely and deeply. In the field of renal transplantation, the availability of cheap live donors (the amount paid in Bangalore is reported to be around Rs.35,000) is likely to be one of the reasons that cadaver transplantation has not taken off in India. When opinion-makers have access to live donors, very few are altruistic enough to help in the tough job of developing a cadaver transplant programme. Also, in the present scenario of free availability of live donors, very few doctors involved in transplants have the commitment to push the cadaver programme. Not many lay people realise that this is a major impediment in transplanting other organs like the liver, lungs and heart. The only cadaver transplant programme that is somewhat successful in India is for the cornea, and the success in this field suggests what is possible if commitment is available. The fact that so many people are willing to donate their eyes gives the lie to the oft-repeated statement that Indians are unwilling to donate their organs.
The rates that are being charged for medical education are horrifying. One institution in Chennai is reported to be charging Rs 25 lakh for an MBBS seat and amounts like Rs 45 lakh for a post-graduate seat depending on the demand. This is unaccounted-for money, and the fact that the regulators are turning a blind eye to this wholesale subversion of the rule of law in India is a pointer to the depth of the rot. I do not hold the view that all the doctors from these colleges are bad, or, conversely, that all the products of the regular system are paragons of virtue. But the principle here is that this method of admission lays the ground for all kinds of abuses. To take but one example, the pressure to recover the investment in medical education on these students must be immense. Will they not be tempted even more than others to do unnecessary surgery, investigations, etc?
What all this illustrates is that the present systems and institutions in India are so designed that the potential for corruption is built into the system. It is true that any number of laws cannot totally eradicate the problem. It is also true that corruption exists in all societies. But the point here is that in India it is of such colossal proportions that it is damaging the entire society. When a system of ethics is not part of the accepted norms of society, the potential for dangerous destabilisation exists. And this is what we are now witnessing in India. Never before has it been so obvious that money can buy anything. The resultant divisions between those who have money and those who do not, is becoming deeper than ever before. Superficially, it appears that poverty has decreased, or at least not increased in the last few years, but the difference in consumption has definitely grown by leaps and bounds.
The moral effect of this difference should not be underestimated. When you can buy anything, from a kidney to a medical degree, the message is that you are living in a society where everything is a commodity, available for sale; you only have to find the money. The next easy step is that the method of acquiring money is unimportant; the only important thing is to have it. We have then arrived at the situation where the very people who are supposed to implement the law subvert it in order to get money.
It is now more important than ever to keep fighting this canker. We must use every means available to us to re-establish the role of ethics and morals in society. Although we may concentrate on the medical profession because we belong to it, we must intervene in other areas too. If the legislature, the judiciary and the executive are all corrupt, the possibility that other areas of society will be corrupt too, increases. Amongst medical professionals, we must seek to make ethical behaviour the norm. The efforts of the Forum for Medical Ethics Society must be strengthened and expanded.