Dirty organ trade: 476 kidney surgeries under scrutiny as Mediheal faces sanctions

Mediheal hospitals owner, Dr Swarup Mishra addresses a past press conference. [File, Standard] A committee probing suspected fraud in kidney transplants at the Mediheal hospitals wants authorities to investigate the owner, Dr Swarup Mishra, for potential criminal involvement in organ trafficking. It has also called for investigations into nephrologist Dr A S Murthy, urologist and transplant surgeon Dr Sananda Bag and anaesthesiologist Dr Vijay Kumar. The committee wants the four doctors probed for possible violations of national transplant laws and ethical standards. The report says that Mediheal should be investigated for cash payment practices "to ensure adherence to international ethical standards and prevent commercialization of transplant services." The Independent Investigative Committee on Tissue and Organ Transplant Services (IICTOTS) chaired by Prof Elizabeth Bukusi, was appointed by Health Cabinet Secretary Aden Duale through an April 23, 2025, Gazette notice. Mishra owns Mediheal hospitals, which he founded in 2005 alongside his wife, Pallavi. The hospital has branches in Kenya, Rwanda and Uganda. The facility is licensed to conduct kidney transplants alongside Aga Khan University Hospital, Moi Teaching and Referral, Nairobi West, MP Shah, St Luke's Orthopaedic, Kenyatta National Hospital, and the Kenyatta University Teaching, Referral and Research hospitals. The committee has recommended that the Kenya Medical Practitioners and Dentists Council (KMPDC) be probed for regulatory failure, along with individuals from other oversight bodies who may have neglected their responsibilities. Additionally, the committee wants KMPDC to carry out a thorough investigation into Mediheal's kidney transplant activities. The report notes incidents of document tampering, intimidation of whistleblowers by security agencies and recommends that the moratorium on the registration of new doctors be extended. Mediheal is currently facing 180 active court cases and is in financial distress, with debts amounting to Sh7 billion. Operations in several of its facilities have significantly slowed down. According to the report, published on July 22, 2025, Mediheal conducted a total of 476 kidney transplants between 2018 and March 2025. Of these, between 150 and 170 patients were aged over 60, with the oldest being 80 and the youngest just eight years old. The report covers 452 donors and 447 recipients, with the Eldoret branch accounting for 81 per cent of the patient files and 76 per cent of the transplants. "The analysis uncovers concerning patterns in consent procedures, cash payment practices, follow-up care and documentation standards that warrant immediate attention," the report states. Out of the 2,300 staff working across Mediheal's various facilities, more than 300 were expatriates from India. According to the report, each transplant team at Mediheal consisted of three doctors of Indian origin, a nephrologist, urologist and anaesthetist, who managed the patients throughout the procedure. The facility admitted that it did not verify the relationships between donors and recipients, relying instead on genetic testing. The report also revealed that 25 donors were from Israel and Azerbaijan, raising concerns over possible patient misidentification, document forgery, or targeted recruitment from regions sharing similar names. In terms of gender, men made up 77.21 per cent of the donors, while women accounted for 18.36 per cent, and a category listed as "others" made up 4.43 per cent. The report noted that these trends were similar across other facilities offering kidney transplants, although the proportion of female donors was slightly higher in those institutions. Kenyans formed a large part of the donors with 53.32 per cent, non-Kenyans accounted for 25.88 per cent while 20.80 did not have a known nationality. Kenyans were also the biggest beneficiaries of the transplants, accounting for 52.21 per cent, non-Kenyans were 27.88 per cent and 19.91 per cent don't have a known nationality. From the data, the average age of the donors were youths aged 32- 25 years while the average age of the recipients is 47-97 years. Kenyan men donated 241 kidneys while women donated 55 kidneys. The names of recipients and donors in 60 cases were not availed, unknown donors to Kenyan patients accounted for 33 cases, while cases of unknown donors to foreigners were eight. Mediheal hospitals accounted for 148 out of 204 cases where Kenyans donated kidneys to their fellow countrymen. The facilities accounted for 32 out of 33 cases where Kenyans donated kidneys to unknown recipients and three out of four cases where four kidneys were donated to foreigners. Of the 110 cases where foreigners donated to foreigners, Mediheal accounted for 98 cases, while three and two cases of a foreigner donating to an unknown recipient and a foreigner donating to a Kenyan respectively, were done there. The facility had missing patient files or incomplete and did