Categories
Organ Markets

The Latest on Iran’s Kidney Market

In short:

Iranian paid unrelated donors have lower quality of life and higher incidence of microalbuminuria compared with related [unpaid] donors.
  

From an editorial in the same journal issue:

…their identification of a difference in microalbuminuria postnephrectomy between paid and unpaid donors fuels
concerns that the clinical evaluation of donors may be compromised when donor payments are allowed. Although the absence of prenephrectomy information precludes definitive conclusions, the short time since donation suggests that abnormalities may have been present prior to nephrectomy and accordingly, that the donor clinical evaluation may not have been as thorough as necessary.

The most plausible alternative explanation for the findings is that the proteinuria was in some way related to the higher level of poverty in the paid donors.

  
So – either paid living kidney donors are receiving an adequate evaluation OR paid living kidney donors are overwhelmingly poor which causes great kidney-related health problems.

Note that each of these possible explanations fall neatly into the offered objections to implementing a paid kidney market.
  

From one of the article’s references, aka a study on whether Iran’s living kidney donors (100 in this case) were knowledgeable about complications and risk:

Seventy-nine donors were men and 21 women. Mean age was 27 ± 4.4 years. Ninety-seven donors were unrelated to the recipient and three were related (LRD). The motivation for donation was altruistic in nine (three LRD and six LURD) and financial in 89. Eighty donors were not aware of the possible short- or long-term complications of nephrectomy. Six donors mentioned the possibility of potential intraoperative complications, and 16 mentioned the risk of renal failure. Only 44 donors knew that they should visit doctors regularly after donation, most of them (61%) from the postoperative group.
  

And my favorite (from the op-ed again), the reminder that after nearly 60 years, we still don’t have any comprehensive reliable data on living donors’ health and well-being:

Sadly, the risk factors for and clinical significance of proteinuria in living kidney donors remain unclear. The existing literature on this subject is hampered by use of nonstandardized definitions, a paucity of controlled studies, and virtually no information regarding progression over time.
   

Abstract (full not available without subscription): http://onlinelibrary.wiley.com/doi/10.1111/ajt.12488/abstract
Full article: http://onlinelibrary.wiley.com/doi/10.1111/ajt.12486/full

Categories
Living Kidney Donor Organ Markets

Syrian Refugees Sell Kidneys to Survive

About one million Syrians have fled into Lebanon because of the civil war in their home country and now many don’t know how they can make a living. In their distress, they sell their organs. It’s a dangerous and, of course, illegal business. That’s why the gang has its operations performed in shady underground clinics.

Full Story: http://www.spiegel.de/international/world/organ-trade-thrives-among-desperate-syrian-refugees-in-lebanon-a-933228.html

Categories
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.

Categories
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)

 

Categories
Ethical Considerations Liver Donor Living Kidney Donor Organ Markets

More Proof That Organ Markets Are a Bad Idea

A Michigan State University researcher has found that selling a kidney or liver lobe is becoming more prevalent in Bangladesh, despite its illegality.

The sellers are poverty-stricken, and often in debt, particularly due to micro-loans from NGOs. Desperation leads the vulnerable members of the family unit (usually women) to sell their organs first, followed by other family members when A. the debt has not been fully paid, B. the organ donor/seller is physically compromised and can no longer work, and/or C. the broker reneges on the deal and never remits payment.

Think about it: if one engages in illegal activity and doesn’t get paid, who does one complain to?

 

Another disgusting layer is the fact that the brokers and recipients are often Bangladeshi-born foreign nationals living in places such as the United States, Europe and the Middle East. Because organ-selling is illegal, the brokers forge documents indicating the recipient and seller are related and claim the act is a family donation.

 

As Moniruzzaman says in the video (which is well worth watching and only four minutes), “The body parts of the poor are finding their way to the wealthy few.”

 

http://www.medicalnewstoday.com/releases/257465.php

 

Read LDAPT’s other posts on buying and selling kidneys, aka organ markets: click here