Transplant and Trafficking in Nepal: The Ethical Concerns

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By Monir Moniruzzaman, PhD

While organ transplant is highly successful in saving lives, it has created an illegal trade in human organs. The World Health Organization estimates that 10,000 organs are purchased from the black market every year.

Organ Trafficking In Nepal

In Nepal and other countries in South Asia, organ trafficking from living donors is thriving, although the government outlawed the practice in 2007. Several media outlets recently reported that Hokse, a village close to Kathmandu (the capital of Nepal) was known as “Kidney Valley,” where almost everyone has sold a kidney.

In July 2015, The Daily Mail exposed the case of Geeta, a 37 year-old mother living in Hoske, who sold a kidney in return for $2000 (all monetary values are in US dollars). Geeta spent some of her money on buying land and used the rest to build a house. In the end, Geeta’s house was entirely destroyed by the recent earthquake that killed over 9,000 people in Nepal.

transplant-scars

Image description: three individuals are shown lifting their shirts to reveal large scars. Image source: Flickr Creative Commons.

Like Geeta, many other villagers from Hokse and the surrounding districts have sold their kidneys. The brokers enticed poor villagers by telling them that their kidneys would grow back and they could end their poverty by selling their body parts. The brokers escorted the kidney sellers to South India where the surgeries took place.

The Daily Mail reported that many sellers did not receive the money that they were promised. One of them was paid as little as $200 by an organ broker. As the money ran out quickly, some sellers asked their family members to sell their kidneys as well; Geeta’s husband has also sold a kidney.

The reporter found that some sellers were dismissed from their community, and even their children faced discrimination at school, as selling an organ is considered a stigmatized act in Nepal. Once the sellers’ health deteriorates, many of them become frustrated and addicted to alcohol.

The newspaper also noted that organ selling has increased as a consequence of the recent earthquake in Nepal.

The situation in Nepal mirrors similar trends in India. After the tsunami in India in 2004, many fishermen were displaced and some tsunami victims, particularly women, have sold their kidneys due to financial pressures.

The Ethical Concerns

The trafficking of human organs in Nepal and elsewhere raises a key question: is it ethical to purchase vital organs from the desperate poor?

As the demand for organs outstrips the supply, some bioethicists propose to establish a regulated organ market. They argue that such a system could save the lives of ailing patients, lessen the sellers’ exploitation, and eliminate the black market.

Others argue that organ trafficking is exploitative, unethical, and inhumane; they oppose any trade in human organs.

At present, organ trafficking is outlawed in almost every country in the world. Iran is the only country where a regulated organ market has operated since 1997.

My research with seventy kidney and liver sellers in Bangladesh, spanning more than a decade, suggests that a regulated organ market would not eliminate exploitation, violence, and suffering against the poor, but rather it may cause even greater negative outcomes.

As I witnessed, organ sellers’ economic situations worsened, social status declined, and health conditions deteriorated after selling their organs. It is unlikely that a regulated organ market would alleviate the sellers’ poverty, reverse their social standing, and improve their overall well-being. Rather, such a system would institutionalize their abuse.

One may argue that a regulated market could offer bigger payment and post-operative check-ups for the organ sellers, but it would not eliminate the widespread deception, coercion, and corruption that exist in black markets.

In this trade, only the vulnerable poor, including earthquake victims and tsunami survivors, serve as organ sellers, while the wealthy patients benefit as organ buyers. A regulated market would not ensure equity and justice to organ sellers.

In such a system, the moneylenders could exert pressure on the villagers to repay their loans by trading organs. Husbands could pressure their wives to sell their organs for economic gains. Other criminal activities, such as violence or even murder of vulnerable people may be rife in a regulated organ market.

A regulated market would likely impede cadaveric organ donation, as well. In South Asia and many other countries, including Iran, cadaveric donation is virtually absent, since there is an alternative way to buy organs from the living poor.

Not only kidneys, but also liver lobes and live corneas are currently up for sale. So, the ultimate question is: how far we can go with this technology? Can we cut off a leg or a hand from the poor, assuming that the remaining body parts are sufficient for them?

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism therefore opposes any form of payment, trade, or commerce in human organs. It emphasizes that we need to criminalize organ trafficking throughout the world.

