Squatting in a dirt alley in the India
n slum of Villivakkam, the young man pulls up his shirt and runs his finger along the rough, 8-inch scar that erupts below his rib cage and runs down his abdomen into the folds of his skirt-like longyi.
This is where they cut me open to get the kidney out,` he murmurs, describing the operation he underwent in a Madras hospital three years ago. `They paid me 20,000 rupees (about $800) for it, half before and half after. It`s all gone now,` he says, laughing self-consciously. `I had a lot of debts, and I drank the rest. I was stupid, and now I`m sick. I can`t even work anymore. I`m 27 years old, and if I carry a bucket of water down the street I have to sit down and rest.`
It`s a story that`s becoming increasingly familiar across India, Latin America and other parts of the developing world: poor people recruited from slums and shantytowns to sell parts of their bodies for quick cash. The buyers: wealthy Japan
ese, Middle Easterners and Europeans who, frustrated with laws against buying organs in their home countries, go abroad to countries where they can check into a hospital, find a middleman to procure a donor, pay for the transplant and return home -- all in a matter of weeks.
`The practice is apparently widespread, from what we`ve been hearing,` says an official with the World Health Organization in Geneva. `And we`re very concerned.`
The concern is warranted. With kidneys selling for anywhere from a few hundred to tens of thousands of dollars, the trade has become so lucrative that there have been reports -- some substantiated, some questionable -- of children in Argentina being stolen and killed for their organs, of Chinese prisoners executed and their kidneys sold, of prisoners in the Philippines being released after donating a kidney, of bodies washing up on Brazilian beaches with their organs surgically removed.
At one psychiatric clinic outside of Buenos Aires, Argentina, doctors have been accused of murdering lunatics for their body parts. Large, well-organized trafficking rings have even been uncovered: In December, Juan Andres Ramirez, Interior Minister of Uruguay, announced the arrest of 20 persons who were allegedly flying slum dwellers to other countries to `donate` their organs.
While some of the stories are patently untrue -- widespread reports in the early 1980s that Latin American children were being stolen and their organs sold to rich Westerners, for example, were later shown to be part of a bizarre Soviet disinformation campaign -- there are thriving, well-documented and quite legal markets in Bombay, Madras, Calcutta, Manila, Cairo and Hong Kong.
Many of the buyers are nationals, but much of the trade is fueled with oil money from outside. ?Most or the buyers are coming from the Emirates, Qatar and Kuwait,` says the World Health Organization official, describing the kidney business in Cairo and Bombay. `Apparently there`s a big shortage of kidneys in the Gulf states right now.`
The growth of this grisly trade has resulted from two related trends over the past two decades. On the one hand, medical and technological developments have raised the success rate of transplants and increased the demand for organs but as demand has gone up, laws have been implemented in most of the world forbidding people to pay organ donors, thus cutting the potential supply. That imbalance has spawned a complex network of desperate buyers, shady middlemen, opportunistic doctors, and poor and uneducated donors.
While corneas, lungs and other organs can be transplanted from live donors, most of the trade is in kidneys, since a healthy, well-nourished donor can live reasonably well with only one. Since the first renal transplant was done in 1954 between twin brothers, the survival rate has gone up dramatically, thanks to advances in surgical techniques, the training of large numbers of transplant surgeons and the development of drugs such as cyclosporine that suppress immune system attacks on transplanted organs. For patients who suffer from chronic kidney failure, there is now greater hope that they can be released from the expensive, endless and intrusive mechanical process of dialysis (which cleanses impurities from the blood) and live a normal life with a transplant.
Successful transplants rely on a good blood and tissue match between donor and recipient, and the best donors are often members of one`s family But patients who lack a willing family member have only two choices: wait until a properly matched kidney from a cadaver becomes available, or go to one of the world`s kidney marketplaces.
Until a few years ago it was possible in the United States
and Europe to bring donors in from outside. As early as 1985, the World Medical Association noted that `in the recent past a trade of considerable financial gain has developed with live kidneys from underdeveloped countries for transplantation in Europe and the United States.`
But as more and more such cases came to light, governments began to respond. Washington outlawed trade in body parts with the National Organ Transplant Act of 1984 -- sparked by the revelation that a doctor in Virginia had circulated brochures in the Caribbean, offering people a free two-week vacation in the United States if they agreed to leave a kidney behind when they went home.
Other Western governments soon followed suit. During the summer of 1988, Englishman Colin Benton died in a private hospital in London after a kidney transplant. The case attracted no attention until his widow revealed a few months later that her husband had paid about $3,000 for the kidney to a Turkish donor who had flown to Britain for the operation.
The case provoked an uproar, and the next year Parliament quickly passed the Human Organ Transplants Act of 1989, outlawing the sale of organs from both live and dead donors.
But in other parts of Europe -- including the former East Bloc countries and the former Soviet Union -- commerce in organs continued to thrive. In Germany, where roughly 7,000 people are on dialysis and only 2,000 to 3,000 a year are getting transplants, the market is big.
In one notorious 1988 case, a German company called the Association of Organ Donations and Mutual Human Substitution sifted through public bankruptcy notices to find prospective clients, then sent them a letter that read: `You`re broke. You`re a social leper, tainted with the legal and social equivalent of AIDS. The most horrid vultures will pursue you .... In case you don`t have the guts for a life of crime, if your courage isn`t up to a big break-in, a bank heist or a new life abroad, I offer you a solution founded on logic. Donate your kidney.`
The founder of the company, Count Rainer Rene Adelmann von Adelmannsfelden, offered to pay up to $45,000 for kidneys and to arrange operations -- including doctor, donor and hospital fees for $85,000, taking a 10 percent cut for himself. Germany has no legislation on organ transplants, although the Cartel of German Transplantation Centers has adopted a code binding on all doctors performing transplants that says, `Any trade in organs ... is, in principle, excluded.`
That has not stopped the nation`s entrepreneurs from digging up new possibilities. Early last year, a German firm based in Berlin, Ona Trading Gmbh, started offering short trips to Moscow, where for roughIy $72,000 (or three times the price of a legal transplant in Germany) its clients could obtain a kidney. Ona Trading, in a letter to patients and their doctors, said it could arrange approximately 120 operations a year.
With the Commonwealth of Independent States in such disarray, the trade is continuing. Russia
n morgue officials and forensic medicine experts held a conference in Khabarovsk in September on ways to sell organs from dead bodies, including corneas and kidneys, for hard currency.
According to the German weekly newsmagazine Der Spiegel, doctors at the Charite Hospital in the East German section of Berlin used to remove organs from patients who had not been declared legally dead, giving them to party officials or selling them to the West for hard currency.
Citing records and testimony from staff members at the hospital, Der Spiegel said critically-ill patients were sometimes brought hundreds of miles to the hospital so they would be available for the transplants -- a practice that killed four such patients in 1988. And according to the German newspaper Bild Zeitung, the communist regime had arranged to have organs transplanted from political prisoners to faithful supporters of the Stasi, the East German security force.