LOOKEAST

Nandi Theint | Nicola Smith

ONE of the world’s biggest private hospital groups is embroiled in a ‘cash for kidneys’ racket in which impoverished people from Myanmar are being enticed to sell their organs for profit.

India’s Apollo Hospitals, a multi–billion dollar company with facilities across Asia, boasts that it conducts more than 1,200 transplants a year, with wealthy patients arriving for operations from all over the world.

■ Apollo Indraprastha

Paying for organs is illegal in India, as it is across most of the world, but an investigation has revealed that desperate young villagers from Myanmar are being flown to Apollo’s prestigious Delhi hospital and paid to donate their kidneys to rich patients.

“It’s big business,” one of the racket’s ‘agents’ told an undercover journalist. Those involved “work together to get around the obstacles between the two governments,” the agent added. The hospital “asks the official questions. And on this side they tell the official lies.”

India’s leading surgeons, Dr Sandeep Guleria, who trained in the UK and received one of the nation’s highest honours, the Padma Shri, for his services to medicine was named by patients and agents as the surgeon who conducted the transplants

The scam involves the elaborate forging of identity documents and staging of ‘family’ photographs to present donors as the relatives of would–be patients. Under Indian and Burmese laws, a patient cannot receive an organs donation from a stranger in normal circumstances.

Apollo Hospitals said it was “completely shocked” by the findings and would launch an internal investigation. “Any suggestion of our willful complicity or implicit sanctioning of any illegal activities relating to organ transplants is wholly denied,” it added.

One of India’s leading surgeons, Dr Sandeep Guleria, who trained in the UK and received one of the nation’s highest honours, the Padma Shri, for his services to medicine was named by patients and agents as the surgeon who conducted the transplants.

■ Dr Sandeep Guleria

He denied any knowledge of the illegal activities identified by the media investigation and no evidence has been found to contradict this. Linking him to a transnational organ transplant racket was “offensive and laughable,” he said.

In 2016, the Indian newspaper the Deccan Herald reported that Dr Guleria was expected to be summoned for questioning in connection to a separate kidney scandal linked to Apollo’s Delhi hospital. He dismissed this report as false.

The media first learned of the ‘cash for kidneys’ racket through the case of Daw Soe Soe, a 58–year–old patient who paid 8 million Myanmar kyat for a new kidney in September 2022.

Receipts show her operation was conducted at the Indraprastha Hospital, Apollo’s flagship hospital in Delhi. Her donor, she said, was a complete stranger.

“I am aware that both Myanmar and India laws do not allow strangers to donate organs. But since we are in Myanmar, the agent teaches us to tell the fake story that we are relatives.”

A journalist then posed as the relative of a sick aunt who urgently needed a kidney transplant but had no family members able to donate. They contacted Apollo’s Myanmar offices and were told that a stranger would be sourced to donate their kidney.

“If none of them [relatives] is possible, we will have to find a donor,” Dr Htet Htet Myint Wai, whose business card says she works for Apollo office’s in Myanmar, told the undercover journalist. “It’s easy to find a donor.”

The journalist was told by a second individual associated with Apollo, Phyoe Khant Hein, that 80 per cent of transplantations facilitated in Myanmar are between strangers. “Only 20 per cent are relatives,” he said.

Media first learned of the ‘cash for kidneys’ racket through the case of Daw Soe Soe, a 58–year–old patient who paid 8 million Myanmar kyat for a new kidney in September 2022. Receipts show her operation was conducted at the Indraprastha Hospital, Apollo’s flagship hospital in Delhi

The journalist was then introduced, via Mr Phyoe and a female agent, to a 27–year–old man from the outskirts of Mandalay who said he needed to sell his kidney as his elderly parents, whom he lived with, were “not in a good financial condition”.

“One of my uncles has done this before and I told him that I want to do it and he gave me a contact,” added the young father of one, who said he was ready to go ahead with the operation.