not conduct post-transplant audits for morbidity and mortality. "The only transplant outcome audit document provided was a PowerPoint presentation, which was not a comprehensive audit as it lacked minutes, signatures, dates, times and a list of participants." It was noted that Mediheal did not provide evidence for the use of psychological counsellors or data showing comprehensive psychosocial evaluations. The report further found that there was no embassy documentation to support the medical tourism status of patients from other countries. It also found a name that appeared several times in documents and was designated as the next of kin for several international patients. Legal verifications for transplants were handled by the same lawyer who was affiliated to the hospital, with the report saying it could pose a conflict of interest. "The committee questioned how the legal advisor was able to verify relationships between foreign patients from different countries without proper documentation from their respective home countries." Mishra promised the committee to share videos of patients consenting to transplant, but the ones he shared were of patients in post-transplant and were for marketing purposes. Patients' files submitted had discrepancies with the names, dates of surgery and nationalities differing, including donor names and different recipients. Between November 19 and December 5, 2024, a single surgeon and anesthesiologist conducted surgeries on 24 patients, raising work overload questions. From the affidavits provided, donors, particularly Kenyans, were signed on the day of the surgery, indicating they may have been pressured and coerced. Consent forms from the facility asked patients to allow the use of their data for research and educational purposes, which is unethical and implied coercion. Documents for foreigners were not translated to enable the patients to understand the medical procedure they were to undergo. Mediheal charges Sh2.3 million for a kidney transplant compared to Sh990,743 in other facilities, with the report noting this difference may point to irregularities. From their submissions to the committee, Mediheal said they charge Africans Sh3.2 million and foreigners Sh4.4 million for a kidney transplant. The reports notes that this could point to organ commercialisation since from their data, 25.1 per cent of donors were indicated as likely to receive cash for donation compared to 3.6 per cent in other hospitals. Documents tabled before the committee raised issues of the defunct National Health Insurance Fund making irregular and un-procedural payments to Somali nationals. The hospital serves a higher proportion of foreign patients with the pattern suggesting it operates as transplant tourism destination. The laboratory that Mediheal was using to test Kenyan samples is in India and not under regulation by Kenyan authorities which could have led to tampering to produce falsified results. The transplant procedures involving 347 patients were paid for in cash while 77 were through private insurance. Mediheal's ethics committees ceased existing in 2022 and the report notes that it did not take minutes of committee meetings, instead focusing on identification documents. Several staff licenses and appointment letters for different cadres were found to be expired while documents on roles and travel details for transplant related activities were incomplete."Staff were not receiving certified training for their current job roles; for example, a nurse aide was employed as a theatre technician." The report notes that the facility did not update its documentation leading to the conclusion that the current job status of the staff was unknown. Many nurse aides were employed with only one year of training from different backgrounds which is unregulated raising questions on patient safety and regulatory risk. It noted that there were pay discrepancies in staff files with staff in the same cadre getting different salaries. "Indian expatriate staff were paid more than Kenyan staff, and their salaries were disbursed in rupees." Indian nurses working at the facility did not have the required temporary practicing licenses and were not specialists. A nephrologist interviewed by the committee said he was not registered with the Kenya Renal Association despite practicing in the country for over eight years. Only identified as Dr AM, he revealed that he was in charge of pre-and post-transplant care and said that he was in charge of counselling, which the committee said was a conflict of interest. Another employee identified as Ms SC left the facility towards the end of 2023 after going three months without pay. She was in charge of marketing the services but later became the transplant coordinator and later coordinator and social worker on the ethics committee for transplant documentation. This promotion and change of roles happened despite Ms SC holding a Bachelor's degree in Language and Literary Studies and no medical background.

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