Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: I was surprised that Dr Goyal
and colleagues1 had an unusually high (100%)
rate of participation from eligible subjects, all of whom had been kidney
donors despite a 1994 law banning the sale of kidneys in India. Upon being
confronted by research assistants at their homes, the subjects may have had
great trepidation at being arrested. It seems likely that the fear of being
on the wrong side of the law played a role in promoting 100% participation.
India is a country with high levels of simplicity, superstition, customs,
caste-based cultural segregation, and, of course, abundant mysticism. Adequate
and ethical informed consent notwithstanding, I suspect that the unspoken
fear of potential retribution from law-enforcement authorities played a role
in these interactions with research assistants, even if the researchers deliberately
tried to avoid these implications. This fear of recrimination may have led
the respondents to understate their financial outcomes of kidney donation.
Perhaps they simply wanted to downplay the whole miserable experience.
Chandran PKG. Consequences of Selling a Kidney in IndiaConsequences of Selling a Kidney in India. JAMA. 2003;289(6):697. doi:10.1001/jama.289.6.697-a