Karnataka's infamous kidney transplant case of 1993 has reports to prove that it was the ignorance of the donors and greed of the nephrologists that allowed shady deals to thrive. The report was filed by Dr MS Rajashekar, professor and head of the department of Urology, Victoria Hospital, who was asked by the police to peruse the entire process that the accused adopted in the racket.

The ignorance of the donors and recipients were fully exploited to earn quick money, with total disregard for medical ethics, precautionary tests and necessary pre and post-operative treatment, thus endangering the lives of the donors and recipients. One of the recipients in the case, PK Jain, died after the transplant and the donor in this case, Deveerappa is barley able to make a living, being completely incapacitated by the removed kidney and being denied post-operative treatment.

To begin with, the donor and recipient were not even distantly related while it is necessary that the donor is a close relative of the recipient like a son, daughter, brother, sister, father or mother. The donor and recipient in this case did not know each other and so there was no question of any understanding between them. None of the legal procedures like a special consent from the donor and consent from another close relative was sought. In addition to the consent there must be an affidavit from the donor for voluntarily donating one of his kidneys. This legal affidavit must be attested by one of the close relatives of the donor and should be obtained in the presence of one or two witnesses.

Obviously, the accused did not go through these procedures.

A psychiatrist's opinion on the mental states of the donor and the recipient and their willingness to go through the procedure has to be obtained. The donor and recipient are required to go through a whole range of tests. Only the basic ones were carried out, and the test results were ignored. For instance, according to the report, the recipient's haemoglobin level was dangerously below the required level for a transplant and he was unfit for a surgery. It was just 6 grams while the required level is 10 grams. The doctors conducting the surgery should have first ensured that his haemoglobin level was brought to the required level by giving him two to three pints of blood preferably from the prospective donor.

The kidney transplantation team includes one or two nephrologists, two urologists, three to four assistant surgeons, two anaesthesiologists, two to three nurses and attendants. Since the racket involved a close ring of doctors, it was not possible to have the required team for the surgeries.

The required precautions were not taken during the operations. The doctors did not counsel the patients about the surgery and did not make sure the tissues of the donor and recipient matched. For transplant, the left kidney is chosen because of its lengthy blood vessel compared to the right kidney. In his case however, the right kidney was removed though the accused' report showed that the left kidney was removed. No explanation was given for removing the right kidney. The exact date of admission of the recipient is also not mentioned. The doctors who conducted the surgery on the dead recipient knew the consequences of not doing the preliminary tests and after the tests to give pre-operative and post-operative care. Had they followed the procedures, the patient could have been saved, Dr Rajashekar, concluded in his report.