Human kidneys: The new cash crop - Currents: Poverty

New Internationalist, March, 2003 by Nancy Scheper-Hughes

New medical technologies have spawned a world trade in human organs that is largely resistant to regulation, says Nancy Scheper-Hughes, who offers an overview (below) and reports from Moldova and the Philippines (above).

WITH the demise of the Soviet Union, the agricultural economy of rural Moldova collapsed in the mid-1990s. Here, in the heart of central Europe, economic globalization has meant one thing only for agricultural villagers -- that 40 per cent of the adult population has had to leave home to find work abroad. Today Moldova is the poorest country in Europe: an indigenous 'third world' within European borders.

Though Vladimir, a skinny lad with a rakish metal stud in his lip, had never been further from his village than to Moldova's small capital city of Chisinau until a few years ago, he was easily lured away with the promise of a good job at a Turkish dry cleaner's factory. Nina, a local kidney hunter, arranged his passport, visa and bus ticket to Istanbul, a bumpy 18-hour overnight ride.

Once in Istanbul, Vladimir was housed in the basement of a run-down hotel in the immigrant neighbourhood of Askary. He shared the space with several other Moldovan villagers, including a few frightened village girls barely out of high school. Nina arrived to break the news to one of the girls that her 'waitressing' job would be in a bar where 'exotic' dancing was required. Then Vladimir was told that he was wanted for more than pressing pants. He would start by selling a few pints of his blood and once a 'match' was found, he would be taken to a private hospital where he would give up his 'best' kidney for $3,000, less the cost of his travel, room and board and the fees for his 'handlers'. A few days later Vlad was told that an elderly transplant patient from Israel, who had travelled to Istanbul with his private surgeon, was matched and ready to go. When Vlad demurred, Nina arrived with her pockmarked, pistol-carrying Turkish boyfriend who said that he was quickly losing patience. 'Actually,' Vlad says ruefu lly, 'if I had refused to go along with them, my body minus both kidneys and who knows what else, could be floating somewhere in the Bosphorus Strait.'

WHILE kidney selling is a deeply stigmatized act in Moldova, it has become a routine event in slums and shantytowns half a world away in the Filipino capital of Manila. This is despite the fact that the operation has put a great many young men permanently out of work, Kidney sellers say they are no longer able to lift heavy cargoes. 'No-one wants a kidney seller on his work team,' an unemployed father of three told us while his wife fumed at him from a distance.

Bangon Lupa is a garbage-strewn slum built on stilt shacks over a polluted and faeces-infested stretch of the Pasig River that runs through the shantytown on its way to Manila Bay. In Bangon Lupa 'coming of age' now means that one is legally old enough to sell a kidney. But as with other coming-of-age rituals, many young men lie about their age and boast of having sold a kidney when they were as young as 16 years old. 'No-one at the hospital asks us for any documents,' they assured me. The kidney donors lied about other things as well --- their names, addresses and medical histories, including their daily exposure to TB, AIDS, dengue and hepatitis, not to mention chronic skin infections and malnutrition.

So while donors are not scarce, foreign transplant patients willing to risk the operation in a Third World country are. This, despite the fact that a kidney transplant in a private hospital in Manila costs foreign patients (mostly from Japan, the Gulf States and North America) only $30,000 compared to the $200,000 charged at private clinics in Turkey, Europe and the US.

FROM the exclusively market-oriented 'supply and demand' perspective that is gaining ground among transplant specialists and bioethicists today, the buying and selling of kidneys is viewed as a potential solution to the global scarcity in organs and as a 'win-win' situation that benefits both parties.

The Secretary of Health of the Philippines, Dr Manuel Dayrit, had two proposals on his desk at the time of my interview with him in February 2002. The first would create a government-regulated kidney bank (to be called KIDNET) that would allow poor people to sell and deposit a kidney into a virtual 'organs bank' that would presumably make them available to all Philippine citizens who needed them Dr Dayrit was, however, reluctant to discuss just how the Ministry of Health might set a 'fair price' for a poor person's kidney, preferring to leave this task to the free market. Dr Clemente, the director of Capitol Hospital in Manila, agreed: 'Some of our "donors" are so poor that a sack of rice is sufficient. Others want medical care for their children, and we are quite prepared to provide that for them.'

The second proposal is a government-sponsored programme to grant Death Row prisoners (most of them killers) a reprieve in exchange for donating a kidney. Their death sentence would then be replaced by life imprisonment. Supporters of this programme believe that the donor incentives programme could end up convincing society that the death penalty is a terrible waste of a healthy body.