17 November 2006

Transplant Tourism

The image above illustrates the going price rates of a kidney in the black market in different parts of the world. It might sound disgusting and downright distasteful, but this is reality, and it's happening now. Other countries not mentioned in the diagram above include India, China, and Moldova.

The term, "transplant tourism" is an offshoot of the now vibrant term, "medical tourism," and it usually means traveling to another country (most often a 3rd world or a developing country) to purchase medical care or transplant organs that's either unavailable or more expensive in your home country. The less famous terms are "flesh trade" and "organ market."

Consider these premises:
  • while humans have 2 kidneys, they can live with only one

  • there is a worldwide shortage of organs for transplantation, and the waiting list of patients is growing longer and longer

  • there is now widespread acceptance of a kidney transplant from a live donor who is genetically unrelated (close genetic matching between the donor and recipient is no longer perceived as a hindrance to achieve a highly successful outcome)

  • there are many people willing to sell their kidneys in developing countries
Over the years, organ transplantation has proved to be a safe and successful means of extending one's life. Because it is a successful surgical option, more and more patients with chronic renal failure or end stage renal disease want it. Today, there are many reasons why you should end up with a diseased kidney --- diabetes, hypertension, inherited disorders, glomerular diseases (kidney inflammation and progressive destruction), autoimmune diseases, lithiasis (stones), trauma, and many others.

When demand exceeds supply, two things happen --- there would be a shortage, and prices will rise. Consequently, when there is shortage and rising prices, there will always be shameless fleecers who will exploit the situation. Organ shortage can give birth (and it has!) to a global organ black market. There are 90,000 patients on the waiting list in the US, of whom 6,000 die every year. In New York, for example, 3,360 have died waiting for an organ transplant since 1995.

The existence of a global organ black market today is partly due to the so-called repugnance factor over the whole idea of organ transplantation between donor and recepient who are both genetically and emotionally unrelated. I think governments and health authorities should sit down and start formulating clear and accepted guidelines (or laws if that's possible) that would benefit both recepient and donors. Organ black markets should be eliminated. No one but exploitative middlemen earn immoral profits from the existence of organ black markets.

How far would sick people go to express their need to buy kidneys? Very far. Very creative, too. Some would go to the extent of advertising on highway billboards. Some would make personal requests on nationwide TV and radio. Some would list themselves in multiple registries. Some will do a bit of Googling or pepper friends and strangers with email requests. Finally, some will go to medical tourist sites and hope to find a kidney.

How much do people sell their kidneys? Here in the Philippines, the officer in charge of medical tourism has said that it should at least be in the ballpark of US $4,000 (P200,000), and not the pathetic US $2,000 you see in the image above. The Filipino kidney donors selling their kidneys are always duped with lower prices ranging from P50,000 to P70,000 (around US $1,000 to $1,400), and in a country of poor people, those amounts of money are already okay with them as payment. Kidney sellers abound in Pulang Lupa, Luneta, Bacood and the Baseco compound in Manila, Novaliches in Quezon City, and Addition Hills in Mandaluyong City.

Should kidneys be exchanged for cash? While it is highly discouraged, of course, not only due to ethical issues but because of a catalogue of life-thereatening complications (usually infectious), my answer here is still a yes, especially if the donor requests it. Otherwise, it's always a blessing when recipients can find altruistic donors. Dr. Enrique Ona, chair of the Philippines' National Transplant Advisory Board, prefers the term, "gratitudinal gifts," which I think is a just a way of romanticizing the obvious market dynamics at work.

  1. Is It Ethical for Patients with Renal Disease to Purchase Kidneys from the World's Poor?

  2. Exchanging Kidneys: How Much Unfairness Is Justified By An Extra Kidney and Who Decides?

  3. This Little Kidney Went to Market (requires registration)

  4. Ethical Incentives — Not Payment — For Organ Donation

  5. Kidneys For Sale

  6. Call To Legalise Live Organ Trade

7 reactions:

Sidney said...

In my opinion it should be like blood donors. No payment. We should not do business with human organs.

Sidney said...

By the way, a very interesting post. I knew it was happening but I didn't knew it was so widespread.

may said...

i do not agree in selling body parts, but if i cannot feed my kids and selling my kidney is THE ONLY means i have to buy them a decent meal, i will do it without thinking twice. that's why i totally understand those who sell their kidneys. but those middlemen who take advantage of these "kapit sa patalim" situations are the ones i don't get, they are shameless.

ipanema said...

At least in our country, people are selling body organs and get something out of it. Whereas China's infamous organ harvest involves political prisoners who are innocent of what or why their organs are harvested and sold. Who earns? Not the person or his family. This has been repeatedly denied by China. But just a couple of months ago, a BBC correspondent went to one of the hospitals in China, pretending to find an organ donor for his sick father. It was all caught in video (YouTube) - a medical officer telling him where it all came from and the price.

With those prices quoted above, it's a big market.

Should kidneys be exchanged for cash? If it will be able to help the family, yes.

It's interesting to note the places where donors come from. Judging from those places, perhaps it's more economic in reason.

bayi said...

As far back as 20 years ago I was aware that blood was being sold at about RM300.00 (USD75 then) per pint. The price has gone up now with the skyrocketting cost of living. I have not heard of the sale of kidneys in Malaysia though I am aware that we can live with only one.

joyce said...

hi doc! it's been a long while, i know :) but my question is, what are the disadvantages of having only 1 kidney? ofcourse, God gave us 2 for a reason, and now, after reading this, I would like to think that it is to give away one of them when someone needs it (and hence gain points in heaven) :)

Dr. Emer said...

It's still better to have and keep your pair of kidneys, Joyce. Don't give or sell them unless someone's life is really in danger. Kidneys filter waste materials from the blood. If you have two and you take away one, you will survive, of course, but filtration will be less efficient as before