‘Medicare is a huge business, says Madras High Court; doubts fairness in authorising organ transplantations

Madras High Court criticizes organ transplant approval process, suggesting bias towards corporate hospitals over smaller ones.

Observing that medicare is a huge business, the Madras High Court on May 31, 2024 said, a lot of skeletons will tumble out of the cupboards of Organ Transplantation Authorisation Committees if an enterprising investigative journalist undertakes a thorough probe of all the approvals granted so far.

Justice G.R. Swaminathan said, there are reasons to believe that organ transplantation applications submitted through big corporate hospitals were being approved without assigning any reason while the applications received from lesser known private hospitals were being withheld or rejected.

“That is why, I called for a uniform liberal approach (in a judgement delivered on Thursday in a similar batch of cases filed by donors and recipients seeking approval for kidney transplantation). When suffering is common to all, the status of the hospital and the patient should be immaterial,” the judge wrote.

Explaining it in detail, he said: “Let me visualise this way. ‘A’ is a leading corporate hospital. ‘B’ is an ordinary hospital. Both are located in the same area. ‘A’ hospital charges ₹10 lakh for a given surgery. ‘B’ hospital charges ₹4 lakh for the same procedure. If the same surgeon will carry out the surgery, a patient who cannot afford the services of the corporate hospital, would naturally get admitted only in ‘B’ hospital.”

He went on to state: “This will irk the management of ‘A’ hospital. If approval is required from the department for a given procedure, ‘A’ hospital will see to it that while its applications are fast tracked and given green signal, the applications of ‘B’ hospital are not fast tracked and if possible rejected. This is the way of capitalism. This is the way businessmen behave. Competition is always cut-throat. All is fair not only in love and war but also in business. And medicare is a huge business.”

Adding pun, Justice Swaminatha wrote: “The choice of the letters ‘A’ and ‘B’ was incidental. ‘A’ can be substituted by ‘K’ or ‘M’ or ‘R’ or anything!” He also said that a probe into the approvals granted by the organ transplant authorisation committees need not be necessarily carried out by an investigative journalist, “tongue-in-cheek” it could be done even by an YouTuber.

The judge pointed out that the present writ petition had been filed by a 30-year-old Railway employee who had been advised by his nephrologist, at a not so popular hospital in Chennai, to undergo kidney transplant at the earliest. His wife and other near relatives came forward to donate their organ but it could not materialise due to incompatibility. He found a non-near relative donor but their joint application was rejected.