BOOK REVIEW: THE MARKET FOR HUMAN ORGANS
Amal Joseph
Book: The Red Market by Scott Carney; Hachette Book Publishing India, 2011; pp xvi + 254, Rs 550.
Scott Carney chooses an unusual trade to write about – that of human body parts. From a single cell the human egg to a fully grown child, everything is up for sale in the global red market and Carney documents each one of them in great detail. The usual laws of trade apply to human organs too, except that the seller is always poor and the buyer is always rich and both of them are desperate for different reasons and the middleman slices off a huge amount of money while the soft bureaucracy and the law enforcers look the other way.
Carney is right: “the flesh[moves] upwards – never downwards… unrestricted free markets act like vampires, sapping the health and strength from ghettos of poor donors and funneling their parts to the
wealthy (p 6).”
That India was and continues to be one of the major centres of illegal trade in organs and tissues should surprise no one; the right combination of a highly developed tertiary care medical infrastructure, an affluent and growing middle and upper class that feed them, grinding poverty that forces people to sell whatever they have in order to sustain themselves somehow, lax laws and a complicated legal system all together make it possible.
Carney realized the enormity of this trade when one of his students died in Varanasi and the body had to be sent back to Louisiana, US. That is when he was exposed to the entire machinery that deals with death – the police, forensic specialists, morticians, airlines, etc. This, he says, “was the beginning of my own understanding of the international market for human bodies”. And this led him to various parts of India, Cyprus, and the United States to document the trade in tissues.
The Gravediggers
Until 1985 when the Indian government banned the export of human organs, grave digging was a flourishing industry. It was so extensive that “just about every classroom skeleton in America must have come from India” (p xii). The Chicago Tribune reported in 1985 that in one previous year alone
India exported 60,000 skulls and skeletons. That means that about 60,000 graves were robbed. The Los Angeles Times reported that at their height, Kolkata´s bone factories took in an estimated $1 million a year (p 50).
All this in Communist Party of India (Marxist) – CPI(M) ruled West Bengal! The modus operandi seems very simple: “Rob the graves, separate soft tissue from the unyielding calcium and deliver the bones to the distributors, who assemble them and ship them to dealers around the globe” (p 41).
The finer details are nauseating: “First the corpses are wrapped in netting and anchored in the river, where bacteria and fish reduce them to loose piles of bones and mush in a week or so. The crew then scrubs the bones and boils them in a cauldron of water and caustic soda to dissolve remaining flesh. That leaves the Calcium surfaces with a yellow tint. To bring them up to medical white, the bones are left in sunlight for a week before being soaked in hydrochloric acid (p 43).”
While the good quality bones end up as skeletons in medical schools abroad, the poor quality bones have their market too. The long bones are carved into flutes and the skulls are cut into prayer bowls and sold to Tibetan Buddhists in Bhutan who need these to contemplate and “understand mortality” (p xv).
The 1985 ban however has not stopped this trade all together. Carney feels that “the bone factories of Calcutta are back in business” (p 58).
While West Bengal was busy trading in dead bones, Chennai was busy selling live kidneys. The Tsunami Nagar was a temporary settlement of about 25,000 people, mostly fisher folk displaced from their homes near the sea coast due to the tsunami of 2004. Poverty forced many of the women there to sell their kidneys and this place came to be known as the “kidneywakkam”.
Carney estimates that in one year alone at least, 2,000 illegal transplants took place in Tamil Nadu despite the Human Organs Transplantation Act of 1994 being well in place. Even after the scandal
was exposed by the media, none of the doctors involved were ever punished. The government closed “two of the smallest and most ill-equipped nursing homes that were tangentially linked to illegal transplants” (p 65).
Scandals emerged from several other states as well. More than 600 transplants were conducted in a decade in Gurgaon. Many of the unwilling donors were drugged and their kidneys forcibly removed for the recipients in the US, UK, Greece, etc. There were serious allegations of prisoners being executed for their vital organs in Kosovo and China and the Israeli military is known to have harvested corneas of Palestinians killed in combat.
Children were kidnapped from Tamil Nadu and sold to foreigners for adoption. One agency in Chennai had “arranged” for at least 165 international adoptions in 12 years, earning nearly $2,50,000 in “fees” (p 94). “It costs about $14,000 to bring a child to US from India, not including the standard $3,500 fee to the orphanage” writes Carney (p 96).
The global trade in children is alarming. A French agency was involved in the stealing of 103 children from Chad. “In China’s Hunan province half a dozen orphanages were found to have purchased nearly a thousand children between 2002 and 2005” (p 96). The Hague Convention on Inter-country
Adoption, according to Carney, does not cap the adoption fees paid by rich countries and this is seen as the biggest flaw which allows children to be smuggled out of third world countries and probably auctioned to the highest bidder.
Tales of Horror
“Blood Money” is a tale of horror. A thug in Gorakhpur (“a city built on a foundation of shortages”), the encephalitis capital of India, lures innocent poor people, holds them in captivity, bleeds them repeatedly and so often that they become so weak that they cannot even think of escaping. He does all this in a cattle shed with little attention to sterility. When the police raided this leeching shed, 17 people were found there in such a severe state of shock and anemia that they had to spend about a month in hospital just to regain some strength. The blood that was forcibly taken from them was sold to the patients in Gorakhpur hospitals who needed it urgently (for a hefty price of course). Variations of the Gorakhpur horror is a possibility in many Indian towns where voluntary blood donation is still a taboo but requirement of blood remains high.
