Doctors try to revive human organ market

By Gwynne Dyer

LONDON (JP): This is the age of the market, so why not a human spare parts market? There are rich people who want new kidneys or lungs or whatever, and there are people in the world so poor that they'd be willing to sell one of theirs. So where's the problem in that?

Nowhere, according to the International Forum for Transplant Ethics. "The poorer a potential vendor, the more likely it is that the sale of a kidney will be worth any risk there is," the Forum's members argue -- and they published their recommendation to legalize organ sales in a recent edition of Lancet, the world's leading medical journal.

"If the rich are free to engage in dangerous sports for pleasure, or dangerous jobs for high pay," the eminent surgeons of the Forum said, "it is difficult to see why the poor who take the lesser risk of kidney selling...should be thought so misguided as to need saving from themselves." (They seem not to know that 99 percent of the world's dangerous jobs are done by poor people, or at least by people who are definitely not rich).

There is no crime in being rich. There's even a certain virtue in it if you are a member of the International Forum for Transplant Ethics, in the sense that they are all surgeons so distinguished and senior -- Professor I. Kennedy of King's College London; Dr. N. Tilney of the Brigham and Women's Hospital, Boston; Professor R.D. Guttman of the Royal Victoria Hospital, Montreal; Prof. A.S. Door of Sultan Qaboos University, Oman, and sundry others -- that one cannot imagine them sharing the base motives of the less eminent surgeons who originally gave organ-vending such a bad name.

You may recall the Harley Street scandal of the 1980s, when surgeons in the London street that is practically the world capital of private medicine took to buying kidneys from poor Turks for US$4,500, and selling them to rich patients for ten times that amount. It came to light when one newly single- kidneyed Turk staggered out of a private Harley St. clinic carrying a compatriot, also missing a kidney, who could not even walk yet after his operation. (The clinic needed the beds for new customers).

When the doctors who were getting rich on this trade were hauled up before the General Medical Council, they blandly insisted that they had believed the donors (all Turks) were volunteer relatives of the wealthy recipients (Greeks, Israelis, Libyans, anybody but Turks). True, the donors all had to be paid, and they shared no common language with the recipients -- but then all foreigners are a bit odd, aren't they?

It was this disgusting trade that spurred the ban on selling human organs for money, which is now in force in almost all countries. There is still a thriving illegal organ trade, mostly from China (kidneys $20,000, livers $40,000, non-smoking lungs to the highest bidder), but they are "harvested" from executed criminals and illegally sold by local authorities.

These illegal organs do not begin to match the demand: 38,000 people are waiting for kidney transplants in the U.S alone. So the International Forum for Transplant Ethics wants to reopen the discussion. They have either forgotten how the world really is, or they never knew in the first place.

"Most people will recognize in themselves the feelings of outrage and disgust that led to an outright ban on kidney sales..," they observe. "Nevertheless, if we are to deny treatment to the suffering and dying, we need better reasons than our own feelings of disgust." (The "suffering and dying" in this discourse, needless to say, are those suffering from kidney failure who have enough money to pay for a spare kidney, not the far larger number of kidney failure victims who don't).

You search in vain for some sign that these people are masters of irony; that their real purpose is to discredit any remaining advocates of an open market in human organs by making their case all too plainly. But alas, no. They really mean it.

"The commonest objection to kidney selling is expressed on behalf of the vendors, the exploited poor, who need to be protected against the greedy rich," the surgeons concede. But, they point out, the vendors themselves are anxious to sell. (So are child prostitutes, but they don't go into that).

"Trying to end exploitation by prohibition," the doctors conclude, "is rather like ending slum dwelling by bulldozing slums: it ends the evil in that form, but only by making things worse for the victims. If we want to protect the exploited, we can do it only by removing the poverty that makes them vulnerable, or, failing that, by controlling the (legalized) trade (in human organs)."

Let us be charitable. Let us assume that every day these doctors see the distraught and dying sufferers of kidney disease who might be saved by a transplant, and can afford one, whereas 'the poor' are distant, faceless people they never meet.

Let us also assume that they have been too comfortable all their lives to understand what desperation can do to people, and that they are too naive to know how markets really work. They truly may not understand, for example, that legalizing the trade in organs would result in a sudden steep rise in the number of executions of 'criminals' in China.

Even then, they are hard to forgive. These are safe, prosperous people who dispense medical care to other safe, prosperous people, and they are clearly comfortable with the notion that non-prosperous people are not entitled to the same care.

"Another familiar objection (to kidney sales)," they conclude, "is that it is unfair for the rich to have privileges not available to the poor....If organ selling is wrong for this reason, so are all benefits available (only) to the rich, including all private medicine...."

I didn't say it. They did.