Organ Shortage Fuels Illicit Trade in Human Parts

Brian Handwerk
for National Geographic Ultimate Explorer

January 16, 2004

In 2002 U.S. doctors performed 24,900 lifesaving organ transplants.
That's the good news. But for every person lucky enough to receive a
transplant, two others are added to a waiting list that now features
more than 80,000 people in the U.S. alone. As desperation grows, so may
an illicit trade in human organs in much of the developing world.

"In the United States, a new person is added to the United Network for Organ Sharing (UNOS) list every 14 minutes," UNOS spokesperson Anne Paschke told National Geographic News. The Richmond, Virginia-based organization administers the nation's Organ Procurement and Transplantation Network (OPTN), established by the U.S. Congress in 1984.

In 2002 over 6,000 Americans died while waiting for organs, according to UNOS data.

What would it be worth to somehow move to the top of the list? Perhaps no cost would be too high, but organs are not generally offered for sale—at least not legally.

In most of the world, laws specifically ban the sale of organs. U.S. law, for example, prohibits any "valuable consideration" resulting from an organ donation.

But with demand so high, many have attempted to profit by selling organs such as kidneys, obtained from living donors tempted to give up their "spare" organs for cash.

Last month (December 2003), police in South Africa and in Brazil broke up an international ring trafficking in human kidneys. The racket also involved people in Israel—and possibly even further afield.

Brazilian police reported that dozens of willing donors were flown from that nation's destitute neighborhoods to South Africa where transplant surgery was performed on patients, including some from Israel. Recipients may have paid as much as U.S. $100,000 for their ill-gotten organs. Donors received a fraction of that amount, but a substantial sum nonetheless to those in desperate straits.

Though this ring is now out of business, the operation was far from unique. National Geographic Ultimate Explorer host Lisa Ling recently traveled to India to investigate reports of a widespread trade in organs illegally harvested from that nation's poor.

Kidney Village

Ling visited a desperate neighborhood known locally as "kidney village" because so many of its residents had illegally sold one of their kidneys. The practice is underground, but widespread enough that finding many donors was not a problem for the Ultimate Explorer team.

"They said that they received about $800 a kidney, which for them is a year's salary," Ling told National Geographic News. "It's a decent amount of money to them, but of course when it runs out they can't sell more organs."

Many of those Ling met hadn't realized much lasting financial benefit as a result of their illegal kidney sales, but neither were they distressed at having undergone the potentially dangerous procedure.

Having lost one kidney, donors are more at risk for any problems that could later affect their remaining kidney. Also, the transplant operations themselves can be dangerous or fatal—particularly when carried out in clandestine and illegal facilities.

"We didn't meet anyone who had gotten sick as a result of selling one of their kidneys," Ling said. "The people we met were still living normal lives so they didn't have many regrets, they were surviving OK on one kidney. When you encounter folks who are so poverty-stricken, it's a gruesome option for them but it is an option. It certainly raises a lot of ethical questions."

Such practices in the developing world have led to '"transplant tourism," in which patients travel from wealthier countries without a black market organ trade to parts of the world where both an organ and operation can be had—for a price.

With demand so high and illicit trade already underway in the developing world, might some form of compensation be tried to ease the organ shortage in industrialized nations?

Experts Urge Compassion, Not Compensation

Anne Paschke explained that UNOS is not opposed to a study of possible incentives that could be provided for postmortem donations—but even such tentative proposals would fall far short of any "for profit" organ sales.

"It would take action by Congress in order to test financial incentives," Paschke said. "We would support legislation that would allow pilot projects, a very careful testing of some type of financial incentives. We just don't know if it would have a positive or a negative impact."

Some individuals have suggested that more overt compensation could financially benefit donors while physically benefiting thousands in urgent need of transplants. The argument also maintains that a regulated trade would be preferable to existing black market organ dealings, which can be exploitative and unsafe.

Yet such proposals have found little popular acceptance in medical and bioethics circles, where most fear the exploitation of the poor and foresee the first steps on a slippery slope that leads to a dehumanizing trade in bodies and body parts. "I don't think that I've ever seen anyone speak representing an organization that would support such a system," Paschke said.

So how to make more organs available to waiting patients worldwide?

Paschke noted that UNOS is focused on utilizing the organs that are donated as efficiently as possible by streamlining the process that gets them from a deceased donor to a suitable recipient.

Another critical goal is increasing the number of voluntary donors—which has remained relatively flat even as the waiting list has grown.

The effort relies not on compensation but on compassion.

"What kind of message motivates people to become donors? Most will say, 'Yeah, donation is a good thing,' but that doesn't mean that they've made a decision for themselves or had a conversation with their families," Paschke said. "Our latest research shows that people are inspired when they see a real person, the story of a person who's been helped, so we're trying to focus on individuals, on the real people who are on the list."

Meanwhile, despite such efforts, the real people on the list must deal with the very real fear that they may not get the organ they need in time.