The Laws in Existence for Kidney Sales and their cases In Brazil, a 1997 law makes it illegal to sell or solicited body organs and if caught could serve three to eight years in prison. Ten years ago, a law was passed that every Brazilian adult, except in special cases, was to be an organ donor. In Israel, It is also a felony to buy or sell organs and a proposal that would make it legal to reimburse a kidney donor for the costs incurred. A Brazilian man from Recife who was unemployed with a wife to support and two children was interviewed by Professor Nancy Scheper- Hughes, a medical anthropologist from University of Berkley for the medical ethics forum at Harvard Medical School entitled: “Organs for Sale? The Economics of Altruism”. He tells Hughes, “I will sell my organ of which I have two and which the removal of will not cause my immediate death”. The Human Tissue Act of 1983 in South Africa has however a loophole that grants a hospital’s medical director and pathologist the right to remove tissues and organs when a diseased body is unidentified or unclaimed by relatives. But the fine is minimal compared to the rest of the world, with a maximum fine of $300 or imprisonment of no more than a year if caught receiving payment for an organ/tissue or transfers/trafficking. In India, one of the most concentrated areas of illegal trade has a 1994 law that criminalizes organ sales but allows for “unrelated kidney sales”, a loop hole that has clearly led to corruption. It is not uncommon for people to wake up with stitches on their stomachs because of a kidney removed without any consent at all. Mohammad Saleem is one of those victims. Lured to the city of Gurgaon ( near New Delhi, India) with promises of a better construction job, he was held before work was supposedly begin and was then “forcibly anesthetized by two masked men” (Lakshmi). He woke up hours later sitting on a metal cot in a city hospital ward with fresh stitches and one kidney. The police investigation led to a kidney bazaar run by a group posing as doctors and was led by a man by the name of Amit Kumar who has been running this racket for 15 years“. He used to charge $37,500 from rich patients around the world and pay $1,270 to the laborer after forcibly removing the kidney” says Manjit Singh Ahlawat, Gurgaon’s joint commissioner of police in the Washington Post article dated earlier this year. Kumar is still on the run today and has yet to be caught for the organ trafficking charges that he faces. In a National Geographic documentary hosted by Lisa Ling shows the story of a middleman ( although he vehemently denies it) by the name of “Reji” who promises a woman by the name of “Malika” that she will be paid $3,500 for her kidney yet falls short of the agreed bargain and pays her only $700 (Woman Sells her Body Parts). In the Philippines, reports of a concentrated slum area in Baseco, Manila Bay has as many as 3,000 impoverished people who have parted with their kidneys, according to the Harvard Gazette. Last April of 2008, Health Secretary of the Philippines, Francisco Duque signed an order to create a government regulatory board to oversee kidney donations and transplants that gives priority to Filipino patients over foreigners in the allocation of locally available kidneys. Duque also temporarily banned kidney transplants involving foreigners. The fines for selling or buying of organs are stiff fines and a 20 year prison term which rarely gets sentenced due to the heavily corrupt government system. Earlier this year, Angel Lagdameo deemed the sale of body organs as “morally unacceptable” (Mogato). The Philippines has been heralded as one of the top 5 “hotspots” for human organ trafficking according to WHO .