The current problem of organ shortage can be resolved by recycling our body parts. It is certainly unethical to exploit the poor, who need their body parts intact, simply for their physical survival and well-being.

moniruzzamanMonir Moniruzzaman, PhD, is an Assistant Professor in the Department of Anthropology and Center for Ethics and Humanities in the Life Sciences at Michigan State University. Dr. Moniruzzaman is a member of Declaration of Istanbul Custodial Group.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, December 3, 2015. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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References:

  1. Delmonico FL, Martin D, Domínguez-Gil B, Muller E, Jha V, Levin A, Danovitch GM, Capron AM. 2015. Living and deceased organ donation should be financially neutral acts. American Journal of Transplant 15(5):1187-91.
  2. Fleckner, Mads. 2015. Revealed: Nepalese village where almost everyone sold their kidneys to ‘organ traffickers’ to buy a house… only for them to be destroyed by devastating earthquake. The Daily Mail, July 10. http://www.dailymail.co.uk/news/article-3155817/Nepalese-village-sold-kidneys-organ-traffickers-buy-house-destroyed-devastating-earthquake.html
  3. Gopalan, TN. 2007. Tsunami victims ‘selling kidneys.’ BBC News, January 16. http://news.bbc.co.uk/2/hi/south_asia/6266641.stm
  4. Hippen, Benjamin. 2005. In Defense of a Regulated Market in Kidneys from Living Vendors. Journal of Medicine and Philosophy 30:593–626.
  5. Koplin, Julian. 2014. Assessing the Likely Harms to Vendors in Regulated Organ Markets. American Journal of Bioethics 14(10):7–18.
  6. Matas, Arthur. 2008. Should We Pay Donors to Increase the Supply of Organs for Transplantation? Yes. British Medical Journal 336:1342.
  7. Moniruzzaman, Monir. 2014. Regulated Organ Market: Rhetoric Versus Reality. American Journal of Bioethics 14(10):33-35.
  8. Moniruzzaman, Monir. 2012. “Living Cadavers” in Bangladesh: Bioviolence in the Human Organ Bazaar. Medical Anthropology Quarterly 26(1):69–91.
  9. Satel, Sally, Ed. 2009. When Altruism Isn’t Enough: The Case for Compensating Kidney Donors. Washington, DC: American Enterprise Institute Press.
  10. Scheper-Hughes, Nancy. 2006. Is it Ethical for Patients with Renal Disease to Purchase Kidneys from the World’s Poor? A Debate between Tarif Bakdask and Nancy Scheper-Hughes. PLOS Medicine 3(10):1699–1702.

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12 Responses to Transplant and Trafficking in Nepal: The Ethical Concerns

  1. Julia Steinke, MD, MS, Medical Director of Pediatric Kidney Transplant, Helen DeVos Childrens Hospital says:

    This is an interesting commentary. The lack of available organs and number of patients who are on dialysis and are awaiting transplant is enormous. One can theoretically say that by legalizing the selling of organs will eradicate the abuses detailed in the commentary. However, I agree with the author in that I do not believe that this theory would prove true. The vulnerable and poor will still be the ones to be motivated for the same reasons and be susceptible to coercion. In addition, in regards to the argument that a legalized system would provide donors to have appropriate donor evaluation as we have in the States in addition to follow-up care, how would this be implemented and overseen in third world countries? I believe these things are reasonable in theory but would still prey on the vulnerable, desperate and poor.

    • Monir Moniruzzaman says:

      Thank you for your comment. You are absolutely right that the market would still prey on the desperate poor. Even in the US, only the vulnerable populations (the poor, immigrants, racial groups, single moms, and similar others) will sell their organs. The market would not resolve the huge inequality that exists in our life. Rather, the system would operate, albeit differently but widely, to trick or force the poor to sell their organs. And, there are other ways to resolve the organ shortage problem, such as cadaveric organ donation through opt-out system (rather than opt-in), as well as bioengineering and xenotransplant.

