The Or­gan Mar­ket

The Washington Post Sunday - - Outlook - By William Sale­tan

If you lose your job, you can sell your home. If you lose your home, you can sell your pos­ses­sions. If you lose your pos­ses­sions, you can pros­ti­tute your­self. And if you lose ev­ery­thing else, you can sell one more thing: your or­gans.

Twice in the past two weeks, trans­plant ex­perts from around the world have con­vened in Europe to dis­cuss the emerg­ing global mar­ket in hu­man or­gans. Two maps pre­sented at the meet­ings tell the story. One shows coun­tries from which pa­tients have trav­eled for or­gans in the past three years: Malaysia, Saudi Ara­bia, South Korea and Tai­wan. The other shows coun­tries from which or­gans have been sold: China, Colom­bia, Pak­istan and the Philip­pines.

The num­bers on the maps add up to thou­sands. Ac­cord­ing to the World Health Or­ga­ni­za­tion, the an­nual tally of in­ter­na­tional kid­ney trans­ac­tions alone is about 6,000. The ev­i­dence in­cludes re­ports from bro­kers and physi­cians, ac­counts from In­dian vil­lages, sur­veys of hos­pi­tals in Ja­pan, gov­ern­ment records in Sin­ga­pore and scars in Egyp­tian slums. In Pak­istan, 40 per­cent of peo­ple in some vil­lages are turn­ing up with only one kid­ney. Charts pre­sented at the meet­ings show that the num­ber of “do­na­tions” from un­re­lated Pak­ista­nis is sky­rock­et­ing. Two-thirds of the peo­ple re­ceiv­ing th­ese or­gans are for­eign­ers. Data from the Philip­pines show the same thing.

The first suc­cess­ful or­gan trans­plant took place half a cen­tury ago. Since then di­a­betes, hy­per­ten­sion and other kid­ney-de­stroy­ing dis­eases have spread. An­tibi­otics have im­proved, as have drugs that sup­press the im­mune re­sponse to for­eign or­gans. More peo­ple need trans­plants, and more can be saved by them. But do­na­tions haven’t kept up with de­mand. An es­ti­mated 170,000 pa­tients in the United States and Europe are on trans­plant wait­ing lists. More than 70,000 Amer­i­cans are wait­ing for kid­neys, and the list has grown by al­most 5,000 per year. Peo­ple are dy­ing.

In­stead of wait­ing, many pa­tients have set out to re­cruit their own donors. They started with bill­boards, then moved to Web sites such as Match­ing­Donors.com, JoeNeed­sALiver.com and HelpMyGrandpa.com. Around the world, peo­ple have learned that their or­gans are as­sets. Peru­vians, Ukraini­ans, Chi­nese hos­pi­tals and Amer­i­can pris­on­ers ad­ver­tise their in­nards. Last year, a South Korean play­wright used his kid­ney as col­lat­eral for a loan.

Politi­cians have tried to rein in this mar­ket. The United States banned or­gan sales two decades ago. In­dia did the same in 1994, and China fol­lowed last year. But when lives are at stake, rules get bent. To pro­cure more or­gans, doc­tors have dis­carded brain-death stan­dards, donor age lim­its and re­cip­i­ent health re­quire­ments. States have let trans­plant agen­cies put pa­tients on life sup­port, con­trary to their liv­ing wills, to pre­serve their or­gans. If Congress re­vises its ban on or­gan sales, as some ad­vo­cates hope, law­mak­ers in South Carolina plan to of­fer pris­on­ers re­duced sen­tences in ex­change for or­gans or bone mar­row.

If gov­ern­ments can’t con­trol wages or prices in a global econ­omy, they cer­tainly can’t con­trol the pur­chase of ex­tended life. In the past two years, Is­raeli or­gan bro­kers shifted their busi­ness from Colom­bia to China for faster ser­vice. If China closes its doors, they can shift again. In Pak­istan, kid­neys al­ready sell for a frac­tion of what Chi­nese hos­pi­tals charged. Bro­kers can com­pare or­gan prices from coun­try to coun­try, just like wheat and corn.

Al­ready, bans on or­gan com­merce are crum­bling. In­di­ans who lost their liveli­hood in the tsunami of 2004 sold their kid­neys, ig­nor­ing the law. Bul­garia im­poses stiff sen­tences on or­gan traders, but that didn’t de­ter a lo­cal hospi­tal from serv­ing Is­raeli trans­plant tourists last year. Nor did China’s ban stop a Chi­nese hospi­tal from of­fer­ing a liver to a BBC correspondent. Three weeks ago a Korean news­pa­per re­ported that China’s or­gan crack­down had sim­ply raised the price of a Chi­nese kid­ney in South Korea.

Some re­form­ers think they can solve the or­gan short­age and tame the mar­ket by le­gal­iz­ing sales. Their latest pro­posal, pre­sented at one of the Euro­pean meet­ings last week by Arthur Matas of the Univer­sity of Min­nesota, is a sin­gle-payer sys­tem for or­gans. It’s half-lib­er­tar­ian and half-so­cial­ist. On the one hand, Matas says mar­kets for eggs and sperm are harm­less, kid­ney pur­chases can save coun­tries money, and of­fer­ing poor peo­ple cash for or­gans is no more co­er­cive than of­fer­ing them money to work in mines or join the army. On the other hand, he thinks the gov­ern­ment can fix kid­ney prices and de­ter­mine who gets them.

Good luck. As any coun­try with na­tional health in­sur­ance knows, peo­ple find ways to buy more than they’re al­lot­ted. Ra­tion med­i­cal care abroad and af­flu­ent for­eign­ers will come here. Ra­tion or­gans here, and af­flu­ent Amer­i­cans will go abroad, as they’re al­ready do­ing. It’s true that pay­ments would elicit more “do­na­tions.” But stud­ies re­viewed at the meet­ings in Europe show that flood­ing the mar­ket with pur­chased or­gans re­duces the in­cen­tive to do­nate.

The key to re­vers­ing the or­gan mar­ket is to turn that equa­tion on its head. Stop fight­ing cap­i­tal­ism and start us­ing it. What’s driv­ing the mar­ket is scarcity. Amer­i­cans, Bri­tons, Is­raelis, Ja­panese and South Kore­ans are go­ing abroad for or­gans mostly be­cause too few of their coun­try­men have agreed to do­nate or­gans when they die. Fewer than 40 per­cent of Amer­i­cans have signed or­gan-donor cards, and only about half of their fam­i­lies con­sent to the do­na­tion of a loved one’s or­gans. Some have re­li­gious ob­jec­tions. Oth­ers are squea­mish. Many as­sume that if they don’t sup­ply the or­gans, some­body else will.

They’re right. Some­body else will sup­ply the or­gans. But that some­body won’t be a corpse. It’ll be a fish­er­man or an out-of-work la­borer who needs cash and can’t find an­other way to get it.

The surest way to stop him from sell­ing his kid­ney is to make it worth­less, by flood­ing the mar­ket with free or­gans. If you haven’t filled out a donor card, do it now. Be­cause if the dy­ing can’t get or­gans from the dead, they’ll buy them from the liv­ing.

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