This post is a part of our Bioethics in the News series. For more information, click here.

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.

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.

Monir 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.

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