KIDNEY DONOR BLACK MARKET

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KIDNEY DONOR BLACK MARKET TRADE

More than 80,000 Americans now wait for a kidney, thirteen die daily--the rest are on dialysis. The number of donors decreases each year.

A Brooklyn broker, Rosenbaum, conspired the sale of a human kidney for a transplant. The cost to the recipient was $160,000 and the donor got only $10,000. Rosenbaum brokered such sales many times over the past 10 years.

In the 1970s, pharmaceutical companies developed drugs that could prevent organ rejection. Kidney transplants became common about 13 years ago when the anti- rejection drug ,cyclosporine, became available. With a lack of medical regulation, the organ black-market developed.

The dramatic success rates of operations also fueled kidney transplant growth. Lack of regulations and loose medical ethics followed . Desperate people depend on dialysis machines and the demand for kidneys has not kept up with the demand. The poor sell their kidneys to pay for a daughter’s dowry, to build a small house, or feed their families.

THE PROBLEM

Every year, more than 1 million people worldwide develop end-stage kidney failure. Because of the long waiting list, patients who have enough money resort to other options. It may be unethical and immoral, but it exists.

Since one kidney is sufficient for a good quality of life, people are willing to trade the other one for cash. When there is a shortage of deceased kidney donors, and donations are restricted, and one desperately needs an organ, people are willing to buy organs.

Thanks to the Internet, anyone on the globe can sell one of his or her kidneys without any difficulties. Potential recipients might get lucky and find a transplant that matches. There are literally hundreds of offers to sell a kidney, like shopping on eBay. Donors are desperate, but the poor and vulnerable people suffer.

THE KIDNEY ORGAN TRADE

There are many trafficking networks in India, Turkey, Ukraine, China, and Israel. If you have approximately $70,000 you can travel abroad and get yourself a kidney in these countries.

Out of desperation young people in parts of Eastern Europe sell one of their kidneys for sums up $3000, while the recipients pay between 100,000 and US$200,000 for each transplant. The donor's health generally worsens due to absence of any medical follow-up, their hard physical work, and their unhealthy lifestyle, complicated by inadequate nutrition and high alcohol consumption. In time, most of these illegal donors may themselves need dialysis treatments.

WHO ARE THE DONORS?

90% of organs from China come from deceased prisoners. They sign agreements before execution. A leprosy colony near Madras, India, freely donated kidneys for money offered by agents. Prominent doctors removed the kidneys of nearly 1000 people in a leading city hospital. The donors were offered jobs: they were told blood was being removed, rather than kidneys. The kidneys went to patients from the Middle and Far East.

SOLUTIONS

The strategy to crack down on trafficking in organs and body parts is doomed, since it ignores the fact that efforts to stamp out the underground markets either drive corruption further underground, or causes it to erupt elsewhere. The critical shortage of organs for transplants can only disappear by giving legitimate incentives (like money) to people who might be willing to donate their organs.

IRAN MAY HAVE THE ANSWER

Iran has no waiting list for kidney transplants, since the practice of selling one's kidney for profit is legal and regulated. The government supports such programs. Organizations match donors to recipients, setting up tests to ensure compatibility. The donor gets approximately $6000 for kidney donation. There is a strict regulation of the allocation of organs only to local citizens (no foreigners allowed), restricting international trade.

LEGISLATIVE LOOPHOLES

Most countries still have legislative loopholes since criminal responsibility in organ trade is rarely established in international criminal codes. Congress will probably raise the penalties for underground organ sales, as in Mr. Rosenbuam’s case. Al Gore tried to push a voucher system or a tax credit to a donor's estate to improve voluntary donation. Democratic Senators aren't talking about governmental entities offering donor benefits but they are raising penalties for brokering. The proposed bill allows states to offer health and life insurance to living donors, or funeral benefits to families of posthumous donors. Donors could be offered a tax credit, or perhaps a very generous contribution to a charity of their choice (not to themselves). Organs would be distributed according to formulas already in place, and not be available just to the wealthy. The rewards would go to approved charities or state governments, but not to individuals. Congress might allow donors to accept third-party benefits for saving the life of a stranger. Otherwise, desperate patients and donors will continue to be reluctant co-conspirators in crime, as they seek organs.

COMMENTARY

The illegal organ trade is booming across the globe. It will only disappear when the critical shortage of organs for transplants disappears. If legal incentives, (like dollars), could be given to people who might be willing to donate, the shortage might disappear.

Most countries require living donors to be either family members, or organs removed from cadavers, usually accident victims. It is illegal and unethical to remove kidneys from live donor especially for money. Donating a kidney isn't particularly risky, and does not impair one's health. They are easily available. With any illegal kidney black market that caters to buyers around the world, many countries have benefited from the kidney trade.

Must a person who sells one of his kidneys, be treated as a felon? This has encouraged the black market with middlemen who can benefit, like Mr. Rosenbaum, from Brooklyn. We could lower the cost of medical dialysis treatment by finding a solution to kidney donations. But does the government really want a solution? You might live too long.

What do you think? Your comments are always appreciated. Visit www.drneedles.com for more commentaries on controversial medical subjects.

SOURCES Cherry MJ. Kidney for sale by owner: human organs, transplantation, and the market. Washington: Georgetown University Press; 2005./ Doctors banned from brokering transplants. China Post. 2006 Aug 17. /The Guardian. 2005 Feb 10. /McLaughlin A, What is a kidney worth? Christian Science Monitor. 2004 Jun 9 /Hogg C. Why not allow organ trading? BBC News. 2002 Aug 30