I’ve angered close friends and my sister by rejecting their offers of a kidney donation. When confronted about why, the best I’ve been able to manage is to mumble something incoherent about “ethics” and “not a cure anyway.” It’s been a very interesting self-exploratory journey, and it doesn’t mean that I won’t change my mind next year; hell, I’ve completely reversed my position on embryonic stem cell research after deconstructing the spin from both sides. Larry Rother’s “Tracking the Sale of a Kidney on a Path of Poverty and Hope” in this morning’s New York Times doesn’t offer much insight into my situation, but it does provide some solid numbers that help solidify my present feelings.
Brazilian organ brokers used to pay a decade’s wages—US$10,000—for a kidney, but now the market rate has dropped to about US$3,000, presumably because supply is starting to catch up with demand in a multi-million dollar black market. The Brazilian market is getting quite sophisticated, with Israeli organ traffickers orchestrating medical exams to eliminate unqualified donors and providing transportation to South Africa where the transplant actually takes place. Gone, apparently, are the mythical days of Western tourists waking up minus a kidney in ice-filled Bangkok bathtubs. Still, nobody bothers to tell the donors that what they’re doing is illegal.
The most disturbing revelation of Rother’s piece is that the profiled kidney recipient “described herself as deeply religious and concerned with the ethics of transplants.” That and the fact that a disturbing number of the Brazilian donors lost both their kidney and their money.
Rother’s kidney recipient source had been on dialysis for 15 years and was suffering from heart and lung problems as well as osteoporosis, all common complications associated with the invasive blood-cleansing procedure. She’d watched four other dialysis patients die from complications.
Every year more than 3,000 of the 60,000 Americans waiting for kidney transplants die, and the average time on the transplant waiting list is five years. Dr. Nancy Scheper-Hughes, of Berkeley-based Organs Watch told Rother, “It is a common practice of many larger clinics to advertise on the Internet for transplant tourists,” and that transplant doctors use a “don’t ask, don’t tell” policy.
“The World Health Organization issued guidelines in 1991 to avoid the coercion or exploitation of organ donors. They were endorsed by 192 countries, including the United States, Brazil and South Africa. But the guidelines are not binding, and the recommendations have been widely ignored. At least one country, Iran, has a legally regulated system to trade organs.
“As medical science advances and health care increasingly becomes a marketplace transaction, a fierce debate about commercializing transplants has emerged.
“On one side, said Alexander M. Capron, the director of the ethics department of the World Health Organization, are “transplant surgeons who believe that a good way to remedy the shortage of organs would be to offer payments,” and bioethicists and philosophers who see organ trade as an extension of the principle of autonomy.
“But an opposing group, Mr. Capron said, “fears that the line between selling organs and actually selling people is a rather fine one” and that, as in sex trafficking, the marketplace is one in which coercion and exploitation may be unavoidable.”
In Israel, organ donation rates are among the lowest in the developed world, owing mostly to religious resistance and misunderstanding. As a result, organ brokering syndicates including doctors and even a former health maintenance organization executive have created a market that has driven prices to US$150,000 for a kidney. The brokers, according to Rother’s account, advertise openly in Israeli media. All of this is currently legal in Israel. “As of today, there is no law in Israel that forbids trafficking in human organs,” Meir Broder, a legal advisor to the Health Ministry, told Rother. And because it benefits Israel financially to allow such trafficking, it’s unlikely that any legislation restricting the activity will pass any time soon.
South Africa emerged as the new locus of brokered organ transplants over the past decade after Organs Watch raised ethical questions regarding the Israeli transplant activity in Turkey using Moldavian, Romanian, and Russian donors. In South Africa, brokered transplants are illegal and all of the hospitals currently under investigation are, according to Rother, all owned by the same company, NetCare, a spokesperson for whom predictably “denied conscious involvement in any wrongdoing.”
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