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More Evidence Against Compensating Living Donors

Since the entire transplant system was centered around the needs of the recipient, it shouldn’t be surprising that paying people for their kidneys is an idea that just won’t go away. However, it’s an idea that has been tried – and failed – in numerous other countries, as the literature repeatedly reveals.

From The Hastings Center Report # 39, comes the following on kidney vendors (sellers/donors) in Pakistan:

– Of thirty-two vendors, 3 attended school until grade four, the rest were illiterate.

– All except two had sold a kidney to pay off debts owed to zamindars (feudal land owner); a majority was either still in debt or hadvvaccumulated new debts.

– None reported receiving the total amount they had been promised, and almost all had to pay Rs. 10,000 to Rs. 20,000 to the middleman.

– None of the vendors questioned directly, except one, would recommend selling a kidney to anyone else, including those who had managed to pay off their debts.

– three had elevated blood pressure readings or blood or protein in their urine—significant findings in anyone with one kidney.

– 20 were assessed with the SRQ for anxiety & depression; 10 expressed symptoms & scores high enough to warrant a mental health referral.

– 2/10 were suicidal. 1 attempted suicide with pills.

– All vendors, including those with a nephrectomy done over three years ago, complained of symptoms related to their surgical incision (pain, spasms, pricking), even though an examination revealed well-healed surgical scars.

– Many also complained of tiredness, generalized kamzori (weakness), chukkar (dizziness), and shortness of breath while working. All expressed an inability to work as hard as before, a perception confirmed by family members with whom we spoke.

– Many vendors described pain, numbness, or a burning sensation in the left arm and shoulder or the left side of the abdomen. Some also had leftsided headaches. With these symptoms came a sense of emptiness. This curious sense of feeling “half,” being “empty,” somehow having been transformed into an “incomplete” person, was among the most common statements we heard.

– Some vendors offered unsolicited opinions about the hospitals and physicians involved in transplantations. One man bitterly described the hospital as sub karobar hay (it is all a business) and said he would never return. He characterized those connected to the hospital as kasaee (butchers) and said he hated the place because sub jhootay hein (they are all liars).

– A sense of being victimized and deceived by the medical profession was expressed in general terms, and none knew the name of the surgeon or other physicians in the hospital. (All, however, were familiar with the names of middlemen.) Hospitals and staff were described variously as sub choree da kaam ay (in a business of theft), sub daqa shahi ain (all are the kings of thieves), dhokay baz (those who deceive others) and destroy lives like phansee ka phanda (a noose for hanging people).

– Our empirical data suggests selling a kidney carries negative social, psychological, and emotional ramifications that extend far beyond the vendor to the immediate and extended family and also to the community. In this light, the arguments for organ markets as merely a transaction between two freestanding biological entities exercising their autonomy, seemingly in a vacuum, can be reductive and misleading.

– In the words of the vendors, they sell a kidney because of majboori—a word meaning lack of options, a situation over which one has no control—in order to fulfill what they see as obligations toward immediate and extended families in which they are inextricably embedded, and within systems of social and economic inequalities they can neither control nor escape.

All studies to date clearly indicate that it is the most disadvantaged and the most vulnerable in any society who resort to selling a kidney, and that they do so only when they are left with no other alternatives to feed their families, pay off debts, or get health care. When we consider whether to legalize some form of kidney commerce, then, we should not overlook the fact that it is always the poor and the disadvantaged who end up exercising a “right” or “freedom” to sell their kidneys.

Farhat Moazam, ., Riffat Moazam Zaman, ., & Aamir M. Jafarey, . (2009). Conversations with Kidney Vendors in Pakistan: An Ethnographic Study Hastings Center Report, 39 (3), 29-44 DOI: 10.1353/hcr.0.0136

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