This article was downloaded by: [University of Connecticut] On: 12 October 2014, At: 15:35 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
The American Journal of Bioethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uajb20
Regulated Organ Market: Reality Versus Rhetoric a
Monir Moniruzzaman a
Michigan State University Published online: 17 Sep 2014.
To cite this article: Monir Moniruzzaman (2014) Regulated Organ Market: Reality Versus Rhetoric, The American Journal of Bioethics, 14:10, 33-35, DOI: 10.1080/15265161.2014.947801 To link to this article: http://dx.doi.org/10.1080/15265161.2014.947801
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Kidney Vendors in Regulated Organ Markets
REFERENCES
Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 14(10): 7–18.
Bienstock, R. 2013. Tales from the organ trade. HBO Documentary Films. Available at: http://www.talesfromtheorgantrade.com/ index.html (accessed July 6, 2014).
Moazam, F. 2006. Bioethics and organ transplantation in a Muslim Society: A study in culture, ethnography and religion. Bloomington, IN: Indiana University Press.
Halperin S., A. Raz, R. Kohn, M. Rey, D. Asch, and P. Reese. 2010. Regulated payments for living kidney donation: An empirical assessment of the ethical concerns. Annals of Internal Medicine 152 (6): 358–365.
Naqvi, S. A. A., S. A. H. Rizvi, M. N. Zafar, et al. 2008. Health status and renal function evaluation of kidney vendors: A report from Pakistan. American Journal of Transplantation 8(7): 1444–1450.
Hippen, B. E. 2005. In defense of a regulated market in kidneys from living vendors. Journal of Medicine and Philosophy 30(6): 593– 626.
Downloaded by [University of Connecticut] at 15:35 12 October 2014
Hossain M., E. Goyder, J. Rigby, and M. Nahas. 2009. CKD and poverty: A growing global challenge. American Journal of Kidney Diseases 53(1): 166–174.
Barnief L., S. Klarenbach, J. Gill, T. Caufield, and B. Manns. 2012. Attitudes toward strategies to increase organ donation: Views of the general public and health professionals. Clinical Journal of the American Society of Nephrology 7(12): 1956–1963.
Hippen, B. E. 2006. Prevention may not reduce the demand for renal transplantation. Kidney International 70(3): 606–607. Hippen, B. E. 2010. Professional obligation and supererogation with reference to the transplant tourist. American Journal of Bioethics 10(2): 14–16. Hobbes, T. 1991. Leviathan. Cambridge, UK: Cambridge University Press.
Padilla, B., G. M. Danovitch, and J. Lavee. 2013. Impact of legal measures prevent transplant tourism: The interrelated experience of the Philippines and Israel. Medicine, Health Care, and Philosophy 16(4): 915–919. van Buren, M. C., E. Massey, L. Maasdam, et al. 2010. For love or money? Attitudes toward financial incentives among actual living kidney donors. American Journal of Transplantation 10:2488–2492. Working Group on Incentives for Living Donation. 2012. Incentives for organ donation: Proposed standards for an internationally acceptable system. American Journal of Transplantation 12(2): 306–312.
Regulated Organ Market: Reality Versus Rhetoric Monir Moniruzzaman, Michigan State University While a market in human organs has many broader ramifications (i.e., not only for organ sellers, but also for their families and communities, as well as for altruistic donation, medical profession, and cultural practices; see Delmonico 2008; Scheper-Hughes 2011; Titmuss 1970), I particularly focus on significant harms to organ sellers that Koplin examines in depth. Koplin’s article, “Assessing the Likely Harms to Kidney Vendors in Regulated Organ Markets” (2014), reviews the medical, social, and economic harms to kidney sellers, and reinforces that these widespread harms could persist under a regulated organ market that some physicians, economists, and bioethicists have persistently proposed. I firmly support Koplin’s arguments and echo his claim that the utilitarian assertion in favor of paid organ donation is rendered incomplete. My long-standing ethnographic research on 67 kidney and liver sellers in Bangladesh, spanning more than a decade, strengthens Koplin’s arguments against a regulated organ market, as I present in the following. My point is that a
regulated organ market is not an “Aladdin’s lamp” that by itself would eliminate the widespread deception, coercion, and corruption that exist in illicit organ markets, nor would it ensure justice, equity, and rights to organ sellers; rather, the market would exacerbate violence, exploitation, and suffering against the economic underclass. At the very least, the poor have every right to keep their body parts intact, for their physical survival. Koplin argues that market proponents define the risks of organ donation primarily in terms of mortality after surgery, and compare this to the associated risks involved in dangerous professions; however, commodifying organs has significant health impacts on organ sellers. The perceived health risks associated with organ donation are so ubiquitous that most doctors (and perhaps most of us) would not want to donate their living organs to someone who is not related to them (see, among Egyptian doctors, Hamdy 2012); well-off recipients usually buy organs instead of seeking organ donation from family members.
