Ethical Considerations Living Donor Research Organ Markets

How Victims of Organ Trafficking in Bangladesh Fare

My prior post addressed how the attitudes underlying kidney markets has infiltrated our own. Today, I want to discuss how the kidney sellers fared after relinquishing their kidney: (any bolding is mine)


After the surgery, the first thing the sellers notice is the rough cut about 20 inches long on their bodies. The sellers are unaware that if the buyers had paid only $200 more, the surgeons could have used laparoscopic surgery, which requires an incision as small as four inches. To minimize the cost, the sellers are also released from the hospital within five days after having this highly sophisticated operation. Sellers return to the broker’s unhygienic apartment with a permanent scar of this bioviolence.


Staying in India, especially after the operation, is so inconvenient that almost every seller travels back to Bangladesh within a few days, despite the doctor’s recommendation to stay a few weeks longer. While travelling by train in such early stages of recovery, some sellers experience bleeding from their wound. Malek, a 28-year-old seller, visited doctors in Calcutta for the bleeding but could not afford to stay for his treatment. When the sellers cross the border into Bangladesh, they reenter their old life with a new, damaged body, the end product of the bioviolence.


After returning home, sellers are under constant psychological pressure to explain their absence and to hide their scars.. If the scars are revealed, the sellers make up a story of an unfortunate accident that happened during their job in a distant city. However, some sellers are unable to hide their actions; they are stigmatized and are called “the kidney man.” A few sellers also decide not to get married, ever.

Above all, the sellers’ health profoundly deteriorate in the postvending phase. They experience numerous physical problems and went through severe psychological suffering. The sellers refer to themselves as “handicapped.” Yet, none of the sellers could afford the biannual postoperative health checkup, which costs only 1,500 Taka ($22).


Most sellers (27 out of 33 sellers) do not receive the full amount of money they had been promised…

Only two sellers, Abul (32) and Rahmat (28), benefited economically, opening a livestock farm and buying land with the payment. The others have not escaped poverty and are actually living in worse conditions than they were before their operations…

Of Bangladeshi sellers, 78 percent reported that their economic condition deteriorated in most cases after the surgery; many sellers lost their jobs and were still unemployed, while others were able to work fewer hours because they had only one kidney.


Every year, most sellers vividly remember their operation day—“the death day,” as one of them called it. Every day, all sellers live with the fear of dying sooner because they have only one kidney


Some sellers therefore felt strange when their recipient died. Those sellers could not comprehend how one of their body parts could have died when they themselves were still alive.


The sellers I interviewed tended to withdraw from their family, friends, and society. They suffered from grave sadness, distress, hopelessness, and crying spells. In their frustration, some sellers therefore became
addicted to drugs.


Thirty-three Bangladeshi sellers typically experience pain, weakness, weight loss, and frequent illness after selling their kidneys


A quick review of studies from other countries with legal, quasi-legal or illegal kidney markets will tell the same tale. Commodifying kidneys benefits recipients, and physicians but is highly detrimental to the person relinquishing the organ.


Moniruzzaman M (2012). “Living cadavers” in Bangladesh: bioviolence in the human organ bazaar. Medical anthropology quarterly, 26 (1), 69-91 PMID: 22574392

Ethical Considerations Living Donor Research Organ Markets

Biolviolence and Organ Donation

I’d never heard the term “bioviolence” until today, when I began reading an article by Monir Moniruzzaman entitled “Living Cadavers in Bangladesh”. While the article is an examination of organ trafficking in Bangladesh, its themes extend into issues regarding all forms of human organ and tissue use – and commercialization.

This paragraph in particular:


In essence, bioviolence is an act of inflicting harm and intentional manipulation to exploit certain bodies as a means to an end. This term not only refers to the act itself (i.e., extracting organs from the physical body) but also to the processes involved (i.e., deception and manipulation for organ procurement) in the exploitation of bodies, mostly of impoverished populations


In addition to organ donation, the author cites assisted reproductive technology (surrogacy), Henrietta Lacks’ HeLa cells, and clinical drug trials as other forms of bioviolence – the people used or taken from are usually impoverished or otherwise disadvantaged while whose those who benefit from the results are affluent and/or privileged.

But back to organ donation:


Margaret Lock (2000) addresses the symbolic violence, particularly in cadaveric organ procurement, elaborating how the transplant industry creates an insatiable demand for organs, which will, as she argues, always remain greater than the supply because the medical eligibility to receive an organ grows even more acute (see also Illich 1976; Koch 2002; Scheper-Hughes 2003a; Sharp 2006). At the same time, the industry studiously ignores the source of harvested organs almost all the time. Lock therefore underscores that this artificially created organ scarcity and the procuring of organs from every source generate unavoidable violence, which flourishes in every aspect of the transplant enterprise, but has been largely masked by powerful rhetoric associated with “the gift of life.” According to Lock, this constitutes symbolic violence, as it folds seamlessly into the institutional setting, appears as a natural phenomenon for daily life, and becomes normalized through the rhetoric of scientific progress (Lock 2000:291).