Even more surprising than ever is China’s laws where all executed prisoners have their body organs harvested and sold to “visitors” from nearby countries such as Singapore, Taiwan and Hong Kong. In another youtube posting entitled : “China Exposed: Organ Trade and Execution”, Mr. Gao Pei Qi, a former member of China's Public Security Bureau who now lives in exile in London was interviewed and described a prison system so entwined with China's hospitals that executions are scheduled and sometimes ordered in concert with transplant demands. He continues to say “death row prisoners were made to kneel before being shot in the head or heart before their corpses were rushed into waiting vans where surgeons removed organs while the bodies were in transit to local crematories”. Harry Wu, a former political prisoner who now runs human rights foundation and is a research fellow at the Hoover Institute at Stanford University described one incident in which an ailing Chinese Air Force pilot was matched with a female prisoner on death row. "The female prisoner was already sentenced to death," said Mr. Wu. "But there was no timing for the execution. The pilot needs an organ, so they set up the execution. This is very normal” (OPTN: Organ Procurement and Transplant Network). After noticing several young Chinese people under his care, Dr. Thomas Diflo, M.D’s , noticed his returning from abroad with new functioning kidneys and when asked have admitted the donor of their new kidney is an executed prisoner from China’s government. He further testifies: The debate about the use of executed Prisoners’ organs for transplantation proceeds on several levels. The first level involves the entire concept of capital punishment…China classifies more that 68 offenses as capital, including under some circumstances car theft, embezzlement and discharging of a firearm. The Chinese government has denied these allegations and claim that the uncollected bodies of condemned criminals whose family members refuse to collect are used for their organs. Prisoners who have volunteered their organs to medical institutions and also upon the approval of the executed prisoner’s relatives are used for body organs. He further says before the House of Representatives: “The concept of “brain dead” has not been well defined or fully accepted in China and there is no requirement for certifying brain death prior to organ procurement can lead to the potential for procuring organs from prisoners who are not brain dead. There are numerous eyewitness accounts of continued movement and heart activity in some prison- donors, indicating that these people have been subject to the removal of their organs while they are, strictly speaking, still alive”. In Japan, despite a law passed over ten years ago permitting organ transplants from brain-dead donors, the number of donors are slim. Since most Japanese people believe in the afterlife, having a body incomplete of organs will not be able to live in the “other world”. For a traditional Japanese person, the self or soul is diffused throughout the body. Last June 2, 2008, a story broke on ABC that had lots of Americans riled up. Four members of a Yakuzza Japanese crime gang had kidney transplants at UCLA, buying into the waitlist and receiving kidneys from American’s organ pool. While there were estimates of 100 people who died here in Los Angeles who were severely in need of a new kidney, The Japanese crime lord and his group had very successful transplants. Many are questioning the foreign national’s right to acquire American’s “organs” for the right amount of money and are coming up with a figure of only 5 % to be allowed to non citizens to dip into the donor pool of American kidneys. Rumors of a $100,000 donation to the UCLA facility has also been mentioned coming from the gang lord and his men (Childs). Here in America there is much debate over the ethical issues of Kidney’s for sale. The National Organ Transplant Act of 1984 bans the buying and selling of organs and has set up taskforces such as OPTN & SRTR , organizations that research and track vital information on past and current transplants/ conditions. However, the Living Kidney Organ Donation Clarification Act has amended The National Organ Transplant Act to provide that a ‘paired donation’ of kidneys is not considered a human organ transfer for a value consideration. A paired donation is when: Person ‘A’ needs a kidney. Person ‘B’ has a kidney to spare but it is not compatible with Person ‘A’. Person ‘B’s kidney is, however, compatible with Person ‘C’ and Person ‘C’s kidney is compatible with Person ‘A’. So, Person ‘B’ donates a kidney to Person C who then donates a compatible kidney to Person A. This process has been proven successful in providing more kidney transplants when compatible kidneys are in short supply compared to demand. The bill essentially makes the swaps less expensive by considering it "not a transfer for value consideration”. President Bush has also signed The Organ Donation and Recovery Improvement Act which legally reimburses donors up to $12,000 for travel expenses, salary for time off e and miscellaneous expenses , etc. to encourage donations from Americans. But from what we can see, the poverty stricken countries are the targets for all the middlemen and illegal organ traffic trade. The shortage of kidneys from living donors has opened a black market where there is an enormous demand for kidneys. This organ trade clearly exploits the poor and for most who can afford a kidney from the black market, it is a palatable option to buy a kidney from a stranger instead of a family member, so as not to put their loved ones at risk of any future complications. Dr. Richard Rohrer claims that the survival rate of a functioning kidney from a cadaveric kidney could last a good decade; however, there is reasonable hope of a lifetime of kidney function from a living donor. Who wants a kidney from a person who’s much older and dead when there are young, strong and fresh kidneys available instead?
