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The Great Organ Bazaar

LUND, SWEDEN – The Web site 88DB.com Philippines is an active online portal that allows service providers and consumers to find and interact with each other. Naoval, an Indonesian man with “AB blood type, no drugs and no alcohol,” wants to sell his kidney. Another man says, “I am a Filipino. I am willing to sell my kidney for my wife. She has breast cancer and I can’t afford her medications.” Then there is Enrique, who is “willing to donate my kidney for an exchange. 21 years old and healthy.”

Other offers of this type could, just a few years ago, be found at www.liver4you.org, which promised kidneys for $80,000-$110,000. The costs of the operation, including the fees of the surgeons – licensed in the United States, Great Britain, or the Philippines – would be included in the price.

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All of this Internet activity is but the tip of the iceberg of a new and growing global human-tissue economy. Indeed, the World Health Organization (WHO) has estimated that about 10% of organ transplants around the world stem from purely commercial transactions.

Trade in organs follows a clear, geographically linked pattern: people from rich countries buy the organs, and people in poor countries sell them. In my research on organ trafficking, I have entered some of these shadow markets, where body parts from the poor, war victims, and prisoners are commodities, bought or stolen for transplant into affluent ill people.

One woman, originally from Lebanon, told me that a wealthy businessman from Spain paid a huge sum for her kidney. In the end, however, she received no monetary payment. Today, her life is much worse than before, because medical complications following the operation make it difficult for her to work. Similar stories are told by organ vendors I have met from the former Soviet states, the Middle East, and Asia.

Organ trafficking depends on several factors. One is people in distress. They are economically or socially disadvantaged, or live in war-torn societies with prevalent crime and a thriving black market. On the demand side are people who are in danger of dying unless they receive an organ transplant. Additionally, there are organ brokers who arrange the deals between sellers and buyers.

It is also necessary to have access to well-equipped clinics and medical staff. Such clinics can be found in many countries, including Iran, Pakistan, Ukraine, South Africa, and the Philippines.

Indeed, the Philippines is well known as a center of the illegal organ trade and a “hot spot” for transplant tourism. From the 1990’s until 2008 (when a new policy was adopted), the number of transplantations involving organ sales by Filipinos to foreign recipients increased steadily. Many organ sellers from Israel, for example, were, together with their buyers, brought to Manila for the transplants.

Hector is one of the several hundred cases of kidney vendors documented by social workers in three impoverished towns in the Philippines’ Quezon province. His brother was trapped in Malaysia with high debts to criminal gangs, so Hector sold his kidney in order to buy his freedom. Another vendor, Michel, became a broker himself; after selling one of his kidneys to pay for his father’s medicines, the surgeon forced him to deliver more organs. The vendors’ organs were transplanted to recipients mainly from the Philippines, Israel, Japan, South Korea, and Saudi Arabia.

Trade in humans and their bodies is not a new phenomenon, but today’s businesses are historically unique, because they require advanced biomedicine, as well as ideas and values that enhance the trade in organs. Western medicine starts from the view that human illness and death are failures to be combated. It is within this conceptual climate – the dream of the regenerative body – that transplantation technology develops and demand for biological replacement parts grows.

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One of the more obvious manifes­tations of treating the human body as a resource to be mined is the hospital waiting list, used in many countries. A man I interviewed recently for a study of Swedes who had been on the waiting list, but who decided to purchase kidneys abroad, described to me his trip to Pakistan for the transplant: “I’m not the kind of man who uses other people, but I had to. I had to choose between dying and getting back my life!”

In an era of transplants on demand, there is no way around this dilemma. The biological imperatives that guide the priority system of transplant waiting lists are easily transformed into economic values. As always where demand exceeds supply, people may not accept waiting their turn – and other countries and other peoples’ bodies give them the alternative they seek.