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International traffic in human organs
Volume 19 - Issue 07, Mar. 30 - Apr. 12, 2002
International traffic in human organs
THE kidney trade is a global phenomenon; it is present in both the developing and the
developed world. Since the introduction of the immuno-suppressant drug Cyclosporine in
the early 1980s, organ transplantation has become a relatively safe operation. More andmore patients suffering from End Stage Renal Disease opt for kidney transplants instead ofremaining on dialysis. The result? In many parts of the world, the demand for kidneys faroutweighs the supply. Brokers have stepped in, offering kidneys for sale to cover the deficit.
In Soweto, South Africa, a dialysis patient selected for termination of
dialysis support (photo by Nancy Scheper-Hughes).
Organ Watch, an NGO based in the University of California, Berkeley,tracks "the global traffic in human organs." A research team led byNancy Scheper-Hughes, Professor of Anthropology at Berkeley and one of the foundingmembers of Organ Watch, has conducted comprehensive field research into the globaltraffic and documented the practices of organ harvesting in many parts of the world, notablyArgentina, Brazil, Cuba, Israel, Turkey, South Africa, the United States, the UnitedKingdom and India. This research shows that abuses associated with kidney transplantsoccur all over the world in various forms. The abuses range from the harvesting of organsfrom executed prisoners in China (where doctors are intimately involved in the executionsin order to ensure that the organs are kept in good condition) to the removal of organs fromdead bodies in Argentina and South Africa without the permission and knowledge of thefamilies of the dead.
In Brazil 'compensated gifting' (a phrase often used to describe the trade) is accepted bymany transplant surgeons. Scheper-Hughes' finding is that there is a lot of exploitation ofpeople in subordinate work positions. As in India, donors often work in the houses, officesor factories of recipients and are promised secure employment, housing or other benefits inreturn for 'donating' their kidneys.
In Brazil the organ trade is illegal and, as a means of combating it, a 'presumed consent' lawhas recently been passed. Unless people specifically state that they do not want to donatetheir organs after death, it is presumed that they have consented and organs are routinelyharvested from cadavers. However, this has failed to eliminate the trade in human organs.
There is also much resistance to presumed consent. Lots of people, particularly from poorer
sections of society, opt out by getting the statement "I am not an organ donor" stamped ontheir identity cards.
Iran provides an interesting case study of a country where the kidney trade is legal andregulated. The trade is organised and controlled by two government-endorsed NGOs - theCharity Association for the Support of Kidney Patients (CASKP) and the CharityFoundation for Special Diseases (CFSD). The role of CASKP is to put potential recipientsand donors in touch with each other, and organise tests to ensure the compatibility of donorsand recipients and the mental stability of donors. After the transplant the CFSD is requiredby law to pay the donor a sum of 1,00,000 Tomans ($1,219), which comes from governmentfunds. Recipients often promise donors secure employment or extra money after thetransplant (although CASKP and CFSD have no control over this).
Rumours of kidnapping children for organ stealing made Brazilian
street children 'nervous', like this one who would constantly rush up
to adults at the Sao Paulo train station for protection and safety from
unknown 'kidnappers' (photo by Vivian Moos).
In a country where brain-stem death is not recognised by law, the system has virtuallyeliminated recipient waiting lists. Members of the CFSD have claimed that the regulatedsystem is a "new chapter in the world's transplantation history," a "development indonor-recipient relationships" and "an innovation in the Islamic Republic." However, twostudies done by Javaad Zargooshi from the Department of Urology at KermanshahUniversity of Medical Sciences, Iran (The Journal of Urology, Vols. 165 and 166), showotherwise.
Zargooshi interviewed 300 kidney vendors six to 132 months after the transplant operation.
His findings offer a frightening insight into what a regulated kidney trade in India mightlook like. Some 65 per cent of interviewed donors reported that the kidney sale had led tonegative effects on employment. Thirty eight per cent, representing largely uninsuredmanual labourers, had lost their jobs because they were unable to continue working at thesame job after the transplant. Many donors were also frightened to go back to work for fearof injuring their remaining kidney. Ninety per cent of the vendors complained of impairedphysical ability and ill health. Complaints included palpitation, tremors, chest-pain,backache, nervousness and fatigue. Seventy per cent of the donors suffered frompost-operative depression and 60 per cent from anxiety. Several donors said they hadattempted suicide and spoke of donors who had killed themselves. Seventy per cent ofdonors said that they felt worthless after the operation and 85 per cent stated that if given thechance to go back in time, they would not donate their kidney and would also advise othersagainst donating their kidneys. A large number of donors spoke of social ostracisation andincreased marital conflict following the kidney sale.
Zargooshi concludes that "considering the fact that the main or sole reason for donation wasfinancial, it became clear that in the absence of altruistic motivations on which the donorscould depend, financial loss became intolerable and depressing."
Organ Watch reports that wealthy foreigners from Botswana and Namibia come to SouthAfrica to buy organs from live unrelated donors. At one academic and public hospital inCape Town, a steady stream of paying foreigners from Mauritius was largely responsible forkeeping its beleaguered transplant unit solvent following budget cuts and the redirection ofstate funds to primary care.
A kidney 'in prep' for transplant in a South African hospital (photo
by Vivian Moos).
Cases of organ theft have been reported and in June 1995 MosesMokegethi was found guilty of the murder of six children for theirorgans. Organs are also routinely stolen from cadavers without the consent of families(although this takes place on a smaller scale than under apartheid). The Truth andReconciliation Commission is considering other allegations of organ theft.
In South Africa, dialysis and transplantation have been relegated to the position of 'tertiaryhealth care', and this is not provided by the state. Dialysis and transplantation are theprivilege of a relatively small section of society that can afford expensive treatment inprivate hospitals.
Although cash-for-kidney transactions are illegal in the United States (which outlawedorgan commerce in 1984), Organ Watch has reported cases where families of brain-deadpatients have been offered a million dollars to donate their relatives' kidneys.
Scheper-Hughes actually met a doctor based in the United States who arranged kidneys forpatients round the world. "Don't think of me as an outlaw," he told the researcher. "Think ofme as a new version of the old-fashioned marriage broker. I locate and match up people inneed."
These words might have come from a kidney broker operating in Bangalore, or any ofIndia's other transplantation centres.
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