Address correspondence to Monir Moniruzzaman, PhD, Department of Anthropology and Center for Ethics and Humanities in Life Sciences, Michigan State University, 655 Auditorium Road, Baker Hall, East Lansing, MI 48823, USA. E-mail: [email protected]
October, Volume 14, Number 10, 2014
ajob 33
Downloaded by [University of Connecticut] at 15:35 12 October 2014
American Journal of Bioethics
A recent study finds that live kidney donors have an increased risk of end-stage renal disease over a median of 7.6 years (Muzaale et al. 2014). Notably, longitudinal studies on organ sellers are scarce and are based on data collected from kidney donors in the developed countries. The prevalence of death and disease could be much higher for kidney sellers of the developing world, due to dire living conditions and a dearth of postoperative care. My research reveals that almost all Bangladeshi sellers did not receive postsurgical care, not even one appointment, and lack sufficient food, clean water, health care, and other necessities of life. At one time, the government of Bangladesh offered free health checkups for organ sellers, but most sellers did not show up, due to the shame involved in organ selling. In addition, the local medical service was widely mistrusted, and as a result, the project dissipated within a few weeks. One may argue that a regulated organ market can theoretically offer follow-up care, but it may not be effective, as most sellers reside in remote villages and have very limited access to transplant care, which is offered only in major cities in Bangladesh and elsewhere in the developing world. A regulated organ market would not reverse the adverse health outcomes of the organ sellers, but rather would have a trivial impact on the social and structural contexts of organ donation. Also, organ sellers experience severe psychosocial suffering from organ vending; Koplin broadly addresses this topic. My research reveals that living without a kidney is not just a bodily alteration, but also a state of ontological suffering of being in the world. Bangladeshi sellers explained that commodifying body parts jeopardizes the homeostatic balance of their body and self. Post vending, they sensed that their new body existed in binary opposition to their old body. As a result, some sellers said they turned into a “half human” (see also Moazam, Zaman, and Jafarey 2009). Besides, all sellers felt they had an integrated selfhood with their recipients. By sharing flesh and blood, seller and recipient became one body, one person, one being. When the recipients died, sellers could not comprehend how they themselves could be in existential life now that their organs had gone to the afterlife. Sellers also desired to maintain a lifelong relationship with their recipients, but for most, the “commodified kinship” did not last long; the recipients slowly distanced themselves and mistrusted the sellers in the postvending period—an outcome of the market economy. Furthermore, organ sellers felt disembodied, as selling body parts violates long-standing cultural and religious practices, such as body ownership, bodily integrity, and human dignity (Scheper-Hughes 2011). For example, Bangladeshi sellers believe that God is the owner of their body; they regret selling God’s gift. They also expressed that organ commodification is the most disgraceful act a human being can carry out; they lost their sense of self-respect, intrinsic worth, and moral judgment after selling their organs, and considered themselves “subhuman.” Due to such disembodiment and ontological suffering, the self of many Bangladeshi sellers grew heavier. They suffered from grave sadness, hopelessness,
34 ajob
and crying spells, and experienced social stigma, shame, and isolation for selling their body parts. In their despair and distress, some sellers became addicted to drugs, while others concealed what they had done from family members. Seller Mofiz told me that he often sat down, speechless, in a dark place, and thought about committing suicide (see also Moazam et al. 2009; Zargooshi 2001). A regulated organ market would not remedy such subjective and social suffering. To make matters worse, selling an organ does not alleviate the sellers’ poverty. In my study, 81% of organ sellers did not receive the payment they were promised. For example, Koliza, a liver seller, received 150,000 Taka (US$1,875), only half the amount the broker had promised him. Proponents of the organ market therefore argue that a regulated system could offer full payment for the sellers (though the Iranian regulated market proves otherwise; Zargooshi 2001), yet these proponents fail to explain how the payment (if it is paid in full) ensures income-generating opportunities for impoverished populations. Here, Koplin aptly argues that an organ market