The agent, who was present for the conversation, said it would cost roughly 7,957,426.9 Burmese Kyats for the man’s kidney and revealed she had been arranging donations of this kind for the past five years.

Mr Phyoe said the money should not be seen as a payment, but a “thank you”. “It’s not a case of ‘buying’. It’s like we respond to them for their kindness. It’s illegal to trade,” he said.

Globally, 1 in 10 transplanted organs have been trafficked, estimates suggest. “We’re talking about thousands and thousands of organs,” said Dr Trevor Stammers, a retired professor of medical ethics at St Mary’s University and organ trafficking expert. “It’s a massive global trade.”

The UK is not immune. One NHS kidney specialist told the journalist there was a phenomenon of patients travelling abroad for “live” organ transplants donated by strangers.

“The majority of them are people from the Indian subcontinent going overseas. They’re coming back with kidneys; sometimes there’s a story that this was from a relative or whatever, which is obviously difficult to evaluate,” they said.

Both Myanmar and India laws do not allow strangers to donate organs. But since we are in Myanmar, the agent teaches us to tell the fake story that we are relatives.” A journalist then posed as the relative of a sick aunt who urgently needed a kidney transplant but had no family members able to donate. They contacted Apollo’s Myanmar offices and were told that a stranger would be sourced to donate their kidney

NHS data show that at least 158 NHS British patients have travelled overseas for an organ transplant since 2010.

According to the figures, the majority of these operations (25 per cent) were conducted in India, which has long had a problem with organ trafficking.

Experts say the illegal trade is channeled through the nation’s booming private healthcare industry, in which Apollo Hospitals is a major player.

The company has previously been entangled in a kidney racket, with two of its secretarial staff at the Indraprastha Hospital arrested in 2016 alongside a gang of brokers and donors. An investigation into the accused remains ongoing.

Apollo said at the time it had been “a victim of a well–orchestrated operation to cheat patients and the hospital” and that it was duped by traffickers into removing the kidneys of victims believing they were relatives of needy recipients.

It was said to have overhauled its procedures Apollo yet the media investigation suggests serious loopholes remain.

Over the course of several conversations with the undercover journalist, agents and Apollo officials from Myanmar explained that sick patients eager to receive a stranger’s kidney would need to bypass India’s Transplantation of Human Organs Act.

■ This Facebook post from 2018 shows a lunch attended by Dr Thet (front left), Dr Guleria (back left, in blue shirt) and Mr Phyoe (front right with short sleeves)

Passed in 1994, the law stipulates organs may be donated by living donors who are near relatives, like spouses, parents, siblings, grandchildren. Donations between strangers are forbidden, unless it can be proven it is for purely altruistic purposes.

These rules are supposed to be enforced by independent hospital medical boards who must sign off each case before a transplantation proceeds.

Yet this system is being gamed. Agents working together with Apollo’s regional offices in Myanmar say they are forging family trees, household documents, marriage certificates and photographs to establish familial relationships between sick Burmese patients and paid donors.

“Before going [to India] we take photos, and that’s what we have to submit to the board — yourself having gone to the Buddhist temple with this donor; we have to do it so it is logical,” one of the agents told the undercover journalist.

“They have to make the photos look old. It’s like a photoshoot. You put them in all creased and crumpled.”

Household registrations, suggesting the donor and patient live together as relatives, are also created, the agent said. “It needs to be someone living in the same house,” she said.

Globally, 1 in 10 transplanted organs have been trafficked, estimates suggest. “We’re talking about thousands and thousands of organs,” said Dr Trevor Stammers, a retired professor of medical ethics at St Mary’s University and organ trafficking expert

These faked documents, along with a series of test results that confirm compatibility but not a genetic relationship, are then presented to the hospital authorisation committee for rubber–stamping.

Dr Thet Oo, the head of Apollo’s Myanmar operation, further outlined the subterfuge at play to the media’s undercover journalist.

“Because it’s certain that we are going to have to find someone who isn’t a relative, is it possible to put someone who isn’t a relative before the medical board?” the journalist asked.

