During the period I have been involved in transplant surgery (10 years), I have come across cases which have left such an indelible mark on my mind that whilst I was facing them, I wished I was not a transplant Surgeon!

I distinctly remember a man, Mr Kulkarni, who approached me with a problem. He was uneducated but had made a success of himself through sheer hard work. He had set up a small grocery which was flourishing. He had two children—both sons. The elder son, unfortunately, was mentally retarded. His younger son was brilliant and Mr Kulkarni's only hope. He was a source of pride to the father who could never get an education himself but was financing his son who rose to everyone's expectations and and brilliantly well in his qualifying examinations. He got admitted to the I.I.T in Powai. Mr Kulkarni started building castles in the air, how his son would one day become a successful engineer in a large firm and brings him satisfaction and happiness. It was about then that it was discovered that the young man was suffering from irreversible kidney damage. The news came as a rude shock to the entire family. Poor Mr Kulkarni was net However, he had saved enough to take his ailing son to one of the big hospitals in Bombay where a proper diagnosis was made and the patient put on dialysis. Once the young man's condition stabilised, the doctors in the hospital gently broached the subject of kidney transplant donation with Mr Kulkarni. Both Mr and Mrs Kulkarni theirs without the slightest hesitation. Unfortunately, for them, their tissue did not match with those of their son. When the tissue typing of the mentally-retarded older son was done, it was found that he possible donor in the family. The doctors and members of Mr Kulkarni’s family told him that the problem was now solved. The argument was that the mentally-retarded son was, in any event, not a useful members society and it would be in the fitness of things that by donating, one of his kidneys he could save the life of the younger brother.

Mr Kulkarni found himself on the horns of a painful dilemma. He was in an unenviable situation where he wanted to save the life of his dear younger son but at the cost of getting a kidney from his mentally retarded older son who was totally dependent on him, and would not even have understood what it meant to give his kidney away.

Mr Kulkarni went on requesting the doctors to give him time to think over, till the doctors gave him an ultimatum: either he agreed to the kidney transplant or he took away his son. It was at this juncture that Mr Kulkarni came to see me. He wanted advice. What would I recommend?

I must say that I had never had to face such a situation before and was as much disturbed as was Mr Kulkarni. I gave the issue considerable thought. Finally I told him: "Mr Kulkarni, I do not know whether my answer will be appreciated by you or not but I personally feel that you son who is mentally retarded is totally dependent on you for whatever happens to him in future and I do not think you have the right to sign the form of consent to take one of the kidneys from him to save your other son who is normal".

When Mr Kulkarni heard me out, he broke down. I didn't know how to console him. I thought I had disappointed him. But then after a while, Mr Kulkarni controlled himself and said: "Dr Phadke, I am glad that I came to you. You are the first person who gave me an answer which I was giving to myself in my own mind from the day the doctors told the situation. Now my mind is clear. One of my sons is going to die but I'm not going to make any effort to save his life by giving pa take the kidney of my mentally-retarded son. He is totally me and I am the one who does all his thinking for him. And that was the last time I saw him. It has left me wondering. It is easy for a doctor to suggest that a patient's brother or sister donate a kidney. But we are not living their lives or have any inkling of their problems.

The other pathetic story is about a poor mill work named Ganesh. During the protracted and unsuccessful mill-strike called by Dr Datta Samant, there was a mill worker who also happened to be a union leader. That was our Ganesh. After a prolonged strike, he and hundreds of others were dismissed. Later, when the strike was called off, Ganesh along with many others was not re-instated. Ganesh received his provident fund and some other dues in a lump sum. However those other workers who had been thrown into the streets began to make monetary demands on Ganesh, insisting that it was at his coaxing that they had gone on strike. Ganesh felt morally bound to help them out, which he did. In the end he found himself. Penniless. There was no money to feed the family and no one would give him a job.

He first approached his in-laws for some financial assistance. But that source dried up fast. Then he approached money-lenders but soon enough he found that he could not repay the loans. He began to receive threats to his life and the lives of his children. Ganesh was distraught. It was at this point in his life that be began to think seriously of suicide. It was either death or slow starvation. Ganesh decided that rat poison was the answer to his problem.

Then he chanced to read in a newspaper an advertisement for kidney donation and how a man could sell his kidney for a hefty sum of money. He could not believe his eyes! Here, he thought, was a way out. There was no need to take rat poison!

It was in that mood of elation that he came to me for advice. Should he or shouldn't he have a kidney taken out for money! But I was in a dilemma. I did not have an answer!