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World: The Risks, Benefits Of A Free Market In Organs

Some worry about the exploitation of poor people as organ suppliers for middle- and upper-class recipients (AFP) WASHINGTON, May 16, 2006 (RFE/RL) -- A healthy human is born with two kidneys, but only one is necessary to survive. That raises a question. Should people have the right to sell a kidney they don't need?

Today almost every country in the world answers 'no.' The exception is Iran, where sales of kidneys are legal, and prospective sellers can establish a price with prospective buyers.

"I have not fixed a price; I told the recipients that we'd talk about the price when we were ready for transplant," a 24-year-old electrical engineering student who advertised in a newspaper to sell his kidney told RFE/RL's Radio Farda last year. "I don't think that it's nice to call it 'price' -- it's a donation, and one would pay whatever he or she can pay. I think it's something around 5 or 6 million toomans [about $5,000 or $6,000]."

The student said he hoped to use the cash he received for his kidney to get out of debt and finally marry his fiancee.

Social Stigma Attached

In many other countries where kidney sales are illegal, a black market in organ sales nonetheless exists. Black-market prices for organs range widely from $800 to several thousand dollars.

Nancy Scheper-Hughes, an anthropologist at the University of California-Berkeley and director of Organ Watch, an NGO opposed to the buying and selling of kidneys, says she has followed many stories of people trying to sell a kidney. She says would-be sellers can suffer numerous harmful consequences from their decision, depending on the society they live in.

Scheper-Hughes found that in some parts of the world, men who sell their kidneys are socially stigmatized. Men from villages in Moldova, as well as Yemenites in Israel, have returned to their communities only to find themselves unmarriageable. They are considered less than whole.

Some organ donors, particularly laborers, have also faced discrimination in the workplace. Some employers view them as so weakened by giving up a kidney that they are no longer fit for duty.

"Most of these men are manual laborers of one kind or the other and they get excluded because of prejudice against men that do this sort of thing," Scheper-Hughes says. "They get excluded because of many beliefs -- many of them false -- that you never really, truly recover your strength after giving a kidney."

Such consequences are doubtless more bitter if the "sale" is not completely voluntary.

Scheper-Hughes has documented cases of Moldovan men who were promised jobs in Turkey and, when they arrived, were told that in fact there job was to sell a kidney. The only way for them to get home to Moldova again was to cooperate.

Better To Legalize Market?

Stories like this have prompted some doctors to advocate the legalizing of kidney sales. They say that would help eliminate abuses and help provide adequate supplies of transplant organs to people who need them.

Amy Friedman, a surgeon specializing in kidney transplants at Yale University, has published an article in the magazine "Kidney International" calling for the creation of a regulated market for kidneys. "Times are very desperate. Many people are dying without the benefits of transplants that we know are likely to help them extend their lives," Friedman says.

"The [black] market clearly exists," she continues. "It's very hard to know what the volume of transplants on that market is. We know that there are at least some untoward events happening there. And therefore should we not accept that it's going to happen or that it is happening, and much like Prohibition, control it and regulate it and take it out of the closet?"

Friedman says that in Iran the waiting list for patients needing kidneys has all but disappeared. Without the freedom to buy and sell organs, the supply of kidneys in Iran would be inadequate because Islamic law forbids the transplantation of organs from people who have just died.

'They Steal Our Kidneys'

But Scheper-Hughes says there are no guarantees that legalizing kidney sales would end all the abuses now associated with the black market. She says that in Iran legal sales have not corrected a problem of the black market: the exploitation of poor people as organ suppliers for middle- and upper-class recipients.

"We know from research, including research conducted by a postdoctoral fellow of mine who was working in Iran, that the donors are often recruited from marginal populations that include, in addition to very poor people and people in debt, also include populations of young people who are disaffected from their families -- some of whom are spending a great deal of their time in the street and some of whom are drug-using people and so forth," Scheper-Hughes says.

Scheper-Hughes also worries about the international implications of legalizing cross-border trading in human organs.

"In my travels, I've spoken to many ministers of health and to, you know, people representing their government's either health service or so forth, and I have heard almost blood-libel language -- the anger, the hurt of people who are, for example, in the donor countries of Eastern Europe," Scheper-Hughes says.

"[They say,] 'These Turks and these Israelis.' Because there was a link, a very strong link between Moldova, Romania being the donor countries, and Turkey the country where the operations were taking place and the patients coming primarily from Israel," she notes. "And [the angry language] was anti-Semitic, anti-Islamic: 'Those Turkish doctors are dogs to do this to our people. You know, the Israelis are sapping the strength of the bodies of our young people.'"

Organ trade, she argues, could exacerbate not just class enmity, but ethnic enmity, as the poor are asked "to sacrifice part of their body out of desperation" in order to take care of patients who "are invariably better off."

But surgeon Friedman disagrees. She says that today the rich are the only people who can afford to fly around the world in search of a kidney on the black market when there are not enough kidneys available from cadavers.

And Friedman says that a legalized market would at least help to redress that disparity. It would put kidneys within the reach of poor people who have no means to buy them illegally.