The ethics of buying and selling kidneys

In Manila, part of a shanty town is called a “kidney field” for the poor people who have sold theirs.

In India, a doctor was arrested this week for his role in a ring that kidnapped poor laborers who woke up the next day with one less kidney.

In China, prisoner executions were timed to match foreigners’ blood type and arrival for transplant.

This last example drew gasps from some of the 150 people attending “The Ethics of the Organ Bazaar” at the Harvard School of Public Health Friday. They were asked to weigh their horror against a waiting list for kidneys that has 73,000 names on it, a number that has grown 7 percent a year for the last 10 years. And repugnance for buying and selling organs was considered in the context of other taboos, such as drinking leading up to Prohibition or eating horsemeat, forbidden by current California law.

“We have here the elements of tragedy,” said Daniel Wikler, professor of ethics and population health at HSPH, who convened the conference. “Each time a patient with end-stage renal disease is told it will be a long time before they get an organ, life may hang in the balance. We need very convincing moral reasons before we get in the way of life-saving solutions.”

Those solutions come at too high a price when profit enters the picture, Dr. Luc Noel of the World Health Organization said. The people who sell their organs are almost universally poor and vulnerable, he said, coming from such countries as Pakistan, the Philippines, Colombia, India, and Brazil.

A survey in Pakistan found that 69 percent of donors were bonded laborers, similar to indentured servants. After payment for their kidneys, 88 percent were no better off a year later and 98 percent reported that their health deteriorated.

China has agreed to stop selling organs from prisoners, but before it did, the number of organs from deceased donors dropped. The same falloff also happened in Iran, where organs are sold under government regulation.

WHO and other organization members are traveling around the world to urge countries to put in place laws to protect its most vulnerable people from exploitation.

Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital, said it comes down to social injustice.

“Country by country it ends up being the poorest persons,” he said. “We’re not ready for this in Texas.”