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