The organ of last resort - harvesting and sale of organs practiced worldwide

UNESCO Courier, July, 2001 by Nancy Scheper-Hughes

MEDICAL ANTHROPOLOGIST AT THE UNIVERSITY OF CALIFORNIA, BERKELEY

Modern medicine has given rise to a booming trade between poor and rich countries--the trade in human organs. But what of the bodies that are being plundered?

During the summer of 1998,1 was sitting at a sidewalk cafe in downtown Sao Paulo with Laudiceia da Silva, who had just requested a legal investigation into the large public hospital where she had "lost" a kidney during an operation to remove an ovarian cyst.

The young woman's family doctor had discovered the kidney was missing during an examination soon after surgery. When confronted with the information, the hospital representative told a highly improbable story: that Laudicein's missing kidney had been embedded in the large "mass" around her cyst. The hospital, however, refused to produce either their medical records or the evidence--the diseased ovary and the kidney had been "discarded," she was told. To make matters worse, Laudiceia's brother had been killed in a random act of urban violence several weeks earlier, and the family had arrived at the hospital too late to stop his organs being removed on the basis of Brazil's new "presumed consent" law.

"Poor people like ourselves are losing our organs to the state, one by one," Laudiceia said angrily.

"Follow the bodies"

Hers is but one of several credible stories of "kidney theft" that anthropologist Lawrence Cohen and I have encountered in South America, India and Bangladesh as part of our work for the Berkeley Organs Watch, an independent human rights organization seeking to investigate allegations of medical abuse in the harvesting, distribution and transplantation of organs.

The project stems from experience on a prestigious international taskforce set up to investigate the organ trade and develop ethical guidelines to prevent abuses. Soon after reaching the conclusion that the trade was far more extensive than previously thought, the Bellagio taskforce was disbanded. In the absence of any other institution of its kind, Organs Watch was conceived as a stop-gap measure, offering a frontline response to reports of illegal organ and tissue sales or theft anywhere in the world.

Our simple mandate is to "follow the bodies." We follow transplant patients from dialysis clinics to surgery, and donor bodies from township shabeens [bars] to police stations and public mortuaries and from there to the various eye banks, medical clinics and research laboratories where their parts are harvested and redistributed. At times, the surgery theatres feel more like theatres of the absurd, as a few scenes plucked from our fieldwork will show.

In a Chennai (Madras) slum in South India, my colleague Lawrence Cohen met five local women, each of whom had sold a kidney for 32,500 rupees (about $1,200 in 1999). Each had undergone their operation at the clinic of Dr. K.C. Reddy, India's most outspoken advocate of the individual right to sell a kidney. Unlike the more seedy "organs bazaars" of Bombay, Dr. Reddy prides himself on running an exemplary clinic: his kidney sellers are carefully screened, fully informed about the medical risks and provided with free health care at his clinic for two years after kidney removal. The women Cohen interviewed were mostly low-paid domestic workers with husbands in trouble or in debt. The kidney sale was usually preceded by a financial crisis. Did the sale make a difference to their lives, Cohen asked. Yes, for a time, but the money was soon swallowed by the usurious interest charged by the local money lenders. Would they do it again if they could? Yes, the women answered.

Several months later, I sat next to Rosemary Sitsheshe at her home in Guguletu township outside Cape Town, South Africa. Her only son, 17-year-old Andrew, had been caught in the crossfire of township gang warfare just before the end of apartheid. He died of a chest wound under police surveillance. The next day Rosemary went to the local police mortuary to claim his body, but officials turned her away. Two days later, when the family was finally allowed to view Andrew's body, they were shocked: the blanket over it was covered with blood and there were two deep holes on either side of his forehead. Rosemary protested, saying he had been killed by a single, clean bullet to his chest. The state pathologist treated her and her husband abusively.

Later, accompanied by her own private pathologist paid for by the African National Congress, Rosemary learned at the morgue that her son's eyes had been removed and that inside his abdominal cavity the organs had all been severed and carefully replaced. "But were those my son's organs?" she asked. "I know my son's eyes but not the colour or shape of his heart or kidneys." At the local eye bank, Rosemary was told that her son's corneas had been "shaved" and given to two "lucky patients." The remains of Andrew's eyes were being kept in the refrigerator and the director refused to return them to Rosemary for burial.

"Although my son is dead and buried," she said, "is it good that his flesh is here, there, and everywhere, and that parts of his body are still floating around? Must we Africans be stripped of every comfort?" Rosemary Sitsheshe has since taken her complaint against the police mortuary and eye bank to South Africa's Truth and Reconciliation Commission. She asked that her case be treated as one example of a practice that was widespread in police mortuaries under apartheid and which continues in some instances.