“Yes, it’s possible, it’s OK. We hand that over to an agent who does it for us. There are agents who are used to doing this,” Dr Thet replied.

“So they redo it to make it so it’s a relative — is it like that, Doctor?”

“Yes, that’s right. They do it for us so it will work out.”

“Since we are going to be doing this at the Apollo hospital in India, does the hospital in India accept this document with a family tree with someone who isn’t a relative on it?” the journalist continued.

“Yes, they do,” Dr Thet said.

“In the past, you have had a lot of patients who have done this before, so when they did it, have there been patients who are not related but who have had their family tree drawn so it looks like they’re related, and they have been accepted for treatment in India?”

“Yes, there have been,” Dr Thet said.

He also shared with the journalist an Apollo–branded costs document which detailed a range of expenses linked to the transplantation   from the drawing up of a family tree to flights and “registration for the medical board”.

Majority of these operations (25 per cent) were conducted in India, which has long had a problem with organ trafficking. Experts say the illegal trade is channeled through the nation’s booming private healthcare industry, in which Apollo Hospitals is a major player

The document shows that a patient can expect to pay, in total, up to 1,800,653.91 Indian rupees for a kidney transplant. However, this doesn’t include the money paid to a donor.

Dr Thet revealed to the journalist that a patient would be able to “choose” their donor and then arrange a payment to the individual. “In most cases it’s 70 or 80 [lakh],” he added — 7 to 8 million Myanmar kyats.

Once a price is agreed, with an upfront cash payment subsequently made, the pair are then flown to India for their interview with the transplant authorisation committee, which is made up of several Apollo hospital officials and government–appointed members.

According to one of the agents involved — but vigorously denied by Apollo — the board is “just a facade” and asks only superficial questions about the relationship between the patient and donor.

“The Apollo hospital knew about it,” claimed Daw Soe Soe, the kidney recipient who first alerted the media to the racket. “They just pretend not to know.”

The cash for kidney trade exploits the chaos and poverty of Myanmar.

Following the 2021 coup, many medics joined a civil disobedience movement, which is opposed to the ruling junta, and went into hiding. Hospitals have subsequently been left in disrepair and the population deprived of basic medical services.

The economy is also crumbling, with food insecurity rife and job opportunities hard to come by. Around 40 per cent of the country’s population (approximately 22 million people) are living in poverty — a rate that had not been seen for at least 15 years, according to the World Bank.

Against this backdrop, whole communities are being targeted by kidney rackets like the one linked to Apollo.

A village close to Yangon is locally known as Kyaut Ta Lone, which translates as ‘one kidney’ in Burmese, due to the sheer number of villagers who have sold their kidneys.

The experience of Moe Moe, a 26–year–old kidney donor from Yangon, is one shared by many in Myanmar.

■ Medical staff and students take part in an early morning protest against the military coup and crackdown by security forces on demonstrations in Mandalay | Getty Images

After the economic blows of Covid and the 2021 coup, she was left poor and destitute, unable to support her young son or parents. “The economic situation of our house got worse, the debts increased,” she said. “I no longer had my own house.”

Moe Moe subsequently decided to sell her kidney after seeing an advert on Facebook and was paid £2,700, allowing her to pay off her debts. “I didn’t feel any side effects yet,” she said. “I was lucky.”

But not all are.

“The immediate complications that can arise [from a kidney transplant] are bleeding. That would most likely be dealt with in the theatre or would be caught at a fairly early stage,” said Dr Stammers. “But infection can sometimes develop quite some time afterwards.”

Passed in 1994, the law stipulates organs may be donated by living donors who are near relatives, like spouses, parents, siblings, grandchildren. Donations between strangers are forbidden, unless it can be proven it is for purely altruistic purposes. These rules are supposed to be enforced by independent hospital medical boards who must sign off each case before a transplantation proceeds

The “big worry,” he added, is whether the donors involved in the Apollo–linked racket receive proper follow–up care upon their return to Myanmar. “Most studies worldwide have shown that the people who donate [illegally] are worse off afterwards health wise and financially,” he said.

