Deception and deceit in living kidney transplant program

Abstract

In India, the majority of kidney transplants are living donor transplants. The transplant law in India only permits donation from first degree relatives, spouses, grandparents and altruistic donation without any commercial intent. Donation that happens other than first degree relative require to go through the process of authorization by a committee that determines their intent of donation. In spite of the requirements that are clearly laid down in the Act, fake and fraudulent activities have been reported to make donations happen with a commercial intent. This paper is an attempt to inform and empower clinicians and transplant coordinators and give them the requisite skills that would help them to identify fraudulent relationships, detect discrepancies in the documents and help ensure that the hospital and the doctors follow the law of the land and not fall prey to fake documentation that has a commercial intent of donation. Sample cases have been studied based on their coordination and different ways of approaches to detect falsification of documents and tutoring of the donors by the family members or broker. It was seen that with the right approach that included thorough donor-recipient interrogation, close scrutinization of documents and keenly observing the donor-recipient relationship including their body language and attire, various discrepancies could be identified. All transplant teams should include a well-trained Transplant Coordinator who is alert to every case of a living donor recipient pair and makes a thorough assessment of the relationship by observing, interviewing and scrutinizing the documents of relationship to exclude fraud. Some recommendations have also been drawn up to minimize the risk of fraud.