could not compensate for the extensive harms and ensure long-term benefits for vendors’ overall well-being. My research cultivates Koplin’s claim by capturing that Bangladeshi sellers mostly used their money to pay off their microloans; buy material goods, such as a cell phone, a television, or gold jewelry; or arrange a dowry or medical treatment for their family. Once the money had nearly run out, most sellers had already lost their jobs. Some managed to get new jobs, but their damaged bodies impeded their abilities to continue to do physically demanding jobs, such as rickshaw pulling, manual farm work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages not only himself, but also his family, noting that “three of my family members were depending on my income, and now I am done, and so are they.” As a result, some sellers have turned to organ brokering; they prey on their families, neighbors, and villagers just to get by. My research also finds that many sellers entered the organ market to pay off their debts, but soon were back in debt (see Cohen 2003). For example, Koliza took out new microcredit loans to start a poultry farm a year after selling his liver lobe. With a chicken mortality rate as high as 50%, at the return of his microcredit debt Koliza remarked, “I no longer have other parts to spare.” A regulated organ market could not ensure the long-term economic benefits of organ sellers, but rather might corrupt the overall situation. My recent fieldwork reveals that moneylenders have pressured the poor to sell their spare organs to repay loans. Husbands have tricked or forced their wives to sell their organs for economic gain (in one case, a man married twice to profit from the sale of his wives’ kidneys, and in another case, a man sold his wife’s kidney after claiming to take her to the hospital for an appendectomy). A 6-year-old boy was murdered by an organ trafficking racket and his body tossed in a pond after both kidneys were removed (The Daily Star 2014). I also document that four members of one family (a father, two brothers, and a daughter-in-law) each
October, Volume 14, Number 10, 2014
Downloaded by [University of Connecticut] at 15:35 12 October 2014
Kidney Vendors in Regulated Organ Markets
sold a kidney. Buyers regularly publish organ classifieds in major newspapers for soliciting organs, and brokers have expanded their networks from local to national to international levels. Such profound violence, exploitation, and suffering would be rife in the regulated or rampant commerce of organs. In sum, after selling their vital organs, the health of sellers is compromised, their economic situation has worsened, and their social status has declined (Moniruzzaman 2012). The outcomes of organ selling are invasive, harmful, and devastating. As seller Koliza said with regret, “I donated my liver lobe to: i) live better, ii) save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.” It can therefore be argued that a regulated organ market is not the solution, but rather, the strict criminalization of the organ trade is ethically and pragmatically essential. As Koplin notes, a regulated organ market would improve vendors’ well-being or minimize their harms lack evidential warrant. Such a system does not speak to the lives of the economic underclass, but rather seriously discriminates against them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and justice to organ sellers. We ought to oppose the organ market in order to curb this illicit practice. &
The Daily Star. 2014. Killed for kidneys. May 01, Dhaka, Bangladesh. Available at: http://www.thedailystar.net/killed-forkidneys-22349 Delmonico, F. 2008. The development of the declaration of Istanbul on organ trafficking and transplant tourism. Nephrology, Dialysis, and Transplantation 23(11): 3381–3382. Hamdy, S. 2012. Our bodies belong to God: Organ transplants, Islam, and the struggle for human dignity in Egypt. Berkeley, CA: University of California Press. Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 14(10): 7–18. Moazam, F., R. Zaman, and A. Jafarey. 2009. Conversations with kidney vendors in Pakistan: An ethnographic study. Hastings Center Report 39(3): 29–44. Moniruzzaman, M. 2012. “Living cadavers” in Bangladesh: Bioviolence in human organ bazaar. Medical Anthropology Quarterly 26 (1): 69–91. Muzaale, A., A. Massie, M. Wang, et al. 2014. Risk of end-stage renal disease following live kidney donation. Journal of the American Medical Association 311(6): 579–586. Scheper-Hughes, N. 2011. The body in tatters: Dismemberment, dissection, and the return of the repressed. In A companion to the anthropology of the body and embodiment, ed. F. Mascia-Lees, 172– 206. Malden, MA: Wiley-Blackwell. Titmuss, R. 1970. The gift relationship: From human blood to social policy. London, UK: New Press.
