Capitalism and the Body-snatching Ghouls

A conservative estimate, based on research by Organs Watch, is that at least 10,000 kidneys are sold each year. Up to 7,000 kidneys are obtained illegally every year, according to a report by Global Financial Integrity. That same report shows the illegal organ trade generates profits between $514 million to $1 billion a year.

Dr. Luc Noel, a special adviser to the World Health Organization, said commodification of the human body and global inequality produce the environment for such a trade to exist.

“Profit on the human body means exposure to the poorest layer of the population, and on the global level this collides with inequality and the incapacity of some governments to regulate.”

 Five days after his kidnapping, the body of 6-year-old Harun-ur-Rashid was discovered dumped in wetlands near Sirajganj, north of Bangladesh’s capital, Dhaka. The child’s kidneys were cut out — a victim of the country’s black market organ trade.

In addition to people being kidnapped, killed and their organs stolen, some willingly sell their organs on the black market through local brokers who contact regional and national syndicates to facilitate medical procedures and find buyers for kidneys and livers. Desperation, combined with a lack of law enforcement, enables brokers to entice impoverished Bangladeshis with offers of money. Invariably those selling their organs face economic hardship. Some approach local brokers after hearing stories of easy money, and others are targeted by brokers aware of excessive debts. Often surgery is undertaken without any knowledge of the long-term health implications. Sellers of organs typically reported receiving far less money than promised but lack any means to recover their losses. The criminal nature of the activity prevents any legal recourse.

 While most governments and international medical associations condemned the sale of human organs, laws and professional guidelines were inconsistent and often poorly enforced. According to Monir Moniruzzaman, an anthropology professor at Michigan State University who has spent the past 12 years researching the trade “If there was genuine concern on the government’s part we would see some action, but we haven’t seen anything. The law is not being enforced, and on the criminal justice side there are reports of cases being deliberately weakened.”

As in Bangladesh, selling kidney for money is strictly illegal in Nepal and Nepali law forbids kidney transplant outside immediate family members to control the illegal kidney trade  yet the trading of human organ and the illegal sale of the kidney continues. Locals explained that the 'agents' here first spot the people who are hard up for money or those debt-ridden and lure them into this illegal trade.

Chhay, 18, sold his kidney for US$3,000 in an illicit deal that saw him whisked from a rickety one-room house on the outskirts of the Cambodian capital Phnom Penh to a gleaming hospital in the medical tourism hub of neighboring Thailand. Chhay says a neighbor persuaded him and a pair of brothers — all from the marginalized Cham Muslim minority — to sell their kidneys to rich Cambodians on dialysis. “She said you are poor, you don't have money, if you sell your kidney you will be able to pay off your debts,” the teenager told AFP. Identical stories have long been common in the slums of India or the Philippines.

But it is not just in the poor parts of the world that organ business is thriving. More than 120,000 people in the United States are in line waiting for an organ transplant. According to the Department of Health and Human Services, another name is added to the list every ten minutes

Levy Izhak Rosenbaum pleaded guilty in 2011 to brokering the sale of three kidneys — buying them from people in Israel for as little as $10,000, then selling them to U.S. patients who did not qualify for transplants or did not want to wait. The cost of the sale was over $100,000, and the operations were performed at top U.S. hospitals. While he pleaded guilty to three counts, authorities said he brokered many more kidney transplants and made millions from the deals. He was the first person convicted in federal court of profiting from the illegal sale of human organs and served more than two years in prison. When New Jersey federal agents caught Levy Izhak Rosenbaum, a hyperactive inter­national kidney trafficker who had sold transplant packages for upwards of $180,000, the FBI had no idea what a ‘kidney salesman’ was. The prosecutors could not believe that prestigious US hospitals and surgeons had been complicit with the scheme, or that the trafficked sellers had been deceived and at times coerced. The federal case ended in a plea bargain. At the sentencing in July 2012, the judge was impressed by the powerful show of support from the transplant patients who arrived to praise the trafficker and beg that he be shown mercy. The one kidney-selling victim, Elhan Quick, presented as a surprise witness by the prosecution, was a young black Israeli, who had been recruited to travel to a hospital in Minnesota to sell his kidney to a 70-year-old man from Brooklyn. Although Mr Cohen had 11 adult children, not one was disposed to donate a life-saving organ to their father. They were, however, willing to pay $20,000 to a stranger. Quick testified that he agreed to the donation because he was unemployed at the time and estranged from his community. On arrival at the transplant unit, however, he had misgivings and asked if he could get out of the deal as he had changed his mind. These were the last words he uttered before going under anaesthesia. The judge concluded that it was a sorry case. She hated to send Rosenbaum to a low-security prison in New Jersey for two-and-a-half years as she was convinced that deep down he was a ‘good man’. She argued that Elhan Quick had not been defrauded; he was paid what he was promised. ‘Everyone,’ she said, ‘got something out of this deal.’

