I have been observing with great interest in the recent past, the many very animated debates and media coverage about the two very important medical issues prevalent in our country: Surrogacy and Unrelated Kidney Donation. This has taken center stage because of the recent move by the government to introduce the Surrogacy Bill and the press coverage of the events of unrelated transplants in well-known corporate hospitals in Delhi and Mumbai, culminating in the arrests of reputed doctors, administrators and the patients as well.
Let’s examine these medical issues closely and debate the similarities and differences between the two and debate as to why the public perceptions are so different.
Surrogacy is a procedure wherein couples or individuals, unable to have a child for various reasons, have the ovum fertilized by the sperm of the partner and implant this embryo in a surrogate, who then carries it in her womb for 9 months. This is usually done by couples who are infertile for various reasons, single parents, those who wish to be single parents and same-sex couples. Though there is an option of adoption in these cases, some opt for surrogacy because of the sense of joy and fulfilment of having one’s own child. In most of the cases in our country, due to the absence of an altruistic surrogate, a paid surrogate mother is used.
An Unrelated kidney donation and transplant is a desperate measure taken by a patient with kidney failure who needs a transplant but is not able to get a related altruistic donor or a deceased donor transplant (Cadaver transplant) because the waiting period may run into years and very few of these transplants are done
Both these procedures provide immense benefits to the recipients:
In surrogacy, there is an immense joy and a sense of fulfillment for a childless individual of bringing a new life into this planet that is of their own flesh and blood.
In case of an unrelated transplant, it is truly a gift of life for the recipient with kidney failure who would have had a slow painful death without the transplant. One procedure brings in a new life for the parent, while the other gifts the person with a second life. Unfortunately, both these procedures in most instances depend on non-altruistic subjects, many a time money exchanging hands and also in some cases middlemen being involved with exploitation of the donors.
Now lets us look at the risks of surrogacy to the surrogate vs the risk to a living kidney donor.
In surrogacy, the surrogate carries the baby in the womb for 9 months and the childbirth may be normal or may need a caesarean section for delivery (the rates of which may vary between 20 to 40% depending on the clinical situation). It is also to be noted that many surrogates are older and multiparous since they might have had children of their own earlier, and this may increase the risk.
Though pregnancy is considered a safe physiological event unfortunately there is a small risk of serious complications including fatality as evidenced by the death of one our most versatile actress Smita Patil due to post partum complications. The risk of complications of pregnancy (some minor and others major) may be in the range of 10 to 20% and the overall maternal mortality in our country is about 174 per lakh depending on the risk factors and the need for Caesarean section (of course the risk in a rural maternity setting is much higher than in an urban corporate hospital setting).The risks are certainly higher for rural impoverished women in developing countries.
With regards to Living kidney donation related or unrelated ,it is a well established medical procedure being performed for well over 60 years and is considered a very low risk ,accepted medical procedure. Now a days with laproscopic surgery (key hole surgery ) most donors are discharged home by 3 to 5 days and can resume regular work in a couple of weeks .The risk of complications mostly minor is around 3% and mortality is about 2 to 3 per 10000 surgeries. The risk of any chronic (long term ) complications are also low
All in all if one compares surrogacy with unrelated kidney donation and transplant both are very beneficial medical procedures with huge psychological boost for a childless couple with the former and truly a gift of life for a patient with kidney failure with the latter.
Both have very few complication rates: Kidney donation is a very short stay in the hospital whereas with surrogacy the surrogate carries the baby for 9 months and may need a caesarian section in some cases. The overall mortality is low in both instances.
Unfortunately in both these enormously beneficial medical events, surrogacy and kidney donations happen for non altruistic reasons; money may exchange hands, middlemen may be involved and exploitation of the impoverished does happen.
Even though both these procedures have many similarities, it appears the public perception ,perception of the media ,and celebrities is that Surrogacy is acceptable but Unrelated Kidney Donation is an aborrhent crime.
Many celebrities have openly accepted non altruistic surrogacy and have had surrogate babies but no one has accepted or endorsed the possible benefits of non altruistic kidney donation.
On the contrary unrelated kidney donations have had serious negative publicity and many well known doctors administrators and even patients have been arrested for this so called crime.
The million dollar question that needs to answered is Why is renting a womb more acceptable than buying a kidney :One gives the happiness and fulfillment of the desire to have a child and the other gives life to a dying patient and both of them have somewhat low risk of serious complications
Though all of us would condemn the exploitation of the impoverished citizens by middlemen ; the civil society should debate, deliberate and come up with an answer to this question which to me is certainly a burning issue right now.
If we accept paid non altruistic surrogacy, let’s be fair and accept paid unrelated kidney donation too; If we consider the former unethical and unacceptable then let’s do the same with the latter but let’s use the same yard stick to judge both is my contention.
Let the society be the judge.