Buying and selling human organs may be illegal worldwide but this hasn't halted affluent patients buying organs from poverty-stricken living donors, writes Nancy Scheper-Hughes.
Laudiceia Cristina da Silva, a young mother and office file clerk, sued the large public hospital in Sao Paulo, Brazil, where, during a routine operation to remove a small ovarian cyst in June 1997, she emerged from anaesthesia in great pain with a 17-inch scar across her side and minus her left kidney.
Hospital officials insisted her "missing kidney" was embedded in the mass of tissue that had accumulated around her ovarian cyst. But the story was highly improbable. The diseased ovary and the kidney had been "discarded", they said, and the crucial medical records misplaced. The state Medical Ethics Board refused to review the case, having no reason, it said, to doubt the hospital's explanation.
But da Silva and her physician believe that her kidney was stolen to serve the needs of another, wealthier patient in the same hospital.
"When rich people look at poor people like us," da Silva said angrily, "all they can see is a bag of spare parts."
Da Silva's case, while extreme, has counterparts elsewhere, from India to Argentina to Turkey, where kidney transplants from live patients are rapidly replacing the conventional practice of using organs from cadavers. Since survival rates are significantly better with living-donor organs, savvy transplant patients around the world are now demanding "fresh" organs. This trend, made possible by the introduction of powerful anti-rejection drugs, has in turn paved the way for a crude and beastly practice: the buying and selling of organs between strangers, creating an international traffic in miserably poor human beings to supply the needs of affluent patients.
Buying and selling human organs, whether from the dead or from the living, is against the law in virtually every country, and has been opposed by the world's medical associations as a violation of ethics.
Despite that, Organs Watch estimates that thousands of transplant patients from the Persian Gulf states, Japan, Italy, Israel, the United States and Canada have purchased kidneys abroad from "donor" nations, including India, Pakistan, Turkey, Peru, Mexico, Moldova, Romania and South Africa. Kidneys range in price from $1,000 to $20,000.
Avraham, a retired lawyer in Jerusalem, explained why he went to considerable expense and danger to travel to Eastern Europe to purchase a kidney from a rural worker rather than wait in line for a cadaver organ in Israel.
"Why should I have to wait years for a kidney from someone who was in a car accident, pinned under the car for many hours, then in miserable condition in the intensive care unit for days and only then, after all that trauma, have that same organ put inside me?" he says. "That organ is not going to be any good! Or, even worse, I could get the organ of an elderly person, or an alcoholic, or a person who died of a stroke. It's far better to get a kidney from a healthy person who can also benefit from the money I can afford to pay."
In the town of Mingir, in central Moldova (the poorest country in Europe), a young man named Vladimir was lured by a local kidney hunter to Istanbul, Turkey, where he was pressured into giving up a spare body part. Back home, Vladimir has become a stigmatised recluse, unemployable and unmarriageable in a country where kidney-selling is viewed as a form of prostitution.
Elsewhere, kidney-selling has become routine. In the garbage-strewn slum of Bangon Lupa in Manila, Philippines, "coming of age" now means that one is legally old enough to sell a kidney. As with other coming-of-age rituals, many young men lie, not only about their age, but about their exposure to tuberculosis, AIDS, dengue fever, hepatitis, chronic skin infections and malnutrition.
"No one at the hospital asks us for any documents," one kidney "donor" assured me. Most of the kidney sellers I met did not have any idea what a kidney was for, only that they had two of them - one to spare and, if lucky, to sell. A healthy Filipino kidney from a young seller is a real bargain. It can be had for $2,000 or less.
From the market-orientated, supply-and-demand perspective that is gaining ground among transplant specialists and bio- ethicists and ministries of health in the world today, the buying and selling of kidneys is viewed as a windfall, a potentially "easy" solution to the global scarcity of organs. Already, some countries are beginning to chip away at traditional barriers against trade in organs.
Last month, the secretary of health of the Philippines, Manuel Dayrit, approved a programme that would permit compensation to Filipinos selling kidneys to an "acquaintance". Dayrit was reluctant to discuss just how the government would set a "fair price" for a poor person's kidney. He said he preferred to leave this task to market forces.
A Manila hospital director agreed. "Some of our donors are so poor that a sack of rice is sufficient," he said.
Meanwhile, in Israel, a long-discussed and heatedly debated bill is now winding its way through the Knesset. It would make overt organ-selling a criminal act but it would allow an Israeli citizen to "donate" a kidney to a stranger for some financial compensation. The law is designed to eliminate Israel's notorious organ brokers.
But, in truth, there is no way to "regulate" a black market in living human organs. The organs market has produced a world that is literally cut into two - a world of organ buyers and organ sellers (and their surgeons and brokers) who, in the name of "saving lives", have produced a moral and political tragedy of as yet unrecognised proportions.
- Los Angeles Times/Washington Post
Nancy Scheper-Hughes is a professor of anthropology at the Berkeley University, California, and is the director of Organs Watch. Her book, The Ends of the Body: the Global Traffic in Organs, will be published soon.