International traffic in human organs

Published : Mar 30, 2002 00:00 IST

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 and more patients suffering from End Stage Renal Disease opt for kidney transplants instead of remaining on dialysis. The result? In many parts of the world, the demand for kidneys far outweighs the supply. Brokers have stepped in, offering kidneys for sale to cover the deficit.

Organ Watch, an NGO based in the University of California, Berkeley, tracks "the global traffic in human organs." A research team led by Nancy Scheper-Hughes, Professor of Anthropology at Berkeley and one of the founding members of Organ Watch, has conducted comprehensive field research into the global traffic and documented the practices of organ harvesting in many parts of the world, notably Argentina, Brazil, Cuba, Israel, Turkey, South Africa, the United States, the United Kingdom and India. This research shows that abuses associated with kidney transplants occur all over the world in various forms. The abuses range from the harvesting of organs from executed prisoners in China (where doctors are intimately involved in the executions in order to ensure that the organs are kept in good condition) to the removal of organs from dead bodies in Argentina and South Africa without the permission and knowledge of the families of the dead.

In Brazil 'compensated gifting' (a phrase often used to describe the trade) is accepted by many transplant surgeons. Scheper-Hughes' finding is that there is a lot of exploitation of people in subordinate work positions. As in India, donors often work in the houses, offices or factories of recipients and are promised secure employment, housing or other benefits in return for 'donating' their kidneys.

In Brazil the organ trade is illegal and, as a means of combating it, a 'presumed consent' law has recently been passed. Unless people specifically state that they do not want to donate their organs after death, it is presumed that they have consented and organs are routinely harvested 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 on their identity cards.


Iran provides an interesting case study of a country where the kidney trade is legal and regulated. The trade is organised and controlled by two government-endorsed NGOs - the Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD). The role of CASKP is to put potential recipients and donors in touch with each other, and organise tests to ensure the compatibility of donors and recipients and the mental stability of donors. After the transplant the CFSD is required by law to pay the donor a sum of 1,00,000 Tomans ($1,219), which comes from government funds. Recipients often promise donors secure employment or extra money after the transplant (although CASKP and CFSD have no control over this).

In a country where brain-stem death is not recognised by law, the system has virtually eliminated recipient waiting lists. Members of the CFSD have claimed that the regulated system is a "new chapter in the world's transplantation history," a "development in donor-recipient relationships" and "an innovation in the Islamic Republic." However, two studies done by Javaad Zargooshi from the Department of Urology at Kermanshah University of Medical Sciences, Iran (The Journal of Urology, Vols. 165 and 166), show otherwise.

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 might look like. Some 65 per cent of interviewed donors reported that the kidney sale had led to negative effects on employment. Thirty eight per cent, representing largely uninsured manual labourers, had lost their jobs because they were unable to continue working at the same job after the transplant. Many donors were also frightened to go back to work for fear of injuring their remaining kidney. Ninety per cent of the vendors complained of impaired physical ability and ill health. Complaints included palpitation, tremors, chest-pain, backache, nervousness and fatigue. Seventy per cent of the donors suffered from post-operative depression and 60 per cent from anxiety. Several donors said they had attempted suicide and spoke of donors who had killed themselves. Seventy per cent of donors said that they felt worthless after the operation and 85 per cent stated that if given the chance to go back in time, they would not donate their kidney and would also advise others against donating their kidneys. A large number of donors spoke of social ostracisation and increased marital conflict following the kidney sale.

Zargooshi concludes that "considering the fact that the main or sole reason for donation was financial, it became clear that in the absence of altruistic motivations on which the donors could depend, financial loss became intolerable and depressing."

South Africa

Organ Watch reports that wealthy foreigners from Botswana and Namibia come to South Africa to buy organs from live unrelated donors. At one academic and public hospital in Cape Town, a steady stream of paying foreigners from Mauritius was largely responsible for keeping its beleaguered transplant unit solvent following budget cuts and the redirection of state funds to primary care.

Cases of organ theft have been reported and in June 1995 Moses Mokegethi was found guilty of the murder of six children for their organs. 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 and Reconciliation Commission is considering other allegations of organ theft.

In South Africa, dialysis and transplantation have been relegated to the position of 'tertiary health care', and this is not provided by the state. Dialysis and transplantation are the privilege of a relatively small section of society that can afford expensive treatment in private hospitals.

United States

Although cash-for-kidney transactions are illegal in the United States (which outlawed organ commerce in 1984), Organ Watch has reported cases where families of brain-dead patients 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 for patients round the world. "Don't think of me as an outlaw," he told the researcher. "Think of me as a new version of the old-fashioned marriage broker. I locate and match up people in need."

These words might have come from a kidney broker operating in Bangalore, or any of India's other transplantation centres.

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