When released Rosenbaum, an Israeli citizen, didn’t get deported because federal immigration officials found that his crime was not one of "moral turpitude" that would have subjected him to being kicked out of the U.S. 

Prosecutors look kindly on kidney buyers because they are sick and looking to save their lives. But buyers have no qualms about taking a kidney from deprived persons without any medical insurance, any future, and sometimes no home. They have to be made accountable.

It was in the early 1980s a new form of human trafficking, a global trade in kidneys from living persons to supply the needs and demands of ‘transplant tourists’, emerged. The first scientific report on the phenomenon, published in The Lancet in 1990, documented the transplant odysseys of 131 renal patients from three dialysis units in the United Arab Emirates and Oman. They travelled with their private doctors to Mumbai, India, where they were transplanted with kidneys from living ‘suppliers’ organized by local brokers trolling slums and shantytowns. The sellers were paid between $2,000 and $3,000 for a ‘spare’ organ. On return, these transplant tourists suffered an alarming rate of post-operative complications and mortalities resulting from mismatched organs, and infections including HIV and Hepatitis C. There was no data on, or discussion of, the possible adverse effects on the kidney sellers, who were still an invisible population of anonymous supplier bodies, similar to deceased donors. Organ trafficking was included in the 2000 United Nations Palermo Protocol on Human Trafficking, which recognizes that even willing participants in underworld illicit kidney schemes can be counted as victims. Indeed, most are coerced by need, not physical threats or force. Some even pay significant amounts of money to be trafficked. 

Unlike other forms of trafficking that unite people from shady backgrounds, the organ trade involves those at the highest – or at least middle-class – levels of society: surgeons, doctors, laboratory technicians, travel agents, as well as criminals and outcasts from the lowest. A total of 109 illicit transplants were performed at Saint Augustine’s Hospital, including five in which the donors were minors. Netcare, the largest medical corporation in South Africa, pleaded guilty to having facilitated the transplants. Well-connected brokers have access to the necessary infrastructure such as hospitals, transplant centres and medical insurance companies, as well as to local kidney hunters, and brutal enforcers who make sure that ‘willing’ sellers actually get up on the operating table once they realize what the operation actually entails. They can count on both government indifference and police protection. Because human trafficking for organs is seen to benefit some very sick people at the expense of other, less visible or dispensable people, some prosecutors and judges have treated it as a victimless crime.

The complicit medical professionals perform expert teamwork – technicians in the blood and tissue laboratories, dual surgical teams working in tandem, nephrologists and post-operative nurses. It is fair to state that rogue transplant surgeons operate with considerable immunity. This is unfortunate because they constitute the primary link in the transplant-trafficking business. The anthropologist Nancy Scheper-Hughes wrote “Transplant surgeons vie only with the Vatican and its cardinals with respect to their assumption of privilege, irrefutability and of a kind of ‘divine election’ that seems to place them above (or outside) the mundane laws that govern ordinary mortals. Like child-molesting priests among Catholic clergy, these outlaw surgeons are protected by the corporate transplant professionals hierarchy.” In Scheper-Hughes’ view, surgeons either participate in illegal transplants with full volition, or they cultivate a willful blindness to their participation. 

Kidney sellers are predictably poor and vulnerable: the displaced, the disgraced or the dispossessed. They are the debtors, ex-prisoners or mental patients, the stranded Eastern European peasants, the Turkish junk dealers, Palestinian refugees, runaway soldiers from Iraq and Afghanistan, Afro-Brazilians from the favelas and slums of northeast Brazil, and Andean Indians. Most enter willingly into a ‘transaction’ in which they agree to the terms, which are verbal, but only realize later how they have been deceived, defrauded or cheated. Few are informed enough to give consent. They do not under­stand the seriousness of the surgery, the conditions under which they will be detained before and after the operation, or what they are likely to face with respect to the discomfort or immediate inability to resume their normally physically demanding jobs. Transplant tourists are asked to pay a great deal of money – normally somewhere between $100,000 and $180,000 – of which the sellers receive a mere fraction.

Kidney selling is no longer a strange or exotic act. It is normal, everyday, and entrenched.

Adapted from here