REFERENCES Cohen, L. 2003. Where it hurts: Indian material for an ethics of organ transplantation. Zygon 38(3): 663–688.
Zargooshi, J. 2001. Quality of life of Iranian kidney “donors”. Journal of Urology 166:1790–1799.
A Closer Look at the Iranian Model of Kidney Transplantation Kiarash Aramesh, Tehran University of Medical Sciences In his arguments against the claim that “kidney sellers would benefit from paid donation under a properly regulated kidney market,” Koplin (2014) has presented the Iranian model of kidney transplantation (IMKT) as an example of regulated system for donor compensation. In the past 8 years, through my engagement in the field of medical ethics in Iran, I have been in close contact with the IMKT. Although this model was successful in providing vital care for thousands of desperate patients, it has always been surrounded by ethical controversies and debates (Aramesh 2009). A huge body of literature has
been created by the proponents and opponents of this model, including some descriptive studies. As Koplin mentioned, some degrees of discrepancy exist in the published results of these studies. I believe that parts of both the critics and defenders have been influenced by their general views toward the Iranian health system at its large scale; even descriptive reports do not seem to be free of such influences. For example, the most cited article against the IMKT that has been conducted in a city in a western province of Iran has used a lot of banned newspapers as its references (Zargooshi 2001). While reports with more
Address correspondence to Kiarash Aramesh, Tehran University of Medical Sciences, Medical Ethics and History of Medicine Research Center, 16 Azar St., No.23, 4th floor, Tehran, Iran. E-mail: [email protected]
October, Volume 14, Number 10, 2014
ajob 35
The American Journal of Bioethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uajb20
Regulated Organ Market: Reality Versus Rhetoric a
Monir Moniruzzaman a
Michigan State University Published online: 17 Sep 2014.
To cite this article: Monir Moniruzzaman (2014) Regulated Organ Market: Reality Versus Rhetoric, The American Journal of Bioethics, 14:10, 33-35, DOI: 10.1080/15265161.2014.947801 To link to this article: http://dx.doi.org/10.1080/15265161.2014.947801
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Kidney Vendors in Regulated Organ Markets
REFERENCES
Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 14(10): 7–18.
Bienstock, R. 2013. Tales from the organ trade. HBO Documentary Films. Available at: http://www.talesfromtheorgantrade.com/ index.html (accessed July 6, 2014).
Moazam, F. 2006. Bioethics and organ transplantation in a Muslim Society: A study in culture, ethnography and religion. Bloomington, IN: Indiana University Press.
Halperin S., A. Raz, R. Kohn, M. Rey, D. Asch, and P. Reese. 2010. Regulated payments for living kidney donation: An empirical assessment of the ethical concerns. Annals of Internal Medicine 152 (6): 358–365.
Naqvi, S. A. A., S. A. H. Rizvi, M. N. Zafar, et al. 2008. Health status and renal function evaluation of kidney vendors: A report from Pakistan. American Journal of Transplantation 8(7): 1444–1450.
Hippen, B. E. 2005. In defense of a regulated market in kidneys from living vendors. Journal of Medicine and Philosophy 30(6): 593– 626.
Downloaded by [University of Connecticut] at 15:35 12 October 2014
Hossain M., E. Goyder, J. Rigby, and M. Nahas. 2009. CKD and poverty: A growing global challenge. American Journal of Kidney Diseases 53(1): 166–174.
Barnief L., S. Klarenbach, J. Gill, T. Caufield, and B. Manns. 2012. Attitudes toward strategies to increase organ donation: Views of the general public and health professionals. Clinical Journal of the American Society of Nephrology 7(12): 1956–1963.
