to Track Global Traffic in Organs
to Track Global Traffic in Organs
McBroom, Public Affairs
In some parts of India, poor people use their kidneys as collateral for money lenders who have come to expect desperate people to sell their body organs.
In South Africa, eyes from the corpses of poor -- mostly black -- people in police mortuaries have been harvested without consent and delivered to a local eye bank, then appear later at medical centers in other countries.
These are two examples of a growing international traffic in human organs that until now has been largely unmonitored and prone to human rights abuses.
This week, a new Organs Watch program, the only one of its kind in the world, was launched by four professors -- two from Berkeley and two from Columbia University Medical School.
Their new documentation center located at Berkeley will investigate reports and rumors of human rights abuses surrounding organ trafficking, identify hot spots where abuse may be occurring and begin to define the line between ethical transplant surgery and practices that are exploitative or corrupt.
"Transplant surgery has entered a global market and we need to keep a close watch on that," said Nancy Scheper-Hughes, an associate professor of anthropology who has been a driving force behind the new center. "In the organs trade business, abuses creep in before you know it."
Research in several countries over the past five years has shown that trading in human organs has developed along class, gender and racial lines, with organs flowing from the poor to the rich, from women to men and from brown- and black-skinned to white-skinned people, said Scheper-Hughes.
Moreover, in some instances, the trade is being carried out in violation of national laws against selling organs internationally or selling them at all. Cadavers of poor people and executed prisoners have been violated and organs taken without previous consent, raising concerns about the vulnerability of socially disadvantaged individuals, she said.
At a cultural level, the organs trade points to a "collapse of cultural and religious sanctions against body dismemberment," according to the program's mission statement.
Transplant surgeons and other medical people from at least a dozen countries will report to the Organs Watch center,which will act as a clearing house. Project coordinator Kathleen Erwin at Berkeley will archive and organize the material, while the research scientists involved will investigate abuse reports and lobby to change national and international laws governing the trade.
The first call for such an organs watch came in a 1997 report from the Bellagio Task Force on Securing Bodily Integrity for the Socially Disadvantaged in Transplant Surgery, a project headed by David Rothman with help from Scheper-Hughes.
The task force, composed of transplant surgeons, organ procurement specialists, human rights activists and social scientists, concluded that commercialization of the trade in human body parts was putting powerless and deprived people, especially those in third world countries, at grave risk. Such people could never be in a position to receive an expensive organ transplant, but only they would need money badly enough to sell their organs, said the task force. The one-way trade between rich and poor virtually guarantees abuse, the report concluded.
In later research, anthropology Professor Lawrence Cohen documented that one-way trade in the so-called "kidney belt region" of southern India, where he investigated the trade route from organ sellers -- usually poor rural women -- to hospitals and recipients, often wealthy people from Sri Lanka and Bangladesh, or from the Gulf states.
Cohen found that poor people sold their kidneys to get out of debt or to support their families; yet most of these families were back in debt very shortly, minus their kidneys.
"Most sellers would say, 'I'd do it again. I have a family to support. What choice did I have?'" said Cohen.
"In some neighborhoods, the structure of debt appeared to rest on kidney selling, since lenders would advance money knowing the organs were collateral.
"But I argue that the money from kidneys didn't really get these families out of debt. Moreover, there was no follow-up care after the operation, nor efforts to prevent infection in the donor."
Nor was there a clear benefit for the recipient, due to the high cost of being maintained on cyclosporine, a drug that suppresses immune reactions to transplants. People were not informed about the cost of the maintenance drugs, and middle class recipients could find themselves deeply in debt after the operation, said Cohen.
Nevertheless, six transplant centers have emerged in hospitals in southern India within a decade, and the trade in human organs is growing, he said.
Cohen also found that periodic kidney scandals of doctors who tricked people out of their kidneys were mostly stories manufactured by rival hospitals. The rumors were part of the competitive commercialization of the trade. In fact, there was no need to trick people, said Cohen, since more than enough kidneys were available from the poor.
"The poor in India have begun to consider selling their body parts. These are the wages of poverty," said Cohen.
Scheper-Hughes said that in Brazil she found softer forms of sale that raised serious questions about the exploitation of people in subordinate work positions. Exchanges were taking place between employers and employees or wealthy people and their domestic workers in which the lower status individuals "donated" their kidneys in return for secure employment, housing or other basic needs. Scheper-Hughes also is investigating the allegations of two women in Sao Paulo who woke up from gynecological surgery without a kidney.
In both Brazil and South Africa, Scheper-Hughes found widespread abuse of the cadavers of poor people, involving eyes, pineal glands and heart valves. In ethnographic research, she also has documented widespread fears among the poor that their bodies will be violated after death.
"This is a key issue," said Scheper-Hughes. "These people care very much about the dignified and pro-per care of their bodies after death." She calls the global trade in human organs "the new cannibalism."