ROTTERDAM World markets match buyers and
sellers for goods as different as oil and wheat or cars and
computers. Why not for human organs like kidneys?
Strong demand for life-saving transplants and short supply
of organs has raised ethical issues about whether humans should
be treated like vessels to provide spare parts.
With a potentially vast supply of organs from often poor
donors in developing countries for mostly rich recipients in
the West, calls for "kidney for sale" schemes are getting
The traditional ethical view that buying and selling organs
is shameful -- upheld by legal bans on sales in Europe and
North America -- is now under pressure due to a dramatic
shortage of one of the most frequently transplanted organs, the
In the United States and Europe, most tissue for transplant
is taken fresh from cadavers of the newly deceased. A smaller
amount comes from live donors, mostly from a relative or
"It is morally wrong to continue to let patients suffer and
die on dialysis when we can do something to prevent it," Arthur
Matas, a University of Minnesota transplant surgeon, told a
conference in Rotterdam on European transplantation policy.
Those who defend these bans "are sentencing some of our
transplantation candidates to death," he argued in a plea for a
regulated market in organs to help meet the growing demand.
Matas was clearly in a minority amid speakers who warned a
market system would discourage so-called "altruistic
But defending the moral high ground is hard, because ever
longer transplant waiting lists have fuelled a growing black
market. The poor sell kidneys to the rich in what Netherlands
Health Council adviser Michael Bos called "medical apartheid."
In a paper for the conference, Dr. Javaad Zargooshi called
a commercial kidney system run in his native Iran since 1988 a
failure. It had taken over 90 percent of the market,
undermining voluntary donations, but donors had no
Gabriel Danovitch, a University of California at Los
Angeles (UCLA) transplant surgeon, noted Hong Kong got half its
kidneys for transplant from altruistic donors before it
returned to Chinese rule in 1997.
"When Hong Kong could buy kidneys in China, live donations
fell to 15 percent," he said. "In Israel, live donations fell
by 30 percent when insurance companies said they would pay for
'transplant tourism' abroad.
In "transplant tourism," rich patients pay tens of
thousands of dollars to receive kidneys in poor countries,
where payments for donors ranges from around $500 in Iraq,
$1,000 in India and $5,000 in Turkey, according to reports
about the black market.
The problem is growing rapidly because medical progress has
made kidney transplants safer just as rising levels of diabetes
and hypertension are causing ever more kidney failures.
When the United States banned kidney sales in 1984, about
8,500 patients were on a transplant waiting list of about a
year. Now they are estimated at 70,000 and the waiting time is
five years or more, Mates said.
Waiting patients are hooked up several times a week to
dialysis machines that purify the blood their failing kidneys
can no longer clean. Their health deteriorates gradually,
making a transplant a better and cheaper alternative.
Matas proposed a regulated system of kidney sales from live
donors, with a state agency or private insurance company paying
a fixed price to sellers. The state would ensure fair
distribution of kidneys and long-term health cover for donors.
He rejected arguments this put a price on body parts,
saying courts already pay damage claims for loss of limbs.
"Prohibiting the poor from selling a kidney still leaves them
poor and removes one possible option to improve their lives,"
China, long the most active kidney seller, has been accused
for years of extracting organs from executed prisoners. Beijing
has denied this and officially banned organ sales last year.
Swiss parliamentarian Ruth-Gaby Vermot-Mangold said nobody
had a right to replacement organs: "If we in the rich West need
organs, we will have to launch campaigns on our own ground to
persuade people to act responsibly and donate their organs."