Correspondents
11 March 2004
Nairobi — A 16-year-old boy, from Trans Nzoia, is offering his kidney for sale to raise fees to enable him join Form One.
The boy says his new school is demanding Sh30,000, an amount his mother, a vegetable vendor, cannot raise. Now he has put up his kidney for sale.
But, possibly, unknown to him, it is illegal to sell body organs, a practice that raises moral questions. And even if he opted to 'donate' the kidney, it is a long, expensive and tortuous process.
A few years ago in Nairobi, a 45 year-old father was diagnosed with the need for an urgent kidney replacement. The only suitable donor was his 13 year-old son. But the man - a sole breadwinner - opted to die than 'compromise' his son's chances in life. Question: Had the breadwinner accepted the kidney and lived, would he have provided a better quality life for the child?
The organ trade is now a global phenomenon. A Moldovan woman, desperate to feed her family, decides to sell one of her kidneys to a rich Westerner for $3,000 - more than a year's salary for the donor, peanuts for the recipient.
Is it an act of exploitation of the poor or a life-saving transaction which could and should be regulated?
These are some of the tough questions European Union justice ministers will have to grapple with in the coming months when they debate new proposals drafted by Greece, aimed at combating the increasing trade in human tissues and organs.
Experts are divided over whether selling and buying organs should be banned or made lawful under tight conditions.
"It is not acceptable to save your own life by diminishing someone else's," said Nancy Scheper-Hughes, director of the medical watchdog Organs Watch.
"If we want organs we should stop cannibalising the living and get them from the dead."
But an Israeli kidney transplant specialist argues in favour of regularising organ trading. "Bad laws can kill patients, but the status quo is also unethical," says Michael Friedlaender, a kidney specialist at Hadassah University Hospital in Jerusalem, as reported by Reuters.
One thing is clear: A market in human organs already exists and is growing, international law enforcement officials say.
The most common trade is in kidneys because donors can live comfortably with just one kidney.
A simple blood-type match can make a transplant successful, which makes going abroad and paying for the operation tempting for patients who have spent years waiting on dialysis.
While the scale of organ trading is unclear because of its clandestine nature and the lack of investigations, international law enforcement officials say people from countries like India and Moldova are selling organs to Western and Middle-Eastern patients.
While some donors may be forcibly taken by so-called brokers to countries such as Russia, Ukraine and EU-hopeful Turkey for the operations, Interpol said most went willingly and knowingly. "It is a decision which is not taken lightly, but they need the cash," Interpol officer Hamish McCulloch told Reuters.
"There are loads of poor people who get exploited and are willing to sell an organ to get money," he added.
EU president Greece is proposing that the bloc ban all trade in human tissues and organs, even in cases where there is consent between the donor and the patient. The proposals also target doctors who perform a transplant in the knowledge that the organs were bought.
In more serious cases, those involving minors and those which endanger the donor's life, offences could be punished with a jail term of at least 10 years. Consensual, free organ donation would not be banned under the law.
Even if the Trans Nzoia boy would get a recipient willing to pretend that the organ is a donation, things might still be difficult for him
According to Dr Joshua Kayiima, a nephrologist and senior lecturer at University of Nairobi, transfer of kidneys to unrelated people is not encouraged in this country because of the complex procedures involved.
"The further in blood relation a donor of a kidney is from the recipient, the more complex and expensive the procedures."
The doctor, however, warns that even if one were to sell his kidney on the black market, a huge per centage of the money would go to the brokers.
But Dr Kayiima discounts the possibility of such a market in Kenya. "The kidney transplant demand is small in this country. And we would have noticed who is donating for money."
Friedlaender says failure to discuss legalising the buying and selling organs would be to neglect patients and their needs. "Someone has to come up with a good reason why this is a problem when it happens between consenting adults," he says.
People with kidney failure have to go through regular dialysis treatment, where a machine cleans their blood instead of their kidneys. Many die waiting for an organ.
"Patients are dying in dialysis... (and) to condemn people to a life in dialysis is not an ethic I can stand by," he says.
Friedlaender used to be fiercely opposed to organ trading, but the consequences of the Palestinian uprising against Israeli authorities changed his mind.
The intifada prevented West Bank Arabs from having transplants in Jerusalem and instead they had the operation in Iraq with kidneys bought from Iraqi donors for $500.
After hearing of this, some of Friedlaender's Arab patients in Jerusalem also went to Iraq.
Some of his Jewish patients, barred from going to Iraq, went to countries such as EU hopefuls Romania and Bulgaria and soon-to-be EU member Estonia to have transplants with organs bought there.
Some 40 percent of Friedlaender's patients had had transplants abroad and the number was growing.
Organs Watch director Scheper-Hughes, a medical anthropologist and professor at University of California, Berkeley, has studied organ trading for more than seven years and says it usually happens without the free consent of the donor.
"Brokers ensnare people with jobs that do not exist and they go to Istanbul, for example, where they are scared into having the operation. That is really criminal behaviour," she said.
She argues that the black market for organs should under no circumstances be legalised.
"How do you regulate a black market? Some states have tried... but the problem is that there is an ethical dilemma: How much do you pay a healthy poor person for mutilating their body?" Scheper-Hughes asked.
"It is always going to be someone desperate who sells."
Instead of legalising the trade, people should be forced to donate their organs once dead, unless they had medical or religious reasons not to do so, Scheper-Hughes argues.
She welcomed the plans for the EU to debate the matter and urged it to not only target the criminal gangs behind the trafficking, but also the doctors performing the transplants.
"It is a corruption of a profession aimed at helping people," Scheper-Hughes said.
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