For centuries, the holy city of Amritsar has been a centre of trade and commerce in north India. But only now have the people seen the unholy ways in which trade has diversified and that the newest commodity that pads the wallets of some well-known people in the city are human kidneys.

MARK OF TRAUMA: Donors with SP Kanwar Vijay Pratap Singh; (below) Kakkar Hospital

On January 11, the police arrested Dr Parveen Kumar Sarin, the top kidney transplant surgeon in the city, in connection with a thriving kidney racket. A.A. Siddiqui, additional director-general of police and chief of the special investigation team (SIT) that busted the scam, calls it the "mother of all scandals in trafficking of human organs". Conniving with Sarin was Dr O.P. Mahajan, principal of the Government Medical College and chairman of the Authorisation Committee, whose permission is needed for any patient to receive kidney from a person outside his family. Sarin, the police say, was the "kingpin" of the racket that involved transactions worth Rs 150 crore while Mahajan approved hundreds of transplants that were in gross violation of the law and the state Government guidelines. The Authorisation Committee which he heads allegedly overlooked financial deals between the donors and the recipients of the kidneys, flouting the rule that transplants should not involve monetary transactions. The committee issued hundreds of clearances on forged documents and even gave blank certificates to Sarin. Mahajan is now under suspension. Middlemen, donors, recipients and lawyers are among the 18 accused who could face imprisonment from three to seven years. The police are now spreading the net outside the state and investigating possible overseas connections.

In the past five years, 2,384 cases of kidney transplant were cleared by four government-appointed authorisation committees in the state. Of these, 1,972 were approved by the Amritsar committee and 1,522 surgeries were done at the Kakkar Hospital, a private institution where Sarin is the surgeon for kidney transplants. That itself should have been an achievement for the 40-something doctor, except that barring some two dozen cases, the transplants involved donors who were lured to sell their organs and recipients who were forced to cough up Rs 5-10 lakh. Says Siddiqui: "Amritsar had become a mandi for kidneys."

The kidneys trade has been going on in Amritsar for a decade. But after the Transplantation of the Human Organs Act, 1996 declared the sale and purchase of human organs illegal, there was a windfall for unscrupulous surgeons-the price tag of a kidney transplant rose from Rs 3 lakh to Rs 8 lakh. The Act stipulates that the kidney donor should be a blood relation of the recipient and only in exceptional cases can the donor be from outside the recipient's family. Amritsar's kidney traders made the exception the rule. Investigators say they have evidence that Sarin dissuaded most of his patients from accepting organs from their relatives and prescribed outside donors. "Transplanting kidneys procured through the mafia brought more money for the surgeon," says Kanwar Vijay Pratap Singh, sp, Amritsar, who is part of the squad that cracked the racket. "We have enough evidence to nail Sarin as the prime beneficiary of the kidney trade," he says.

The modus operandi of the kidney mafia was simple. Middlemen would lure poor labourers by offering them anything between Rs 50,000 and Rs 1 lakh for donating a kidney. Migrants from Bihar and Uttar Pradesh were the main targets. Occasionally, the dealers would go scouting for donors in Delhi and other neighbouring states. Meanwhile, Sarin and his team would create a demand for kidneys by giving the "buy-or-die" option to the patient. When the patient agreed to the transplant, Sarin would direct him to the middlemen. The younger the patient, the higher was the going rate of the organs. "Price of the kidney also depended on the urgency and financial status of the patient," says S.K. Sharma, IGP, Jalandhar, and a senior official in the SIT. Once the deal was struck between the patient's family and the middlemen, lawyers would pitch in to prepare false affidavits on behalf of the donor and the recipient testifying that the kidney was donated and accepted "out of love and affection".

As word of Sarin's "expertise" and the easy availability of kidneys for a price spread, renal patients from other states began visiting Amritsar. SIT investigations reveal that at least 70 per cent of the patients were from outside Punjab. Sarin was a surgeon in a hurry, conducting even two transplants in a day. "He was transplanting kidneys like a juggler," says a government doctor in Amritsar.

And why not? For a transplant deal worth Rs 5 lakh, Sarin and his team got Rs 3 lakh, while the balance was shared among the middlemen, donors and lawyers. The donors often lost out. As against the promised amount of up to Rs 1 lakh, they got just Rs 10,000-40,000. The racket, though an open secret in the local medical and police circles, came to light only when some donors blew the whistle.

Even more bizarre are the tales of donors who were left without proper medical treatment after the surgery. The Act provides for a three-month post-operative care of the donor by the recipient. But this directive was never followed. SIT found that at least two dozen donors died of lack of proper care and were cremated as unclaimed bodies by the middlemen.

The racket also enjoyed the patronage of a powerful lobby of police officials who tried to stonewall the probe from the outset. In December 2002, the probe, then headed by Singh, was abruptly transferred to the crime branch at Chandigarh and later to vigilance officials. The mounting public outcry, coupled with a PIL demanding a CBI probe, forced the Amarinder Singh Government to transfer Rajan Gupta, the then IG (Border) who was known for his proximity to Sarin, and hand over the investigation to Siddiqui.

Armed with a carte blanche from Amarinder, the SIT made rapid breakthroughs. The noose tightened around Sarin and Mahajan after half a dozen middlemen, donors and recipients recorded statements before the magistrate, giving graphic accounts of the modus operandi and the role of top doctors. Phone records also gave clinching evidence against Sarin and Mahajan. What nailed Mahajan was a disclosure by a former member of the Authorisation Committee, Dr Prem Arora, on the scandalous manner in which the transplants were cleared. SIT is now on the lookout for four doctors in Sarin's team who are on the run.

BODY SHOPPERS: Mahajan (above) and Sarin (below) used their clout with local police officials to stonewall earlier investigations into the flourishing kidney trade

The SIT is also probing the sale of kidneys to foreign nationals. In September 2002, a British doctor, Bhagat Singh Makkar, was censured by the UK authorities for promising a client that he could get a kidney for a price in Punjab. "The possibility of the racket catering to illegal human organ trafficking abroad cannot be ruled out," says Siddiqui.

Even as the SIT has cast its net wide, the scandal has sparked off a debate on the flaws in the Transplantation of the Human Organs Act. It also raises the larger ethical question in buying kidneys for patients whose relatives either refuse or are medically unfit to donate. "What option do such patients have except buying a kidney?" asks R.C. Garg, president of the Indian Medical Association in Punjab. He advocates an amendment to the Act to make the sale and purchase of human organs legal. "That's the only way to prevent a scam like this," he says.

But, others disagree on the grounds that this would open the floodgates for the sale of human organs. Others suggest alternatives: widen the ambit of relatives and encourage voluntary donations. Meanwhile renowned nephrologist Dr K.S. Chugh calls for the promotion of "cadaver transplants"-transplanting organs from brain-dead person-to stall the illegal renal trade. The debate has begun. Hopefully the arrest of Mahajan and Sarin and the unravelling of the scandal may help find solutions and suture the exposed underbelly of the exalted profession.