The Muljibhai Patel Urological hospital, located 40 km from Ahmedabad in Nadiad, is one of the premier kidney hospitals in Gujarat, having conducted 1,247 kidney transplants between 1980 and 2002. The hospital cases indicate a disturbing gender imbalance in the statistics related to these transplants.
Dr Mahesh Desai, managing trustee of the hospital, admits that a majority of the donors have been wives, mothers, sisters and daughters. Of all the kidney transplants conducted at this hospital between 1980 and 2002, a majority (921) were related transplants - or those donated by relatives - while the rest were unrelated. A further break-up of figures reveals a stark divide - the total number of men who received a kidney from their wives is 108, while the total number of women who received a kidney from their husbands is seven!
Diabetes and hypertension are the two major conditions that can lead to kidney failure, and there is no evidence to suggest that men are more likely to end up with kidney failure. Besides, diabetes and hypertension affect men and women more or less equally.
However, at the Muljibhai Patel Hospital, 257 mothers donated their kidneys to their children - in 81.7 per cent of these cases the kidney was donated to a son, and the remainder to a daughter. A similar pattern - overwhelmingly favorable towards men - is indicated among women who have donated a kidney to their brothers, and of fathers to their sons. Besides, says Desai, "A brother will give to another brother but not to his sister."
Equally disconcerting is the increase in unrelated transplants in the last two years and the pressure it has put on women. Dr Sujata Rajapurkar, who works as a medical social worker in the same hospital, related the story of a woman who wanted to donate her kidney to a stranger. Fortunately, the woman's parents informed the hospital that their daughter's husband was an alcoholic and was pressurizing her to sell her kidney. Since that incident the hospital has not accepted any unrelated kidney from women donors.
Statistics related to re-transplants tell the same story of gender imbalance. Out of 42 re-transplants (where the earlier kidney fails and another kidney is transplanted) at the hospital, only three recipients were women.
It is abundantly clear - and Desai himself says it - that economic compulsions are one of the major reasons for this gender divide. When a man needs a kidney, women and other male members in the family feel that since he is the principal earner, his life has to be saved at any cost. Expenses for a kidney transplant and post-operative care run into several hundred thousand rupees (1US$=Rs 47). But somehow, the family tries to bear the cost.
When a woman is in need of a kidney, however, the priorities change completely. First, if she is not an earning member, her contribution in the home is not perceived as valuable enough. The woman herself, along with other family members, does not feel that it would be worth spending so much on her for a kidney transplant. Desai observes that the gender divide is sharper in lower middle class families. There are other reasons too, that influence such decision-making. Unlike women, men are more scared of losing a part of their body. "One can clearly see the hesitation on the man's face when it comes to donating kidneys," says Desai. And he says this fear lurks in men even when they are told that a human body needs only one kidney to function. "The fear is similar to their fear of vasectomy - they believe it leads to impotence or weakness. On the other hand, women seldom question or give surgery a second thought."
Says the medical director of the hospital, "Women are the last to receive medical care, whether it is for kidney disease or any other ailment. A majority of the women who suffer from end-stage renal failure do not reach the hospital at all. They suffer silently and die silently."