And then there are the young women who sell their eggs for a price. “Unlike giving blood, donating an egg is a long and painful procedure that takes a minimum of two weeks of hormone stimulation and then surgical removal” (p 115). Cyprus (followed by Spain) emerges as the egg bazaar of the world where the “fertility business blends the shady netherworld of gray market financial transactions with commercialization of human tissue” (p 117). Poor immigrants from Eastern Europe and Spanish-speaking Argentinians, Chileans and Brazilians are the usual clients who are preferred for their white skin. While these women may get around $500 for a donation, an American can get an “upward of $50,000 if she´s an Ivy League grad with athletic build” (p 114). Again, “A one hundred per cent increase in SAT score correlates with $2,350 increase in egg price” (p 114). Two points to note: the human egg, unlike blood or even sperm, is a non-replenishable tissue. The number of eggs that a woman can produce in her lifetime is finite and is determined at birth. Second, removal of eggs
is an invasive procedure and not one but many eggs are removed at a time to ensure a good outcome. In one case an Israeli doctor took 181 eggs from a single unknowing donor, broke them into batches and sold them to 34 paying patients seeking babies (p 127).
At times things can really become bizarre. Lavi Aron and Omer Shatzky are two gay men from Tel Aviv who got married in Toronto in 2008. Wanting to have a child, they found a Caucasian egg donor from Mexico City. A surrogate mother was flown from the US to Mexico along with the sperm of the gay couple. The Mexican´s eggs were mated with the Israeli sperm – one sperm with each “parent” fertilizing one egg and two fertilized eggs were implanted in the American woman. The twins were born in California in 2010 and flown to Israel where they were legally adopted. All for $1,20,000!
The future of trade in human eggs was described by an investor thus: “Surrogates in Asia would carry eggs of super donors in America-models with high SAT scores and prestigious degrees who would be paid $100,000 for their eggs. Those babies could sell for $1 million each – first to my investor friends, then to the rest of the world (p 133).”
From eggs to surrogate motherhood is only a step away and Carney takes us to an infertility clinic in Anand which “fertilises the egg from donors, implants and incubates embryos in the womb of a surrogate mother, and finally delivers contract babies at a rate of nearly one a week” (p 135). Upon successful delivery – mostly by Caesarean section – the surrogate mother is paid about $5,000 to $6,000 for renting her uterus. The surrogate mothers are almost always very poor women. India legalized this uterine renting in 2002. The result is that one can find such clinics in almost every major city in the country.
Trade in biological tissues has an interesting history. Blood transfusion became a possibility around the time of second world war and thousands of Americans and British donated blood to show their solidarity with the army. The availability of blood resulted in the development of more complicated surgeries. When the supply of voluntary blood dried up after the war, hospitals began to buy it from the market. Blood from prisoners was thus sold in the market. Blood from the inmates of the Arkansas Department of Corrections – mostly unscreened – went across to many countries as did the infections from such untested sources. In Canada alone about 1,000 people contracted HIV and 2,00,000 got Hepatitis C (p 170).
Richard Titmuss was the first one to show the dangers of trade in blood. In the Gift of Relationship he showed that buying blood increases the incidence of Hepatitis and argued that the safest system is the one based on altruism. Today, trade in blood is banned in several countries and the Gorakhpurs are seen more as aberrations. Not so with other human tissues. As organs become scarce and technology becomes more advanced, justifications for trade in organs are re-emerging. The Iran model of state-approved organ sales is being talked about and the “Red Market” flourishes.
State-Sponsored Organ Trade
Attempts to apply Titmuss´ arguments about altruism and non-commercialism to non-replenishable organs and tissues fail because no society operates in the ethereal world of altruism alone. What holds good for blood donation does not hold good for other tissues like the human egg or kidney because not only does it entail a permanent loss to the donor, it also involves invasive procedure on the donor with its own morbidity and sometimes mortality. Therefore while altruistic donations can be justified in life-saving situations, a civilized society must question its own moral premises in allowing designer babies for a fancy sum. Indian women should not be treated as rental incubators, especially when legal adoption is a morally and ethically acceptable alternative available. Sadly, The Assisted Reproductive Technologies (Regulation) Bill 2010 seeks to legitimize rather than ban surrogacy. If the uterus can be rented, then the sale of other human body parts can only be a step away. Renting and sale both arise from the same premises – that biological tissues and processes can be commercialized. Today it is legal to sell ova, a non-replenishable tissue. Tomorrow it could be blood or even organs, more so organs of brain-dead persons.
In countries like India, altruism is another name for state-sponsored trade in organs and tissues. Total transparency, according to Carney, may limit if not abolish the red market and this reviewer tends to agree with him. There is a strong case for making the conduct of various licensing bodies like the authorization committees (which allow “emotionally related” organ donations) transparent and the hearings public. This will help reduce the red market.
Some chapters, like trade in human hair or stem cell therapy, really do not “belong” here, but that is a minor issue.
(Economic & Political Weekly, January 7, 2012)
Top - Home