By Valerie Schmalz
The concept of buying a kidney for transplant is foreign to most people, but a flourishing black market in organ donations that preys upon desperate people in poor countries came into public view last month when federal authorities broke up an alleged organ transplant brokering ring.
The ring would be the first known example of living transplanted organs for sale in the United States, according to the Organ Procurement and Transplantation Network, the official organ donation network that contracts with the federal government. Levy Izhak Rosenbaum of Brooklyn, N.Y., conspired to broker the sale of a human kidney for a transplant, according to a federal criminal complaint filed in district court in New Jersey. The purported cost was $160,000 to the recipient of the transplant, of which the donor got $10,000. According to the complaint, Rosenbaum said he had brokered such sales many times over the past 10 years.
The World Health Organization (WHO) estimates that 10 percent of organ transplants worldwide are organs that have been sold to the recipient. A new report on the organ trade is being prepared for presentation to the 2010 WHO Assembly.
Long waiting lists for kidneys and other organs have sparked a decade-long discussion about creating incentives for people to offer their organs for transplant in return for compensation, such as deposits into retirement accounts, money for children's tuition or, in the case of transplants from those who have died, burial costs.
American Enterprise Institute scholar Dr. Sally Satel called for officially bringing the marketplace into the transplant industry in a July 26 opinion piece in the Wall Street Journal titled "Kidney Brokers Flourish When Compensation to Potential Donors Is Illegal."
"The illicit organ trade is booming across the globe. It will only recede when the critical shortage of organs for transplants disappears. The best way to make that happen is to give legitimate incentives to people who might be willing to donate," wrote Satel, citing the 80,000 people waiting for kidney transplants.
"Most people who would want to do this -- I am sure that they will be on the low end of the income scale," Satel said in an interview with Our Sunday Visitor. She said safeguards should be built in that would discourage "desperate people" from selling organs for cash. "When we look at other body parts that are sold, blood, eggs, even whole cadavers, we don't see crying shortages of those. That's just Economics 101."
"It is so clear that altruism is not a sufficient basis on which to run a transplant system," said Satel, herself the recipient of a donated kidney. "Even though I am a big fan of altruism, I think we need to reward people who are willing to give up a kidney so someone else could live."
The 1984 National Organ Transplant Act prohibits any exchange of "valuable consideration" for transplantation and is binding on all transplant hospitals and organ procurement organizations, according to the U.S. Department of Health and Human Services.
Since 1987, the World Health Organization has monitored and attempted to stop commercial trafficking in human organs. The WHO Revised Guidelines Report to the Secretariat, to be presented to the General Assembly in 2010, says: "Experience from all over the world demonstrates that commercial trade in this area evolves from being a market in organs to being a market in people, where -- openly or under cover -- the poor and vulnerable are exploited."
The Transplantation Society and the International Society of Nephrology convened a 2008 summit of 152 participants from 78 countries that resulted in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism aimed at halting the international organ trade.
In an e-mail interview from Africa, Harvard Medical School Professor of Surgery and Transplantation Society Director of Medical Affairs Dr. Francis Delmonico said: "Come to Africa, and Manila and Karachi, and you will understand that what the United States does is consequential on this issue. ... If the United States accepts buying organs there will be markets aplenty around the world to which the distinction of black or blue or white means nothing -- they are markets with the same construct. The exploited person is the vendor for the rich."
Catholic Church teaching prohibits selling organs for transplant, said John Haas, president of the National Catholic Bioethics Center and a member of the Pontifical Academy for Life.
Haas cited Pope John Paul II's encyclical Evangelium Vitae ("The Gospel of Life"), which has a section on organ transplants, and the U.S. Conference of Catholic Bishops' Ethical and Religious Directives.
"The notion of selling your organs reflects a false anthropology," Haas said. "There is not such a thing of me over and against my body that can use my body and dispose of my body as I see fit."
Pope John Paul, in an Aug. 29, 2000, address to the International Congress on Transplants, lauded organ donations for transplant, but said they must always be subject to limits that respect the dignity of the human person.
"Increasingly, the technique of transplants has proven to be a valid means of attaining the primary goal of all medicine the service of human life. That is why in the encyclical letter Evangelium Vitae, I suggested that one way of nurturing a genuine culture of life 'is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope,'" the pontiff said.
But the pope said the donation of an organ is a gesture "which is a genuine act of love" and, "accordingly, any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an 'object' is to violate the dignity of the human person."
Wendy Wright, the president of Concerned Women for America, who donated a kidney to a 21-year-old Ethiopian man in her small church, said the concept of paying donors for organs goes against the entire concept of donation.
"I feel very strongly from a personal standpoint it will end up tainting gifts, and it will discourage altruistic people from donating," Wright told OSV, "and it will cross a very bright line that we do not sell human beings or parts of human beings."
While there are approximately 103,000 people in the United States currently in need of an organ transplant, less than 10,000 transplants were performed between January and April. According to data from the Organ Procurement and Transplantation Network website, more than 13,000 people needing an organ transplant will remain on the waiting list for more than five years. The totals below signify the organs needed for transplants and are based on figures according to July 24 data.
80,384
Kidney transplant
15,892
Liver transplant
1,505
Pancreas transplant
2,235
Kidney/Pancreas transplants
2,869
Heart transplant
1,986
Lung and/or Heart transplant
Valerie Schmalz is an OSV contributing editor.