A Beastly Trade in ‘Parts’

Laudiceia Cristina da Silva, a young mother and office file clerk, sued the large public hospital in Sao Paulo, Brazil, where, in June 1997, during a routine operation to remove a small ovarian cyst, she emerged from anesthesia 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 many 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, increasingly 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 total strangers, creating a thriving international traffic in desperate and 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 it has been opposed by the world’s medical associations as a violation of medical ethics.

Despite that, Organs Watch estimates that thousands of transplant patients from the Gulf states, Japan, Italy, Israel, the U.S. 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 through 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? 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 tricked and pressured into giving up a spare body part. Back home, Vladimir has become a stigmatized 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, “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 a market-oriented, supply-and-demand perspective that is gaining ground among transplant specialists and bioethicists and ministries of health in the world today, the buying and selling of kidneys is viewed as a windfall -- a potential “easy” solution to the global scarcity in organs. Already, some countries are beginning to break down the traditional barriers against the buying and selling of organs.

Last month, the secretary of health of the Philippines, Manuel Dayrit, approved a program 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. Earlier, he told me that 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.”

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 in 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-unrecognized proportions.