Outsourcing Organs: Organ Dealing and Transplant Tourism

According to a survey by Donate Life America, 43% of people are undecided, reluctant or do not wish to have their organs and tissue donated after their deaths. As a result of the shortage of organs, a black market has grown and thrived—particularly in impoverished corners of the world.

Donate Life America surveyed 5,100 U.S. adults. Among the undecided, reluctant or those who did not wish to have their organs and tissue donated, the most common reasons were that they were:

• unsure that they'd be acceptable donors (19 percent)

• undecided (15 percent) 

• want to keep their organs and be buried whole (8 percent).

The survey also revealed that some myths persist regarding donation (followed by the response of Donate for Life president and CEO, David Fleming):

• 52% of respondents were open to the idea that doctors may not try as hard to save their lives if their wish to be organ donors is known
• Response: If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ, eye, and tissue donation can only be considered after you are deceased.

• 61% are open to the idea that it is possible for a brain dead person to recover from his or her injuries.
• Response: While you can recover from comas, brain death is permanent, irreparable.

• 8% believe that organ or tissue donation is against their religion
• Response: All major religions in the United States support organ, eye and tissue donation and see it as the final act of love and generosity toward others.

The misinformation and uncertainty surrounding organ donations, have left many lives in peril—and I'm not just talking about the unfortunate folks currently on the 5 year waiting list for a transplant. As is usually the case when demand exceeds the supply, transplant organs have become a commodity, spurring an organ harvesting industry in places like India, the Philippines, and China to name but a few where "transplant tourism" is becoming popular.

"The Organ Dealer" in the April issue of Discover magazine documents this trade via the story of Amit Kumar (nee Santosh Raut), a self-trained doctor who has been involved in transplant tourism in the 1980s, first as an entrepreneur who secured donors in beggars, handcart pullers, and sweepers, and then learned how to perform the operation himself. He has performed hundreds of surgeries, building a lucrative empire based on a pyramid scam: 

He hired two men to scout the slums and offer anywhere from a paltry $300 to just over $1,000 for a kidney. Later he began paying the agents a fixed amount of a few thousand dollars per donor. To boost their cut, the agents started paying donors less and less.

Kumar was finally apprehended after a constable witnessed a fight between a middleman and a donor, who claimed that the middleman had stolen his kidney after taking him for "stomach surgery." This break led to raids and eventually Kumar's arest. However, other middlemen say that the donor had been a middleman himself and only began to cause problems after a falling out over commission with the middleman who recruited him.

Kumar's story and role in transplant tourism is common to how this business plays out elsewhere in the world. Anthropologist Nancy Scheper-Hughes, who helped set up Organ Watch, disagrees with the free-trade propenents who argue that a legal system of organ donation should be put in place which could in part "provide incentives such as life long health insurance or college tuition for the donor's children." Scheper-Hughes views this as a "kidney tax," which forces the poor to pay an unfair price to access services that they should have access to anyway.

In the mean time, transplant tourists often need additional care as the operations, which do not obviously occur in vetted medical facilities, can leave them with infections, or other ailments, as was the case with H.G., whose story is provided as a case study in Discover. H.G.'s operation left him with a bacterial infection that damaged his newly secured liver, so he actually needed two transplants. This raises difficult and interesting ethical questions: Should individuals who pursue transplant tourism and have have difficulties be moved to the head of the list of those who have been waiting for an organ transplant for years? (In H.G.'s case, the ethics committee decided it would not be right to withhold care as H.G.'s life depended on the second new organ.) Should organ donations be mandatory unless you opt out? Would this potentially help stem the black market for organs? How should donors driven to the trade by poverty be treated? Should they be punished for their role in the market?

There clearly are no easy answers, but I welcome your comments and thoughts on this issue.