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| Larissa MacFarquhar: Paying for Kidneys
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| In this week’s issue, Larissa MacFarquhar writes about people who donate their kidneys to strangers. (Subscribers can access the entire article online.) These donors were motivated by altruism. But what about people who might be willing to part with a kidney for money? Legalizing payment for organs is a ferociously controversial topic in the organ world. Opponents fear exploitation—that the poor will become organ suppliers for the rich. (“You can imagine a scenario where someone would say, ‘Welfare? You’ve still got two kidneys!’ the political philosopher Peter Lawler has said. ”There would be the expectation that your kidney might be understood as part of your net wealth.“) It is presumably true that most organ sellers would be poor; on the other hand, many of the recipients would be poor also. Others worry that paid donors would have a motive to lie about aspects of their medical history that might cause a transplant center to reject them, and it’s true that while many kidney-related problems can be tested for, some crucial ones can be hidden—a family history of kidney disease or diabetes, for instance, or an individual history of kidney stones or drug abuse. The National Kidney Foundation opposes compensation on the grounds that it would ”cheapen the gift“—that it may be an ”affront“ to those who have already donated. (”The argument that paying organ donors is ‘an affront’ to unpaid donors is disgusting,“ Virginia Postrel, who donated a kidney to her acquaintance Sally Satel, wrote on her website. ”Are unpaid donors giving organs to save lives or just to make themselves feel morally superior?“)
In countries where organ-selling is widespread, though illegal—Pakistan, India, the Philippines—organ sellers are often worse off after surgery, physically and even financially, because they may be cheated out of their payments, and because inadequate follow-up care often leaves them unable to work. Opponents of legalization often cite this fact, though it is of questionable relevance, since living donors in the U.S. are, statistically, as healthy after surgery as anybody else. It is not clear what impact the legalization of kidney sales in the U.S. would have on illegal organ trafficking abroad. Presumably most Americans who would have become organ tourists would prefer to obtain a kidney legally at home; on the other hand, some believe that the American ban on sales is an important moral bulwark against more organ selling in places where even legalization would not mean safety. It is often assumed that at least permitting compensation for kidneys would result in more living donors, but this is not necessarily the case. Under the current system, a person who needs a kidney will usually turn to his family, and possibly his friends, for help, but if he could obtain a kidney from a stranger, paid for by his insurance, would he ask a person he loved to undertake the nuisance and risk of surgery? (Of course, this assumes that there would be enough kidney sellers to supply the need.) In Israel, where until recently the practice of transplant tourism—going abroad to receive a kidney transplant—was widely accepted, donations from living relatives were relatively rare. It seems likely, too, that the sort of person who might now donate to a stranger for altruistic reasons would not do so if the donation were a commercial proposition (one altruistic donor asks compensation proponents to consider whether an offer of cash from a boyfriend would increase the probability that the girlfriend would have sex with him)—though there are so few altruistic donors that their numbers don’t much affect the calculus. As things are now, usually around six thousand living Americans donate kidneys each year. Would more people than that donate for money? It is legal to pay surrogate mothers for their time, effort, and suffering, but the demand for them outstrips the supply: there are approximately a thousand surrogate births each year in this country. Of course, donating a kidney is much less time-consuming and emotionally fraught than being a surrogate mother; human egg donation is probably a better comparison, though donating eggs doesn’t require major surgery, with its risks and recovery time. There are no official statistics on how many women donate eggs, but, in 2003, the Centers for Disease Control and Prevention counted just under thirteen thousand embryo transfers involving donated eggs. The pool of potential kidney donors is obviously larger than that for reproductive medicine—men can give kidneys, and kidney patients don’t tend to care about the hair color and S.A.T. scores of their donors. But if—a big if—compensation were restricted to Americans, it does not seem certain that the number of compensated kidney donors would be much greater than the number of volunteers.
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| Growing Organ Market Targets Desperate Poor, Sells Kidneys, Livers, and Corneas
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| Impoverished people in developing countries are increasingly being targeted and ‘exploited’ in the growing black market trade of human organs, according to a paper published in the Medical Anthropology Quarterly. A decade-long study detailing the experiences of people who were victims of flourishing worldwide market for body parts like kidneys, liver parts and corneas, found that these individuals are often manipulated by unethical brokers and organ recipients. Study author Monir Moniruzzaman, a Michigan State University anthropologist who had infiltrated the black market for human kidneys, had interviewed 33 kidney sellers in Bangladesh and found that they typically did not receive the money they were promised and often suffered serious health problems that rendered them unable to work which lead to shame and depression. Moniruzzaman said that doctors, hospital officials and drug companies often ignore the illegal procurement of organs because they also profit. He said that because organ selling is illegal, many brokers often forge documents that indicate that the recipient and seller are related and claim that the trade was actually a family donation. In 2007, the World Health Organization (WHO) estimated that between five to 10 percent of kidney transplants per year were from illegal organ trafficking, and the international market was estimated to be worth $50 million in 2008, according to Michael Bos from the European Platform on Ethical Legal and Psychosocial Aspects of Organ Transplantation. Most of the 33 Bangladeshi sellers in Moniruzzaman’s study had one of their kidneys removed across the Indian border, where organ trafficking has been illegal since 1994, and they had met a recipient at a medical facility where the transplant was performed. “This is a serious form of exploitation of impoverished people, whose bodily organs become market commodities to prolong the lives of the wealthy few,” said Moniruzzaman in a statement released on Monday. One of the experiences described in the paper was that of a 23-year-old Bangladeshi rickshaw puller who had sold part of his liver to a recipient. Mehedi Hasan, like many of the poor in Third World countries did not know what a liver was, and the broker that told him that the sale would make him rich. Hasan had only received part of the money he was promised and he soon became too sick to work, walk long distances or breath normally, and he said that he often thinks of committing suicide. Moniruzzaman reported that organ brokers often show deceptive advertisements in newspapers to lure organ sellers. The study examined more than 1,200 newspaper ads for the study, and said that some even promise kidney sellers a visa to the United States. Moniruzzaman also found that cases of corneas being sold, a Bangladeshi woman, who said that she only needed one eye to see, had advertised to sell a cornea so she could feed her family. Moniruzzaman stressed that most sellers do not make “autonomous choices” to sell their organs, but are often manipulated and coerced into the often times debilitating trade. He added that the international organ market is only a fairly recent phenomenon that has been made possible by medical advancements in the past 30 years. He recommends that U.S. Department of State to play an active role in combating organ trafficking by putting pressure on national affairs and foreign government to acknowledge the problem, and cracking down on brokers, recipients, doctors and businessman involved in the trade. The U.S. can also work to provide aid and encourage implementing cadaveric organ donation systems in countries that do not have a system in which people can donate organs when they die. He also said that the State Department should also ensure that all hospitals and clinics have a transplantation registry and verify the relationship between recipients and donors. While the sale of transplant organs are prohibited in many countries, organ shortage is a universal problem and the development of organ donation programs in some countries are hampered by sociocultural, legal and other factors.
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