Hippen, B. E. 2006. Prevention may not reduce the demand for renal transplantation. Kidney International 70(3): 606–607. Hippen, B. E. 2010. Professional obligation and supererogation with reference to the transplant tourist. American Journal of Bioethics 10(2): 14–16. Hobbes, T. 1991. Leviathan. Cambridge, UK: Cambridge University Press.
Padilla, B., G. M. Danovitch, and J. Lavee. 2013. Impact of legal measures prevent transplant tourism: The interrelated experience of the Philippines and Israel. Medicine, Health Care, and Philosophy 16(4): 915–919. van Buren, M. C., E. Massey, L. Maasdam, et al. 2010. For love or money? Attitudes toward financial incentives among actual living kidney donors. American Journal of Transplantation 10:2488–2492. Working Group on Incentives for Living Donation. 2012. Incentives for organ donation: Proposed standards for an internationally acceptable system. American Journal of Transplantation 12(2): 306–312.
Regulated Organ Market: Reality Versus Rhetoric Monir Moniruzzaman, Michigan State University While a market in human organs has many broader ramifications (i.e., not only for organ sellers, but also for their families and communities, as well as for altruistic donation, medical profession, and cultural practices; see Delmonico 2008; Scheper-Hughes 2011; Titmuss 1970), I particularly focus on significant harms to organ sellers that Koplin examines in depth. Koplin’s article, “Assessing the Likely Harms to Kidney Vendors in Regulated Organ Markets” (2014), reviews the medical, social, and economic harms to kidney sellers, and reinforces that these widespread harms could persist under a regulated organ market that some physicians, economists, and bioethicists have persistently proposed. I firmly support Koplin’s arguments and echo his claim that the utilitarian assertion in favor of paid organ donation is rendered incomplete. My long-standing ethnographic research on 67 kidney and liver sellers in Bangladesh, spanning more than a decade, strengthens Koplin’s arguments against a regulated organ market, as I present in the following. My point is that a
regulated organ market is not an “Aladdin’s lamp” that by itself would eliminate the widespread deception, coercion, and corruption that exist in illicit organ markets, nor would it ensure justice, equity, and rights to organ sellers; rather, the market would exacerbate violence, exploitation, and suffering against the economic underclass. At the very least, the poor have every right to keep their body parts intact, for their physical survival. Koplin argues that market proponents define the risks of organ donation primarily in terms of mortality after surgery, and compare this to the associated risks involved in dangerous professions; however, commodifying organs has significant health impacts on organ sellers. The perceived health risks associated with organ donation are so ubiquitous that most doctors (and perhaps most of us) would not want to donate their living organs to someone who is not related to them (see, among Egyptian doctors, Hamdy 2012); well-off recipients usually buy organs instead of seeking organ donation from family members.
Address correspondence to Monir Moniruzzaman, PhD, Department of Anthropology and Center for Ethics and Humanities in Life Sciences, Michigan State University, 655 Auditorium Road, Baker Hall, East Lansing, MI 48823, USA. E-mail: [email protected]
October, Volume 14, Number 10, 2014
ajob 33
Downloaded by [University of Connecticut] at 15:35 12 October 2014
American Journal of Bioethics
A recent study finds that live kidney donors have an increased risk of end-stage renal disease over a median of 7.6 years (Muzaale et al. 2014). Notably, longitudinal studies on organ sellers are scarce and are based on data collected from kidney donors in the developed countries. The prevalence of death and disease could be much higher for kidney sellers of the developing world, due to dire living conditions and a dearth of postoperative care. My research reveals that almost all Bangladeshi sellers did not receive postsurgical care, not even one appointment, and lack sufficient food, clean water, health care, and other necessities of life. At one time, the government of Bangladesh offered free health checkups for organ sellers, but most sellers did not show up, due to the shame involved in organ selling. In addition, the local medical service was widely mistrusted, and as a result, the project dissipated within a few weeks. One may argue that a regulated organ market can theoretically offer follow-up care, but it may not be effective, as most sellers reside in remote villages and have very limited access to transplant care, which is offered only in major cities in Bangladesh and elsewhere in the developing world. A regulated organ market would not reverse the adverse health outcomes of the organ sellers, but rather