I admit, a lot of this is discomforting. No one wants to believe that people are being harmed for their organs (deceased or living) or that transplant professionals are motivated by anything other than concern for their sick patients (the would-be recipients). But the horror stories of “dead” people regaining consciousness are more than urban legends, and the discourse regarding “cardiac” death and “brain” death are real. As science progresses, so do the ethical lines thin and stretch. And break.

I read articles about organ trafficking (and discuss them) not because I need confirmation that organ trafficking is abhorrent, but because of how the themes mirror themselves in our Western systems of donation.


The interviewed sellers have very limited knowledge about organs in the human body.


How much information are potential (western) living kidney donors given about the functions and role of their kidneys? At least in the U.S. no education is required prior to donation. Nothing about how the kidneys help regulate water, potassium, sodium etc in the body, or produce vitamin D, which assists in bone growth and health. Without providing information, or giving a potential living kidney donor a quiz, how can a transplant center be sure someone is making an educated decision to donate?


Most sellers also revealed that brokers encourage them to participate in the trade by repeatedly telling a story about the sleeping kidney. The story goes like this: A person has two kidneys: one works and the other one sleeps. If one kidney is infected, the other kidney automatically starts working. But if one kidney is damaged, the other one will be damaged, too, because of the polluted blood. Therefore, everyone can be healthy with only one kidney. During the operation, the doctor first starts a donor’s sleeping kidney with medicine. The “newly awakened” kidney stays in the donor’s body and the “old” kidney is removed and given to the transplant recipient. In this manner, selling a kidney is presented as a win–win situation.


While we don’t have this level of fabrication happening in the US, how many times have you the word “spare” used in connection with living donation?

“Donate your spare!”

“I donated my spare!”

“Got a spare?”

“Save a life with your spare!”


After further negotiations, the buyers finally agree to pay 100,000 Taka ($1,400)

Many sellers are not pleased; the buyers promise to offer them a job, arrange a visa and citizenship they will need for going abroad, or allocate land. All sellers are fearful; the buyers guarantee that the operation is 100 percent safe, saying that the sellers will be in the hands of world-renowned specialists.


Compared to:

“…The complication rates are low”

“Living donors go through the donation experience without experiencing any decrease in lifespan and they do not have a higher rate of kidney failure.”

“Kidney donor surgery is a very safe operation”

“Years of research and follow up studies with live kidney donors confirm that donating a kidney does not have an adverse effect on future health in any way”


The kidney sellers reported:

…the recipients attempt to convince them by portraying “kidney donation” as a “noble act” that saves lives…


In the U.S. and West:


Gift of Life.


I shouldn’t have to say the following, but years of dealing of with internet commentors has proven that it’s better to soothe the rabble before it gets riled up:

I am not saying the Western models of living kidney donation (aka altruistic) are, in any way, as indefensible as what’s occurring in Pakistan, India, Bangladesh and other countries. However, in order for our claims as beacons of ethical pureness to be taken seriously, we have to examine how the attitudes that permit the atrocities occurring in those countries are at work in ours. Historically, we have not cared for our living donors in any meaningful way, and we continue to hedge our responsibilities to do so. Just because the kidney sellers in Bangladesh (or otherwise) are harmed more than those in the U.S. does not mean our obligation to our living donors is, in any way, moot. It simply means we’re not as enlightened as we’d like to believe.


Moniruzzaman M (2012). “Living cadavers” in Bangladesh: bioviolence in the human organ bazaar. Medical anthropology quarterly, 26 (1), 69-91 PMID: 22574392

Organ Markets

Take 10 Minutes to Listen To This

Art Caplan and Nancy Schepler-Hughes talk about organ trafficking.


Also – read how Nancy tried to tell every law enforcement and public policy agency about Rosenbaum’s kidney trafficking ring, and no one would listen here.

Ethical Considerations Organ Markets

Paying for Kidneys – One More Time (for the last time)

Once again, the idea of paying folks for kidneys is making the rounds of media outlets, so once again I’ll voice my well-researched and considered thoughts on the matter – probably for the last time. Any further discussion of this topic will result in a link to this very post, because I am SO TIRED of talking about this.


1. Every study from every country (without exception) with legal, illegal or quasi legal kidney markets has shown the paradigm to be beneficial for recipients, doctors, hospitals and governments but highly detrimental to the kidney donor/vendor/seller.

  • deceased physical health
  • increased psychosocial difficulties
  • greater financial struggles
  • lower quality of life.

The U.S. transplant industry and/or government has not adequately regulated or protected living kidney donors in the near 60 years since the first one occurred. They’ve implemented no national standards of care, collected no data, given inadequate informed consent, and provided no psychological aftercare. Creating a market will not improve this situation. Quite the opposite.