  2. Jody says:

    Transplant and Trafficking in Nepal: The Ethical Concerns
    Posted on November 19, 2015
    The trafficking of human organs in Nepal and elsewhere raises a key question: is it ethical to purchase vital organs from the desperately poor?
    I have to say after reading the plight of those underserved populations that are selling these vital organs and those that lack the ethics of properly presenting the risks associated with the sale of one’s body parts, that this is beyond troubling to me from an ethical standpoint. Just the coercion aspects associated with such a sale is enough to understand why it has been banned in all but a few countries. Studies have proven that selling a kidney does not lead to a long-term economic benefit for those that do it and may be associated with an actual decline in their health. Those that sell them do so because of debt or the need to sustain themselves and their families. This begs the question that if those that are so bad off are willing to sell a vital organ maybe it’s time to look a the real picture of change for them. It’s time to leave the organ problem to the scientist’s that can create them in the lab. The real dilemma lies in the fact that this actually becomes a choice that they are able to make due to the financial constraints they live in. If their organs were not of value there would not be this decision to make. Therefore, those that have no ethics and prey on the “least of these” would be out of business. Step it up Scientists. All the evidence shows this is not a good thing and comes at a very large cost to all involved, in more ways than one.

    • Monir Moniruzzaman says:

      Thank you for your comment. You raised a very important point about the value. If we do not assign any monetary value to human organs, there would not be any manipulation, coercion, or deception that clearly exist in extracting the organs!

  3. Shantanique Crumby says:

    In the article called Transplant and Trafficking in Nepal: The Ethical Concerns talks about how poor people are trying to be pressured into selling their organs for money by brokers. A 37-year old man sold a kidney in return for $2,000. This article also states that organ transplant is highly successful in saving lives. I feel that organ transplant is a good thing to do for people who need certain organs to live. So, if you are healthy and can give up an organ that’s a blessing. However, what I didn’t like about this article was that some sellers would be dismissed from their community and even their children would face discrimination at school because of this. The first part of this article says that some brokers would tell poor people who sold their organs that it would grow back. This is such a lie and for that those brokers should have been punished.

    The second part of this article raises some ethical concerns about the poor selling their organs. I agree because, these people are poor and they shouldn’t be pressured into selling their organs. I say this because, they are really the ones who need them. It’s already bad enough they are poor and brokers are trying to steal one of the only things they own. No one should be robbed of their organs for money. Money is evil and it can get most people to do crazy things. Although, I think this article was a wake up call for some people. Lastly, I feel the only way a person should give up their organs is if their family member or close friend needs it. Also, it could be if you want to be a organ donor when you die and then they will put a sticker on your license for that.

    • Monir Moniruzzaman says:

      Thank you for your comments. Selling an organ is stigmatized in many societies. For example, in Bangladesh, people believe that God is the owner of the body, therefore anyone cannot sell the God’s gift. Also, as you mentioned, brokers should be punished as they lure poor villagers, who often do not know what is the function of a kidney, but tempted to sell their body parts for economic profit. The final section, you pointed out that I completely agree that we can offer our organs for saving lives of our loved ones, but should not extract them from the malnourished bodies of marginalized populations.

  4. Samantha Howley-Anderson says:

    I think we need to look at the bigger socioeconomic picture, how can we reduce the poverty that the people are living in? The people who are selling their organs for a small profit obviously feel as though they have no other choice. If they keep the kidney, they may not have a roof over their head or food on the table. That is the true injustice. How can we address that issue, if the people weren’t just trying to survive they wouldn’t need to sell their organs.

    • Mayghen says:

      That is a very good point, Samantha. I couldn’t agree more.

      • Monir Moniruzzaman says:

        Thank you for your comment. Of course, we should focus on the eradication of grinding poverty, rampant inequality, and healthcare commercialization that promote the trade in human organs!

  5. Mayghen says:

    I completely agree that by regulating the market, it would not stop the issues or alleviate poverty in the organ “donors,” nor will it alleviate the power of those receiving the organs. I believe it is unethical for organs to be bought and sold. There are huge consequences that go beyond not getting the agreed upon price for the organ, even though that is a big problem as well. There are health issues that can be caused by a botched surgery including infections that can lead to death. Even if the surgery is successful, their quality of life will be diminished. While you can live with only one kidney, there are many things you cannot do anymore. Lastly, what happens when the money from selling one organ is gone. Do you just sell another? As the author stated, when does it end, after you sell a limb or two?

  6. Monir Moniruzzaman says:

    Thank you for your comment. Regulating an organ market is Not the solution. It institutionalizes the abuse of the poor. As you pointed out, there are widespread detrimental outcomes of selling an organ. And, how far we can go? The solution lies in donating our body parts for saving lives of the others.

Comments are closed.