As part of the media investigation, the undercover journalist attended an Apollo–branded event at the glitzy ballroom of the Hazel Hotel, in eastern Mandalay . It was a grand setting, of marble, mirrors and chandeliers, that concealed the desperation of those present.

Many of the waiting patients had already received the new kidneys for which they paid tens of thousands of rupees and were in attendance for a follow–up. It was also an opportunity for prospective patients to ask questions about treating kidney disease.

The famed Dr Guleria was in attendance, having made the three–hour flight from Delhi to military–run Myanmar.

“He comes to Yangon once every three months,” Dr Htet Htet told our journalist ahead of the event, which had been advertised on Apollo’s Myanmar Facebook page. “He is among the best renal transplant surgeons. The patients from us are always operated on by him.”

Daw Soe Soe told media that Dr Guleria had operated on her when she received a stranger’s kidney in September 2022, and Facebook photos indicate that the surgeon has had a working relationship with Dr Thet Oo for the past five years.

The undercover journalist briefly met with Dr Guleria at the event in Mandalay, accompanied by Mr Phyoe, and attempted to ask him directly about finding an unrelated kidney donor for their fictional aunt.

“This topic has nothing to do with the doctor,”Mr Phyoe quickly interjected in Burmese, which Dr Guleria does not understand. “He cannot know about this. May I call you after this event? Don’t worry. We will help you.”

The conversation was soon brought to a close and ended with a goodbye from Dr Guleria. “See you in Delhi,” he said.

Just one day after the event, Mr Phyoe delivered on his word to help. “We’ve found donors: there’s a young man and woman,” he told the journalist. “There are two of them.”

The cash for kidney trade exploits the chaos and poverty of Myanmar. Following the 2021 coup, many medics joined a civil disobedience movement, which is opposed to the ruling junta, and went into hiding. Hospitals have subsequently been left in disrepair and the population deprived of basic medical services

Officials responsible for overseeing the Declaration of Istanbul, established in 2008 for providing international ethical guidelines for practicing organ donation and transplantation, described the media  investigation as “disturbing”.

“The involvement of hospital employees, if true, is very worrying,” said Dr Sanjay Nagral, co–chair of the body. “It is an elaborate attempt to hoodwink the system for financial gain … and exploit donors who are ordinary citizens in desperate need of money.”

Apollo Hospitals Group denied any wrongdoing.

“Our hospitals have in place comprehensive checks, safeguards, and systems in place to ensure that an organ transplantation is conducted in a legal and ethical manner,” the company said. “There is therefore no chance of any illegal activity”.

Apollo Hospitals added: “It is utterly false and incorrect to state that the authorisation committee was turning a blind eye or that it is just a façade. A rigorous process … and compliance with the law, guides the hand of the committee and the hospital”.

It said the committee was an “independent entity, firewalled from other departments of the hospital,” and stressed that its approval process “cannot be carried out” unless the documents and cases it reviews are first certified by the Myanmar foreign ministry and its Delhi embassy.

Apollo further denied that Dr Htet Htet Myint Wai and Phyoe Khant Hein, who claims to have co–founded Apollo’s Myanmar office, were company representatives and said “any illegality ascribed to Apollo by them are completely false”.

Dr Thet Oo was Apollo’s Myanmar representative but did not have a mandate to “promote any illegal activity”, the group said, adding: “While we are confident that there is no foul play at the Hospital … we will conduct an internal inquiry.”

Dr Thet Oo said: “The allegations that are made are false and I reject them,” adding that his “sole aim” as a doctor was “to help patients”.

“I have been working in a professional manner when dealing with our patients and will never guide them towards any illegal activity,” he said.

Dr Guleria said he meets Dr Thet Oo twice a year but was “frankly unaware of who Phyoe Khant Hein is”. Photos taken from the Apollo–branded event on October 14 indicate that the two men were together at the Hazel Hotel. Facebook photos also suggest they met in 2018. ■

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