2. Kidney transplants are NOT cures, but treatments for kidney disease. The vast majority of recipients will need multiple transplants to achieve a normal lifespan. Exactly how many two-kidneyed people should be harmed to treat one recipient?


3. Focusing solely on the supply side will NEVER produce an adequate solution. According the USRDS, 44% of kidney failure is caused by diabetes; another 26% by hypertension. The ONLY REAL SOLUTION to the so-called organ shortage is to implement robust prevention, diagnosis and treatment programs for both disorders.


As I write this, OPTN claims that 98,271 folks are waiting for a kidney.

Approximately 1/3 are ‘inactive’ at any given time, leaving us with 64,859.

44% with diabetes = 28,538

26% with hypertension = 16,863

Even if prevention/treatment could prevent half from progressing to ESRD or kidney failure, that’s 22,701 less people right now that would be waiting for a kidney.

And if approximately 15% of the wait list at any given time have undergone at least one prior transplant – that’s at least 3405 more kidneys, a number that would grow over time (think of the whole “she’ll tell two friends, and they’ll tell two friends” commercial from eons ago).


4. And finally, donating a kidney is not like giving up a pint of blood. It’s a procedure rife with both short and long-term risks. Is $10,000 (the number tossed around in this newest argument) worth someone’s life, or long-term disability? Is it worth shaving who knows how many years off one’s life expectancy?

And if it’s not, how much money is worth all those risks? How do we quantify a human life?

After we decide that, where does this payment originate? The recipient? The recipient’s insurance? The government?

Such a scheme, no matter the answer to the prior query, necessitates a belief that some people’s health and lives are worth more than others.


The argument ‘for’ kidney markets is always one-sided and short-sighted. The reasons for opposing them are not. Sure, there’s a strong moral component (an ick factor), but for me, the objection is pragmatic – such a thing simply will not work, short or long-term. To think otherwise is to willfully ignore not only pre-existing evidence, but our infrastructure and human limitations.




For other posts on this topic, click on ‘organ markets’ in the categories drop-down in the right-hand column.

Living Kidney Donor Organ Markets

How Legal and Illegal Kidney Trafficking Hurts Everyone

I ran across this scholarly paper the other day, compliments of my google scholar alert. I encourage everyone to read it in its entirety. Below are some excerpts:

The World Health Organization estimates that there is a kidney sold every hour illegally.


After the introduction of cyclosporine (anti-rejection medication) in the mid-70s and global distribution in the 1980s: the kidney took on new meanings; in a living donor, the kidney was now envisaged as a surplus object, an object that could serve wider uses for others…

In this clinical landscape, “the medicalized body” abstracts a person from their parts and made the distancing of the material body from the ‘self’ quotidian.


These new understandings of the body, especially the rhetoric of surplus of one’s other kidney, were quickly normalized and mobilized within medical and patient communities. With transplantation, the living donor’s other kidney was no longer seen as useful to them, but rather of better use elsewhere — in the body of a critically ill patient.


Kalindi Vora argues that the expendability of populations and persons is directly linked to their labour use-value; those who fail to be significant economic actors in the dominant society are not as useful as those who are.
Kidney traffic hinges on division of both the body and of the space in which the body is fragmented. No longer
a ‘gift’, the commercialized kidney renders social relationships through exchange irrelevant. With the division of space which renders donors anonymous, there can be mindful distance of the recipient taking one’s kidney for their own use; this mindful distance is bolstered by the act of monetary compensation to the seller as well as keeps the broker relevant.

Anne Griffin recently detailed the dubious parameters in the criteria used to define the [Iranian] waiting list as ‘eliminated’ in Ghods’s study. Griffin described that poor patients, who largely have to wait for cadaveric donation, since they cannot afford to compensate LRD or LUD’s, were still waiting on kidney transplants; the wait was only over for those with fiscal means. 

(emphasis mine)


Especially in the wake of publications from medical and ethnographic studies of kidney vendors in India, Bangladesh, Iran, and Moldova, variations of the same story were told: selling a kidney never made any significant impact on donor’s economic lives, despite what many economists, bioethicists, and medical professionals claim. What vendors did experience were lost wages, from the post-operative pain and sickness many vendors felt, feelings of deep regret, and societal expulsion in some grave cases. Thus, to promote the dismemberment of the economic underclass as a means of being economically ‘visible’ is both ethically and morally irresponsible. Moreover, rarely mentioned in literature advocating legalized markets (regulated and unregulated) are the risks of nephrectomy to donors or strategies focused on prevention of renal disease.


As Donald Joralemon and Phil Cox aptly state, “if society has a moral duty to rescue, the obligation surely is not limited to rescuing those of means.”

(emphasis mine)