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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 . . . [Full Text of this Article]

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