would have a trivial impact on the social and structural contexts of organ donation. Also, organ sellers experience severe psychosocial suffering from organ vending; Koplin broadly addresses this topic. My research reveals that living without a kidney is not just a bodily alteration, but also a state of ontological suffering of being in the world. Bangladeshi sellers explained that commodifying body parts jeopardizes the homeostatic balance of their body and self. Post vending, they sensed that their new body existed in binary opposition to their old body. As a result, some sellers said they turned into a “half human” (see also Moazam, Zaman, and Jafarey 2009). Besides, all sellers felt they had an integrated selfhood with their recipients. By sharing flesh and blood, seller and recipient became one body, one person, one being. When the recipients died, sellers could not comprehend how they themselves could be in existential life now that their organs had gone to the afterlife. Sellers also desired to maintain a lifelong relationship with their recipients, but for most, the “commodified kinship” did not last long; the recipients slowly distanced themselves and mistrusted the sellers in the postvending period—an outcome of the market economy. Furthermore, organ sellers felt disembodied, as selling body parts violates long-standing cultural and religious practices, such as body ownership, bodily integrity, and human dignity (Scheper-Hughes 2011). For example, Bangladeshi sellers believe that God is the owner of their body; they regret selling God’s gift. They also expressed that organ commodification is the most disgraceful act a human being can carry out; they lost their sense of self-respect, intrinsic worth, and moral judgment after selling their organs, and considered themselves “subhuman.” Due to such disembodiment and ontological suffering, the self of many Bangladeshi sellers grew heavier. They suffered from grave sadness, hopelessness,
34 ajob
and crying spells, and experienced social stigma, shame, and isolation for selling their body parts. In their despair and distress, some sellers became addicted to drugs, while others concealed what they had done from family members. Seller Mofiz told me that he often sat down, speechless, in a dark place, and thought about committing suicide (see also Moazam et al. 2009; Zargooshi 2001). A regulated organ market would not remedy such subjective and social suffering. To make matters worse, selling an organ does not alleviate the sellers’ poverty. In my study, 81% of organ sellers did not receive the payment they were promised. For example, Koliza, a liver seller, received 150,000 Taka (US$1,875), only half the amount the broker had promised him. Proponents of the organ market therefore argue that a regulated system could offer full payment for the sellers (though the Iranian regulated market proves otherwise; Zargooshi 2001), yet these proponents fail to explain how the payment (if it is paid in full) ensures income-generating opportunities for impoverished populations. Here, Koplin aptly argues that an organ market could not compensate for the extensive harms and ensure long-term benefits for vendors’ overall well-being. My research cultivates Koplin’s claim by capturing that Bangladeshi sellers mostly used their money to pay off their microloans; buy material goods, such as a cell phone, a television, or gold jewelry; or arrange a dowry or medical treatment for their family. Once the money had nearly run out, most sellers had already lost their jobs. Some managed to get new jobs, but their damaged bodies impeded their abilities to continue to do physically demanding jobs, such as rickshaw pulling, manual farm work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages not only himself, but also his family, noting that “three of my family members were depending on my income, and now I am done, and so are they.” As a result, some sellers have turned to organ brokering; they prey on their families, neighbors, and villagers just to get by. My research also finds that many sellers entered the organ market to pay off their debts, but soon were back in debt (see Cohen 2003). For example, Koliza took out new microcredit loans to start a poultry farm a year after selling his liver lobe. With a chicken mortality rate as high as 50%, at the return of his microcredit debt Koliza remarked, “I no longer have other parts to spare.” A regulated organ market could not ensure the long-term economic benefits of organ sellers, but rather might corrupt the overall situation. My recent fieldwork reveals that moneylenders have pressured the poor to sell their spare organs to repay loans. Husbands have tricked or forced their wives to sell their organs for economic gain (in one case, a man married twice to profit from the sale of his wives’ kidneys, and in another case, a man sold his wife’s kidney after claiming to take her to the hospital for an appendectomy). A 6-year-old boy was murdered by an organ trafficking racket and his body tossed in a pond after both kidneys were removed (The Daily Star 2014). I also document that four members of one family (a father, two brothers, and a daughter-in-law) each
