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To the Editor: I worked for several years at a hospital in Madras and was exposed there to the "culture" of kidney donation. I would like to emphasize certain aspects of this practice that Dr Goyal and colleagues¹ did not elaborate on, and which I think are crucial to understanding its socioeconomic impact.

First and most importantly, the practice of kidney donation is concentrated in a few extremely financially deprived areas in the growing city of Madras. Alcoholism is very common in these deprived communities and plays a major role in accumulating debts.² However, Goyal et al did not mention the prevalence of alcohol use and abuse in their sample. It would be critical to know if new or ongoing alcohol abuse in donors or their spouses had a role in continuing economic hardship.

Second, dowries are generally demanded among this population and are a large source of financial difficulties. . . . [Full Text of this Article]

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