In 2014, Kerala became the first state in India to offer free cancer treatment to the poor, via a program called Sukrutham. People in Kerala experience elevated incidence of cancers, liver and kidney diseases. In April 2016, the "Economic Times" reported that 250,000 residents undergo treatment for cancer. It also reported that approximately 150 to 200 liver transplants are conducted in the region's hospitals annually. Approximately 42,000 cancer cases are reported in the region annually. This is believed to be an underestimate as private hospitals may not be reporting their figures. Long waiting lists for kidney donations has stimulated illegal trade in human kidneys, and prompted the establishment of the Kidney Federation of India which aims to support financially disadvantaged patients. As of 2017-18, there are 6,691 modern medicine institutions under the department of health services, of which the total bed strength is 37,843; 15,780 in rural areas and 22,063 in urban.