In Theory | Opinion
January 5, 2016 at 10:26 AM
Each week, In Theory takes on a big idea in the news and explores it from a range of perspectives. This week we're talking about government compensation for organ donors. Need a primer? Catch up here.
Nancy Scheper-Hughes is a professor of medical anthropology at the University of California, Berkeley, and director of Organs Watch. She advises the World Health Organization, the European Union and the United Nations.
If you would be willing to ask a living person to sell his or her kidney to you, be aware that you enter a moral, social, ethical and political gray zone. While it may mean that you wouldn't have to resort to organ waiting lists and dialysis treatment in the event of kidney failure, you'd be putting the seller and yourself at risk.
Be aware that the sale of organs has damaged the families of sellers and their communities — in Syria, India, Sri Lanka, Kazakhstan, Moldova, Ukraine, Brazil, Egypt, the Philippines, Turkey and wherever political refugees wash up on the shores of Europe. A kidney for an (un)safe passage to freedom: This is the unbalanced agreement demanded of many families fleeing political conflict and drought. In the watery slums of Manila, the obligation to sell a kidney for the financial sake of the family is being passed down from the father to his wife to their underage sons and daughters, whose bodies are seen as a family piggy-bank.
[Other perspectives: If you're willing to buy a kidney, you're willing to exploit the poor]
Despite what you may have heard from some advocates of compensation for kidneys, the kidney is not a "spare" organ. If you were able to talk to kidney sellers across the world as I have, you would find that even years after the operation, sellers suffer from the operation's negative effects on their bodies, minds and lives.
Medical journals do not report on the invisible and long-term medical, psychological and social consequences of selling a kidney: chronic pain, depression and suicide, self-hatred, distorted body image ("half-man syndrome"), a sense of bodily emptiness and evacuation (the body without organs), anger, regret, isolation — and even physical abuse, battering and forced exile from their native communities.
Economically, kidney sellers are worse off a year after selling their kidney. Because most sellers are poorly educated, unskilled laborers who rely on the strength of their bodies, many are excluded from their previous work that required them to lift heavy objects, to leap and jump, to be unconcerned about the effects of ordinarily rigorous work on their bodies. In Bangladesh and Pakistan, kidney sellers refer to the kidney removal as "the day of my death," a reference to their economic, psychological and social decline.
Underground markets run by organ brokers and kidney hunters exploit the desperation of both buyers and sellers. Even regulated systems, such as the ones established by the Ministries of Health in the Philippines and in Iran, rely on independent "match makers" and intermediaries. The result is the collaboration of surgeons and hospitals with local "kidney hunters" who are unregulated and ply their trade based on deceit and exploitation. Hospitals and transplant teams cannot be left with the responsibility of monitoring the paid donation of living people's organs.
Even governments that have attempted to regulate kidney selling have proposed exploitative means — granting visas to undocumented day-laborers and promising work to economic and political refugees in exchange for kidneys. Last month, Turkish authorities arrested a suspected international kidney broker, Boris Wolfman, who was allegedly recruiting desperate Syrians from refugee camps and detention to sell a kidney in exchange for legal protection.
In the United States, mandated independent advocates for living donors, who represent the needs and motives of every living kidney donor, have failed to identify cases in which force, coercion and fraud have motivated individuals to forfeit an organ. Such was the case of the infiltration of U.S. hospitals and transplant units by an international kidney brokering scheme that trafficked poor kidney sellers from Israel (most of them new immigrants) to provide kidneys to foreign transplant tourists and American citizens. The head of the scheme was finally caught in a police sting and pleaded guilty in federal court in Trenton, N.J.
Imagine the difficulties and complexities of developing far more rigorous and complex regulations on the selling of body parts. Who would oversee the system? Transplant surgeons? Nonprofit groups? Medicare? Or would independent donor advocates be burdened with uncovering the true motives or hidden coercion behind U.S. transplants?
In the final analysis, money for kidneys is not the issue; it's the irresponsibility and hostility toward kidney sellers. So, if you are willing and able to pay someone for an organ to save your life, it is best that you choose someone you know — perhaps even someone you love. You should be able to watch out for the seller over the long term, especially in the case that this person's health fails. You can't put a price on life, but you can exchange money with a promise of mutual trust and care.
Explore these other perspectives: