Organ sellers suffer in many developing countries

Many risk stigma, continuing poverty

Monir Moniruzzaman has seen the kind of poverty that would drive a desperate individual to sell his or her organ.

Conducting ethnographic research, he has interviewed 33 sellers of their kidneys, all in Bangladesh, one of the poorest countries in the developing world. Most of the transplantations were performed in India in those cases.

"Basically, I'm writing about their experiences, how they sold their kidneys and how basically they engage in this trade . . . and how they're exploited in the black market; there's exploitation, and they are subject to sufferings," says Moniruzzaman, an assistant professor in the department of anthropology and Center for Ethics and Humanities in Life Sciences at Michigan State University in East Lansing, MI.

When Medical Ethics Advisor spoke to Moniruzzaman, he was preparing to complete his thesis on this topic in December.

The most prominent form of global organ trafficking, he says, is individuals engaging in medical tourism and traveling to Third World countries.

"The easiest way to get an organ is when the recipients are going overseas and transplantation is done [in another country]," he explains.

Selling organs, he says, is "illegal in almost every part of the world."

"It's illegal except Iran is the only country where [a government-sanctioned, regulated organ market is] happening," Moniruzzaman tells MEA.

Still, the illegal black market thrives, he indicates, driven primarily by wealthy recipients who can afford to pay for an organ and a transplant in a foreign country.

"The law is there, but its practice is problematic . . . I found that there are people from India and China and Bangladesh — you know, they're American, but Bangladeshi-born or Indian-born Americans," he explains. "They are going to their home country, and they are getting an organ from a poor donor or seller."

Because the organ trade is illegal and U.S. laws and the transplant system are more strict, U.S. patients who are on transplant waiting lists and perhaps also desperate for an organ, then go overseas. But when these patients travel abroad for organs, "the American federal law cannot protect the people [who are selling their organs]," Moniruzzaman says.

"How far can we go?"

When an individual pays for an organ, there often are several negative consequences for the donor, particularly those donors who are poor.

"The simple solution — if you just give them money and they are selling their kidneys, it creates a lot of problems, including exploitation, commercialization of the human body — it never happened in human history; we don't sell [body parts]," Moniruzzaman says.

He notes that it is accepted practice to sell blood, but he explains that blood regenerates. On the other hand, "an organ is a solid organ; the body has never been commodified in that sense," he says.

"Speaking in many cultural contexts, the body is integrated [as a] whole," he says. "Why do only the poor people sell their body parts for the wealthy people . . .? We cannot create a system where body parts are in the market, and give money to the poor people and take their body parts," he says. "How far can we go? Like now, it started with the kidney, and whose body is it? It's the poor people's bodies," Moniruzzaman says. "You [would] create a society where only 1% of the population [is] selling their body parts that wealthy people can afford to prolong their life."

Also, he notes, in some cultures, giving up an organ is "one of the most humiliating acts a person can do. So, in many societies, they consider this a shameful and regretful act."

Although the first rule of medicine in the U.S. is "first, do no harm," Moniruzzaman says there has been very little investigation and research into the harm that comes to people who sell their body parts for what they think will be economic gain.

"But I found [that there are] devastating consequences to the seller," he explains. "The harm is not only physical harm — bodily harm where the seller experiences bodily dysfunction, but [also] the psychological harm is devastating…think about ourselves: if we sell a body part or one of the parts of my body, and how that psychological experience would be."

Legalize the market?

Ann Mongoven, PhD, MPH, of the Center for Ethics and the Humanities in Life Sciences at Michigan State University in East Lansing, MI, explains that there are arguments being made — even in "the academic and scholarly medical community" — that the U.S. should legalize the organ trade.

"There are different possible responses [to the illegal organ trade], and some people say the response should be to legalize the market, because since it's happening anyway, it's less likely to be exploitative if it's legalized," Mongoven says.

"Then, we can have transparency and make sure that the prices are good and that the people who donate get appropriate medical care and not just the [organ] recipients, who are almost always, of course, of a higher socioeconomic standard than the donors," she says. "That's one possible response, and there is some possible interest in that in some corridors."

Moniruzzaman strongly opposes the legalization of the kidney trade, because it has negative economic consequences for the sellers. Often, the sellers are stigmatized, Moniruzzaman's research has shown, as well.

"The harm is like an economic harm, where the seller's economic situation is worse than before," he says. "Throwing $1,500 to someone cannot change their economic situation. [When] the money is gone, the seller's gone back to [his or her] old job, and they basically cannot earn the money the were earning before [when their health may be impaired]."

'Do no harm' would be set aside

Mongoven says her instinct is against a legalized market for the living donors, because first and foremost, it would totally nullify the first rule of medical ethics, the "First, do no harm" principle.

"You're harming a healthy person," she says. Still, she says that "clearly what we have now is terrible. So, the question can become , in some ways, what's the lesser evil? But my instinct is against the market. . . I think that the kind of conversation — the continuing conversation you would have to have in order to consider a legal market — has never happened. For example, what is the real experience of donors on the paid market? Does the payment actually make them better off? What are the actual risks and benefits of donation?"

Sources

  • Ann Mongoven, PhD, MPH, Center for Ethics and the Humanities in the Life Sciences, Michigan State University, East Lansing, MI. E-mail: ann.mongoven@ht.msu.edu.
  • Monir Moniruzzaman, Assistant Professor, Department of Anthropology and Center for Ethics and the Humanities in the Life Sciences, Michigan State University, East Lansing, MI. E-mail: monir@msu.edu.