There is much debate worldwide if kidney sales should be made legal with a reimbursement scheme to entice more people to donate but this is claimed to just prey on the poor. The cost of dialysis today can be an overwhelming amount of money to person of average means and in the long run, transplantation is becoming the more economic solution for insurance companies and individuals with a higher rate of survival. Gavin Carney was quoted in the Sydney Morning Herald saying that “world health authorities should direct their passion toward promoting a legal apparatus for trade and that the way to stop illicit transactions –and the depredatation of the underground market—is to sanction legal exchanges”. What is the difference when women are selling their eggs for substantial financial amounts? This issue of kidney sales can be comparable on a certain level to abortion because in a sense, decades ago, most world organizations had a zero policy with the termination of a pregnancy. Can people in poverty then claim it is their right to sell any organ that they wish because it is their body? The solutions seem bleak at this point as there is still much to negotiate and discuss on this current problem of the Organ Black Market. The United Nations has labeled this epidemic a form of organized crime and the Human Trafficking Division insists that international legal texts are needed to define the legal measures of this trade and that there be group monitoring mechanisms of all living donors, with post surgery check ups on a regular basis of up to ten years. Two recommendations of The UN that are important to control this situation on Organ Trade are 1. National legislation and implementation and 2. The need to successfully bring forth awareness to people of the current conditions of the organ trade. Yet the opposition to this debate has a very good point on the matter. Why then is the person losing the most( his/her kidney) have to do it for free when everyone else benefits such as the doctors, nurses, middlemen and most especially the recipient with a new kidney and prolonged life? Everyone profits except for the donor that is left with a scar and a gutful of bitterness. “A recent survey of 239 kidney vendors in Pakistan, for example, showed that 88% made no economic improvement, and (8% reported deterioration in general health status” (Kerstein Ph. D.). If the poor do sell their kidney, they is no long term financial assistance that the monetary exchange has helped them in any way move out of their low economic bracket. A small human rights NGO dedicated to the task of promoting a human rights agenda for dealing with the violations of the bodily integrity of vulnerable populations is Organs Watch headed by Dr. Nancy Scheper- Hughes . Taken from their website , Organs watch stands for: Social Justice, Human Rights, and Organ Transplantation This project brings together a team of anthropologists, human rights activists, physicians, and social medicine specialists to conduct a multi-year project on "Medicine, Markets, and Bodies." Together they will explore the social and economic context of organ transplantation, focusing on the human rights implications of the desperate, world-wide, search for organs. They will carry out original ethnographic and sociological research as well as human rights investigations, and the findings will be broadly disseminated. The project will also establish and promote a human rights agenda for dealing with violations of the bodily integrity of vulnerable populations.
(Excerpt from http://sunsite.berkeley.edu/biotech/organswatch/)
The founder of Organs Watch claims that the kidney is not a spare part, opposed to the general public’s perception on kidneys. She says that within one to five years of selling their organs, their health deteriorates. On occasion, doctors might even have to remove a rib to procure the kidney. She makes a valid argument that most of the people who are selling their kidneys are impoverished people who are manual laborers thus are not able to return to work and lift heavy objects for a month after the removal of their kidney so it excludes them from work and they tend to lose their niche. She points out a radical but very valid counter proposal to the organizations pushing for a legal organ market. A “donor’s bill of rights”, a national registry of living donors and a committee to oversee and authorize each “donation”. There should be an independent donor advocate- someone who has nothing to do with the medical or financial elements of the transplant…if you’re going to plunge into the bodies of the healthy, they need medical coverage for anything related to that kidney sale—and they need it for LIFE” (McLaughlin). Out of all the proposals that are currently being discussed, Scheper- Hughes’ work advocates that the organ trafficking should be universally recognized as a medical human rights abuse and “body tax on the poor”. Expect heavy politics and discussions about this dilemma in the many years to come till a fair and equal
Bibliography
Childs, Dan. Yakuza Transplants Spotlight Organ Network. News on Television. Los ANgeles: ABC, 2008.
China Exposed: Organ Trade & Execution. 2008 26 July
Kerstein Ph. D., Samuel. "Letters to the editor." Wall Street Journal (Nov 20, 2007): A. 17.
Lakshmi, Rama. "India Uncovers Kidney Racket:Poor Laborers Were Victims Of Organ-Trafficking Network." The Washington Post Foreign Service 30 January 2008: A11.
McLaughlin, Abraham. "The Kidney is not a spare part." Christian Science Monitor 9 June 2004: 12.
Mogato, Manny. "Philippine bishops urge halt to organ trafficking." Reuters (January 28, 2008): http://www.reuters.com/article/latestCrisis/idUSMAN101053.
OPTN: Organ Procurement and Transplant Network. 2003. 20 July 2008
Sietzen Jr., Frank. "Speaking Up About a Silent Killer." The Washington Post 22 July 2008: F.3.
Woman Sells her Body Parts. 2008 July 23