“Donate a Kidney, Buy the New iPhone”: The Booming Illegal Global Organ Trade

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Three South Asian men show scars from their kidney removals. South Asian countries such as India, Nepal, Pakistan and Bangladesh are hotspots for the illegal trade in kidneys and other organs. November 16, 2017. (BEE FREE/Flickr Creative Commons).

Three South Asian men show scars from their kidney removals. South Asian countries such as India, Nepal, Pakistan and Bangladesh are hotspots for the illegal trade in kidneys and other organs. November 16, 2017. (BEE FREE/Flickr Creative Commons).

The title of this article is neither a joke nor is it unrealistic. Rather, it indicates an ugly truth that illuminates some of the more adverse results of globalization. It reveals a system that has been called ‘neo-cannibalistic’, that allegedly propagates socio-economic inequalities and is arguably an affront to human quality of life. The illegal organ trade thrives on an extremely low supply, powerfully high demand and little international market regulation; determining an adequate course of action at either the national or international level requires careful consideration of the medical and ethical issues at stake. Understanding the foundations upon which this system is built allows an opportunity to explore solutions to the problem.

The root of the illegal organ trade lies in a global organ shortage. In 2013, 2.8 million people required kidney transplants—but only 73,000 procedures occurred that year (by legitimate means). The demand for organs has been consistently and rapidly outgrowing the supply for years. This limitation is due to a lack of incentive in donating organs, as well as certain national attributes such as cost of health care and availability of transplant services, both of which also significantly curb the organ supply. Countries like India, Pakistan and Bangladesh become breeding grounds for illegal organ black markets as a result of such domestic systems. Donors actually face financial disincentives when they use legal, voluntary routes; the expense of receiving post-transplant care is cost-prohibitive for all except the economic elite (even in “rich countries” like the US). If altruism does drive an individual to donate an organ, the likelihood of finding a transplant surgeon is slim—and given the prevalence of the black market, most transplant physicians would offer illicit compensation regardless. The ease with which organ donors become organ sellers is startling.

Most sellers discover that there are neither returns nor refunds for their services. Sellers in Pakistan often receive less than 80% of their promised compensation, consequently failing to achieve their intended objectives—rather than buying Apple products (as the title of this article suggests), they hoped to use the money for marriage, dowry, housing or business. They also experience rapidly deteriorating health after the sale, as well as social stigmas: male sellers in Bangladesh are derisively called “kidney men”. Adding insult to injury (but unbeknownst to the victims), kidneys are likely sold for a hugely disproportional sum of money to an economic elite from a foreign country. The organ brokers that facilitate the sales have the most to gain. Sellers are promised an average of $1,737 USD, but actually earn an average of $1,377 USD. The organs are then sold in India for $15,000 USD, in China for $62,000 USD and in the US for $262,000 USD. By selling to clientele in the US, the middleman earns back his/her initial ‘investment’ 190 times over.

The international transplant tourism that drives the black market is a result of globalization. Rich citizens of rich countries can afford to search the world for a tissue match. These organ-seekers can even take advantage of the Internet, another globalizing force, and deals are commonly made between recipients and organ brokers online. In developing countries, organ brokers are often associated with organ gangs that coerce poor individuals for their organs or take them by force. In one case, a victim was locked in a hotel room in a foreign country for a month and threatened with the death of him and his family if he resisted the loss of his kidney. Violence, coercion and deception are common tactics used by these gangs—and encouraged by the global organ trade. Globalization has thus allowed wealthy elites to take advantage of the poor internationally. The existing status quo clearly favors one group over the other; conditions in the poorer nations not only produce an illicit supply of organs for those who can afford them, but promotes violence and hardships in the process.

Those who argue against a regulated global organ market contend that it would legitimate both the commodification of the human body and the exploitation of the world’s poor. It seems, however, that permitting “commodification” would in fact limit exploitation. Bilateral and multilateral exchange agreements between countries could equitably facilitate an organ trade. It would ensure that sellers are paid proportionally to everyone else in the transplantation process, as enforced by law. Adequate post-transplant care could be guaranteed. And ultimately, the poor would be given a new degree of autonomy. With legal and fair compensation, they would be able to get married, obtain housing or even start a business. The solution is not a perfect one, but the black market will not subside left unregulated. Working within the bounds of globalization is the only real option as the world attempts to tackle its drawbacks.

The views expressed by the author do not necessarily reflect those of the Glimpse from the Globe staff, editors or governors.

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