When the poor give to the rich

By Susanne Lundin

A few days ago, a friend of mine, a medical scientist and physician in a Swedish hospital, received an astounding offer in her email box.

In poorly written English, the missive read: “My name is Alex. I am [a] 31 years [old] European man. I never drank alcohol and did not smoke cigarettes. My blood is O and I have a good health. If you need [a] liver transplant I am ready to give part of my liver, but I want to receive a big compensation for that.”

Such offers are hardly uncommon. Similar pleas to sell body parts appear in different forums and websites, such asMahmnud75.

This advertisement is typical: “I am an Indian. My native place [is] Brahmpur, district -Ganjam, Odisha. My age is 37 (17-08-1974). My blood group [is] O . I am fully vegetarian. I am interested to sell to an American my left kidney for 80,000 US dollar. I am interested to sell to a Chinese – [my] right kidney for 80,000 US dollar. I am interested to sell to a Russian [my] heart for 100,000 US dollar. I am interested to sell to a Japanese [my] brain for 100,000 US dollar.”

Offers of this type could, just a few years ago, be found at liver4you.org, which promised kidneys for prices between $80,000 and $110,000. The costs of the operation, including the fees of the surgeons – allegedly licensed in the United States, Great Britain, or the Philippines – was included in the price.

Today, that website no longer exists. Many illegal medical cyber-markets exist for only a short time, only to disappear and re-emerge with a new name.

The internet’s role in illegal organ sales is growing, but it is still a small slice of the massive global human-tissue economy. The World Health Organization has estimated that about ten per cent of organ transplants around the world are arranged through commercial transactions.

Trade in organs follows a clear, geographical pattern: people from rich countries buy organs from the people in poor countries who sell them. In my research on organ trafficking, I have entered these shadowy organ markets, places where the body parts of war victims, prisoners and the poor are sold as grisly commodities. Many of these organs are bought, some are stolen, but most end up inside the unwell bodies of affluent people.

One woman, originally from Lebanon, told me that a wealthy businessman from Spain offered to pay a huge sum for her kidney. In the end, however, she received no monetary payment. Her life today is much worse than it was before, mostly because medical complications following the operation made it difficult for her to work. Similar stories are told by organ vendors I have met from the former Soviet states, the Middle East, and Asia.

Organ trafficking depends on several factors. One is people in distress; those who are economically or socially disadvantaged, or live in war-torn societies with pervasive crime and a thriving black market. This is the supply. On the demand side are people who are in danger of dying unless they receive an organ transplant. In the middle are unscrupulous organ brokers who arrange the deals between sellers and buyers.

It is also necessary to have access to well-equipped clinics and medical staff. Adequate clinics can be found in many countries, including Iran, Pakistan, Ukraine, South Africa, and the Philippines.

The Philippines is a well-known centre of the illegal organ trade and a thriving hot spot for “transplant tourism”. From the 1990s until 2008 – when a new policy was adopted – the number of transplants involving organ sales by Filipinos to foreign recipients increased steadily. Many organ sellers from Israel, for example, were brought with the purchaser to Manila for the operations.

Hector is one of the several hundred cases of kidney vendors documented by social workers in three impoverished towns in the Philippines’ Quezon province. His brother was trapped in Malaysia deeply in debt to criminal gangs, so Hector sold his kidney to buy his freedom. Another vendor, Michel, became a broker himself; after selling one of his kidneys to pay for his father’s medicines, the surgeon forced him to deliver more organs. Organs from the poor Filipinos of Quezon were mostly transplanted to recipients from the Philippines, Israel, Japan, South Korea, and Saudi Arabia.

Trade in human body parts is not a new phenomenon. Yet today’s businesses are unprecedented because of the ideas and values that have inadvertently enhanced the trade in organs. Western medicine starts with the view that human illness and death are failures to be combated. It is within this conceptual climate – the dream of the regenerative body – that transplantation technology develops and demand for biological replacement parts grows.

An obvious example of treating the human body as a resource to be mined is the organ donor waiting list, used in many countries. A man I interviewed recently during a study of Swedes who had been on a kidney waiting list, but decided to purchase kidneys abroad, described why he went to Pakistan for a transplant: “I’m not the kind of man who uses other people, but I had to. I had to choose between dying or getting back my life.”

In an era of organ transplants on demand, there is no way around this dilemma. The biological imperatives that guide the transplant waiting list system are easily converted into economic values. As always, where demand exceeds supply, people may not accept waiting their turn. In the case of human body parts, other countries and other people’s bodies continue to offer them the alternative they seek.

Susanne Lundin is Professor of Ethnology at Lund University, Sweden.
A version of this article first appeared on Project Syndicate.

About Michaela

I am a wanderer and a wonderer, like you are. I love our journey and to walk in the company of friends – to learn, experience, share, laugh, cry and above all I simply love this marvelous, magical, mysterious life. I have no plan (cannot believe I am saying this) and my only intention is to be truthful to myself and others.
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