Apr
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How much is a kidney?
April 1, 2008 | | 2 Comments
By Wanching ( Week 8 )
According to Organs Watch, a task force of scientists and transplant surgeons who have launched a global investigation on organ trafficking, at least 15,000 human kidneys a year are sold and obtained through organ trafficking. Out of this 15,000 kidney “transactions”, many have been done through coercion, where victims of human trafficking are drugged before their healthy kidneys are forcefully removed, or the ignorant “donors” were told their kidney has failed and so has to be removed, only to discover later that their kidney has been transplanted to someone else with enough money to pay for the organ and the surgery.
In the age of globalization, countries are no longer as separated from one another as they used to be by sheer geographical distance. International travel has been made more convenient and enables people to cross the globe quickly and easily. The sophisticated medical technology that allows any organs to be cheaply transplanted, together with the increasing disparities between the richest and the poorest on the planet, has also brought about a wave of “transplant tourists”.
Patients in need of organ transplant from Europe, the US and the richer parts of the Middle East are flocking to private Pakistani and Indian hospitals for operations which can be arranged in days at a fraction of the cost back home. This illegal trade of human organs means that disadvantaged individuals are reduced to the role of “organ suppliers” for those who have the cash to pay.
The flow of these “transplant tourists” mirrors the typical movement of “goods” moving from the poorer parts of the world to the richer parts, and the movement of money in the other way round. On the one side of this trade, there is tremendous poverty; and on the other side, desperation on the part of patients who need the organs.
However, despite the lower cost and shorter waiting time, obtaining an organ transplant from the other side of the globe may not be such a good idea after all—both for the donor and the recipient. When there is no biological link between the donor and receiver, doctors are often forced to use dangerous techniques to reduce the chance of the recipient’s body rejecting the organ.
“Agents that slow the immunity system are required to prevent rejection, usually they are very harmful to the patient’s future in the long run, making him or her more susceptible to other diseases”, renal surgeon Dr. Zein al-Moswi said.
And for the donors, it does not need mentioning that the transplant’s harmful effects on them are more obvious. The one kidney left is sure to be put under huge pressure and would eventually fail. Given the poor diet and lack of medical facilities in the poorer countries, the health of these donors will be put at great risk.
In fact, the scale of the “organ transplant business” is so huge that governments in both receiving and donating countries are beginning to take note.
After participating in the fourth meeting of the Monitoring Authority for Transplantation of Human Organs and Tissues, the Pakistani Health Ministry announced in late February that donation of organs would be allowed only by blood relatives of the potential receiver. Severe action would be taken against hospitals and other health institutions found involved in illegal organ trade.
A renowned kidney surgeon who admitted to arranging organ transplants for patients from all over the world was arrested in Chennai, India, late last year. Since then, the New Delhi government has speeded up a major mass media campaign to bring about a change in people’s behaviour to raise awareness of illegal organ transplant in the country.
In late February, Canadian MP Borys Wrzesnewskyj has proposed Bill C-500 which seeks to penalize any Canadian citizen who participates in illegal organ transplant, no matter where in the world the transplant takes place. If the Bill is passed, all transplant recipients will have to obtain a certificate establishing that the organ is donated or obtained legally and that no money was involved in the donation.
On the other hand, medics in Iran, where kidney trade has been legalized, are preaching that market forces will make sure that people in need of money and those in need of a healthy organ would be matched up effectively.
They are echoed by increasing calls urging governments worldwide to promote awareness and encourage voluntary organ donation as a first step onto the road of mandatory organ donation if possible.
Encouraging voluntary donation may not be a bad idea, but for mandatory organ donation, local cultural sensibilities and economic circumstances have to be taken into consideration. No matter how effective a solution it might sound, there are indeed cases where compulsory organ donation does not work. In Brazil, everyone is declared a universal organ donor at birth, meaning that once they die, any useful organs will be donated to other in need without prior consent of the deceased or his/her family. For many of its people who find it hard to make ends meet, the possibility of selling an organ before they die seems like an act of empowerment. Under extreme poverty, somehow it makes sense for them to prefer to sell their body organs for money to be used in their lifetime, rather than to let the state get it free when they die.
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This is a very biased and poorly researched article. The author takes little care to distinguish between the several different issues surrounding organ transplantation. Here are some facts – 1. In the vast majority of cases (where the procedure is done under modern methods) kidney transplant dramatically improves the quality and length of the lives of the recipients, while providing minimal risk to the donor. 2. Drugging or other forms of coersion used to obtain a kidney is unethical and worse – immoral. But donation itself can, and usually is, consentual. The crime of fraud in the former should not restrict the voluntary exercise of individual choice in the latter. 3. The international ban of paying for organs is making the problem of fraud WORSE! By driving the demand for kidneys underground the ban has created a black market that is nearly impossible to police. If compensated organ donation was not criminalized then the immense already-existing world infrastructure of medicine and justice would quickly embrace and protect patients and donors.
Kidney transplant causes minimal health to donors only if the operation is done with good skills and clean, high-tech surgery equipment, but this may not be the case in backward places where “transplant tourists” fins most popular. A study published in the Journal of the American Medical Association found that, of 305 Indians who had sold their kidneys, 96% had done so to pay off debts, but three-quarters remained in debt. Also, 86% said their health had declined since the operation. Director of the Centre for Bioethics at the University of Minnesota, Jeffrey P. Khan, also argued that the “transplant tourist” trade would exploit the poor both monetarily and physically while long-term benefits would go only to the wealthy, “giving rich people a better chance to get available organs first”.
Besides, lifting the ban on unauthorized organ transactions may not necessarily eliminate the black market. Instead, some are worried that legal organ sales would create another huge opportunity for fraud in terms of the sale of low-quality or diseased organs, citing as example the low-quality blood in US private blood banks. So the best way forward would be to promote voluntary donation in the community, and to encourage desperate patients to say no to organs extracted out of fraud or coercion despite the huge shortage.