VIRGINIA BEACH, Va. — In the United States, there were more than 100,000 people on the waiting list for a kidney in 2010, and since 1999, more than 30,000 people have died while waiting for one. The World Health Organization (WHO) estimates that current organ transplantation covers only about 10 percent of the global need. In 2012, the WHO estimated that illegal kidney transplants have risen to 10,000 per year, or about one per hour.
In order to bridge the gap between the high waiting list for transplants and the low number of willing donors, organizations have taken it upon themselves to create a black market for kidneys.
A common misunderstanding about this illegal kidney market is that the kidneys are being harvested without the owner’s consent. Unfortunately, cases like this still exist, but the majority of donors choose to sell their kidneys to a third party company in order to organize the transaction. While this may seem like an economic fix to drive up supply, the system of organ sales ends up disproportionately exploiting the poor.
The trafficking organization matches a donor and recipient, and then sets up a location for the operation. This is usually done with the donor traveling to the country of the recipient, the recipient traveling to the country of the donor or both the donor and recipient meeting in a third country.
The average kidney donor is young, male, resides in a developing country and has an annual income around $480. The average recipient of a kidney through the market is a male in their 40s and from a developed country where they have an annual income of about $53,000.
While the recipient pays as much as $200,000, after the cost of the operation, the doctor’s cut and the organizations’ cut, the donor ends up receiving about $4,700 for their kidney. Due to the lack of regulations and standards, the donor and the recipient are both at high risk during the whole procedure and recovery.
The kidney donor — although they are selling their kidney as a desperate measure to profit from the money — end up doing the opposite. After losing an organ, the donor cannot work for a period of time and are often left with a lot of aftercare treatments and post surgery problems. In the long run, the donor loses money, time and quality of health from the transaction.
The recipient has no guarantee that the kidney transplant they are paying for is a perfect match, or completely healthy. They also will have to pay for post-operation care after the purchase of their new expensive organ, possibly driving them down an endless, economic black hole.
The elements that foster an illegal kidney market are a gap between the waiting list and donors and the level of poverty in a given region. These two elements together create an environment where organ sales are profitable for the organizations conducting them.
What if kidney sales were made legal? Currently, Iran is the only country in the world where this is the case. Rather than a long list of recipients unsatisfied by a short list of donors, Iran has the opposite: Competition among donors to sell their kidneys to willing buyers. In contrast to the long waiting list seen in other countries, Iran’s waiting list was eliminated in 1999.
Since the system is legal, kidney sales are regulated by the government. Two nonprofit organizations, the CASKP and the Charity Foundation for Special Diseases, facilitate the process by connecting vendors and recipients, and ensure the transaction is fair and safe. After the transplant, the donor is compensated by not only the recipient, but by the government as well.
People write down their blood type and phone number and post it near local hospitals in order to advertise their available organ. Since the competition is legal and out in the open, it gets fierce: People tear down each others ads, place their own information to the ads of others and even offer discounts in desperation.
While Iran’s system does eliminate the ever-growing waiting list, and is more carefully regulated than the illegal systems, it still does not entirely protect the health of the donors, and it still disproportionately affects the poor.
Sue Rabbit Roff, a senior research fellow at the University of Dundee, speaks out about wanting a market in the UK, saying it is time to “pilot paid provision of live kidney in the UK under strict rules of access and equity.”
In order to lower the waiting list while ensuring the safety of all involved, a few things need to be taken care of:
- A set of standards, either universal or by each country individually, that set regulations on organ markets. Locations and manners of transplantation, health screening of both participants ahead of time, and options for aftercare provided.
- Transparency between all those involved: Laws to ensure that each member of the transaction is fully aware of the time, effort, risks and money involved in the process so no one is taken advantage of.
- An economic agreement that doesn’t break the buyer, or slowly hurt the vendor. One way this can be accomplished is by having the seller’s aftercare paid for by the health insurance of the buyer or the seller.
Although the process of kidney sales outside of official kidney transplants is currently illegal in most countries, legalizing the market would be the best way of ensuring the health and safety of everyone involved.