October, Volume 14, Number 10, 2014
Downloaded by [University of Connecticut] at 15:35 12 October 2014
Kidney Vendors in Regulated Organ Markets
sold a kidney. Buyers regularly publish organ classifieds in major newspapers for soliciting organs, and brokers have expanded their networks from local to national to international levels. Such profound violence, exploitation, and suffering would be rife in the regulated or rampant commerce of organs. In sum, after selling their vital organs, the health of sellers is compromised, their economic situation has worsened, and their social status has declined (Moniruzzaman 2012). The outcomes of organ selling are invasive, harmful, and devastating. As seller Koliza said with regret, “I donated my liver lobe to: i) live better, ii) save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.” It can therefore be argued that a regulated organ market is not the solution, but rather, the strict criminalization of the organ trade is ethically and pragmatically essential. As Koplin notes, a regulated organ market would improve vendors’ well-being or minimize their harms lack evidential warrant. Such a system does not speak to the lives of the economic underclass, but rather seriously discriminates against them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and justice to organ sellers. We ought to oppose the organ market in order to curb this illicit practice. &
The Daily Star. 2014. Killed for kidneys. May 01, Dhaka, Bangladesh. Available at: http://www.thedailystar.net/killed-forkidneys-22349 Delmonico, F. 2008. The development of the declaration of Istanbul on organ trafficking and transplant tourism. Nephrology, Dialysis, and Transplantation 23(11): 3381–3382. Hamdy, S. 2012. Our bodies belong to God: Organ transplants, Islam, and the struggle for human dignity in Egypt. Berkeley, CA: University of California Press. Koplin, J. 2014. Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 14(10): 7–18. Moazam, F., R. Zaman, and A. Jafarey. 2009. Conversations with kidney vendors in Pakistan: An ethnographic study. Hastings Center Report 39(3): 29–44. Moniruzzaman, M. 2012. “Living cadavers” in Bangladesh: Bioviolence in human organ bazaar. Medical Anthropology Quarterly 26 (1): 69–91. Muzaale, A., A. Massie, M. Wang, et al. 2014. Risk of end-stage renal disease following live kidney donation. Journal of the American Medical Association 311(6): 579–586. Scheper-Hughes, N. 2011. The body in tatters: Dismemberment, dissection, and the return of the repressed. In A companion to the anthropology of the body and embodiment, ed. F. Mascia-Lees, 172– 206. Malden, MA: Wiley-Blackwell. Titmuss, R. 1970. The gift relationship: From human blood to social policy. London, UK: New Press.
REFERENCES Cohen, L. 2003. Where it hurts: Indian material for an ethics of organ transplantation. Zygon 38(3): 663–688.
Zargooshi, J. 2001. Quality of life of Iranian kidney “donors”. Journal of Urology 166:1790–1799.
A Closer Look at the Iranian Model of Kidney Transplantation Kiarash Aramesh, Tehran University of Medical Sciences In his arguments against the claim that “kidney sellers would benefit from paid donation under a properly regulated kidney market,” Koplin (2014) has presented the Iranian model of kidney transplantation (IMKT) as an example of regulated system for donor compensation. In the past 8 years, through my engagement in the field of medical ethics in Iran, I have been in close contact with the IMKT. Although this model was successful in providing vital care for thousands of desperate patients, it has always been surrounded by ethical controversies and debates (Aramesh 2009). A huge body of literature has
been created by the proponents and opponents of this model, including some descriptive studies. As Koplin mentioned, some degrees of discrepancy exist in the published results of these studies. I believe that parts of both the critics and defenders have been influenced by their general views toward the Iranian health system at its large scale; even descriptive reports do not seem to be free of such influences. For example, the most cited article against the IMKT that has been conducted in a city in a western province of Iran has used a lot of banned newspapers as its references (Zargooshi 2001). While reports with more
Address correspondence to Kiarash Aramesh, Tehran University of Medical Sciences, Medical Ethics and History of Medicine Research Center, 16 Azar St., No.23, 4th floor, Tehran, Iran. E-mail: [email protected]
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