The Red Market (9 page)

Since doctors and medical staff control how many people get admitted to the organ transplant list, they are able to inflate the overall eligibility for organ transplants and set a standard rate of available organs against the total supply. Oil cartels employ the same tactics. Over the years the number of available organs from donors has expanded greatly in America, and yet the ratio between donors and listees has remained more or less the same.

The transplant list—or more specifically the organ-harvesting network—creates an impression of scarcity that supports big-money medical centers. Patients with organ failure are told that their only hope is to get a replacement organ. The truth is more likely that patients will regain only a shadow of their lost health with the transplant. This is not to say that a more ethical organ system would rely on paid living donors. Instead, doctors and patients should think more realistically about mortality.

In America, however, it is taboo to suggest US transplant centers are in the business of buying and selling organs. They’re here to save lives. Doctors are supposed to be above the humdrum world of commerce. And yet hospitals with transplant centers have a lot to gain financially. A transplant center is a sort of badge of quality that drums up business for all of a hospital’s departments. Indeed, it is common for hospitals to advertise their transplant centers on highway billboards—not because many drivers are likely to need fresh organs, but to give the impression of overall excellence in all fields.

The National Organ Transplant Act outlaws buying and selling human tissue, but says nothing about the corollary services that surround organ transplants. Transplant surgeons and activists are quick to note that their centers do not actually sell organs, only transplant services. Those services can be pricey. In 2008 actuaries at Milliman calculated the total costs of different organ transplants in real terms. Including the total costs of procurement ($67,500 paid to the hospital to harvest a kidney), pre- and postoperative care, immunosuppressants, and hospital administration, a kidney transplant costs $259,000. Livers go for $523,400; pancreases, for $275,000; and intestines for a whopping $1.2 million. People don’t go to a transplant center to buy medical services: They go to buy organs. In many cases only the wealthy or superinsured (and in some cases government-insured) can even consider the option. And an accounting trick does not change the facts.

The tremendous cost of not officially buying an organ coupled with an exceptionally long waiting list drives people abroad to centers that offer speedy and cheap services. The lower costs mean that people priced out of the American market for organs can find an affordable transplant solution abroad. And they don’t even have to sacrifice quality. One of the places they go to is Aadil Hospital in Lahore, Pakistan, which advertises that the International Organization for Standardization rates it on a par with any hospital in the West.

These days, Aadil openly advertises two packages for transplant patients: $14,000 for the first transplant, $16,000 for people who need a second organ after the first has failed. “You do not have to worry about the donor. We shall provide a live donor arranged through a humanitarian organization, which has hundreds,” said Abdul Waheed Sheikh, CEO of Aadil Hospital in an e-mail.

In India, Brazil, Pakistan, and China, hospitals advertise their surplus of willing donors to high-paying patients. The disparity in price between the first and third worlds is an opportunity for international brokers to extract obscene profits from patients who don’t know how to book transplants on their own.

The price of a kidney transplant at one of the best hospitals in the Philippines, where organ sales are more or less legal, was just $6,316, according to a 2005 report by the Philippine Information Agency. The organ brokers who arrange transplants charge whatever they can and pocket the difference for themselves.

The incoming patient perceives the apparent supply shortage, but because of the power of international exchange they still get an organ for less than half the inflated US price. At the same time, legal confusion, fear, and an information gap have created a classic arbitrage scenario for connected vendors. The vast profits available to the middlemen have dented reform efforts.

Falling prices hit the lowest end of the chain hardest. As we have seen in Indian tsunami refugee camps, sellers work through organ brokers, who, assuming they pay at all, on average pay only a few thousand dollars for a healthy kidney. And that’s despite booming demand. The World Health Organization in 2002 pegged the global number of people suffering from diabetes—a leading cause of kidney failure—at 171 million. By 2030 the number will have climbed to more than 366 million.

“Each country and each region therein has completely different situations than the next one,” explains a Los Angeles–based organ finder doing business online at the website liver4you.org. He asks to be identified only as Mitch. “Since most overseas transplants are doctor-controlled, like [from] private medical practice in the United States, there is a wide range in prices. . . . The donors are in such huge supply where it’s legal, like the Philippines, so they have to accept the average of $3,000 [for selling their kidneys].”

Savings are rarely passed on to the buyer. Their value inflates quickly once the organs move from the streets into the medical supply chain. Mitch says he typically charges between $35,000 and $85,000 for kidney transplants. Depending on where those operations take place, Mitch can clear $25,000 or more per transaction.

While players like Mitch capitalize on legal differences between countries, the practice of organ brokering seems to be ingrained in the very nature of transplants. And it fosters the general lack of transparency. Brokers play key roles keeping the process undercover while maximizing profit along the entire supply chain from the donor’s body to the recipient’s.

Some academics and economists contend that only a legal and regulated system can stop exploitation along the organ supply chain. They contend that paid donations will persist regardless of how the legal system is set up. Transplant surgeons like K. C. Reddy, one of the doctors involved in the Chennai scandal, say that such a system would allow for free movement of organs to needy patients while protecting the interests of the donors. It would guarantee the donors both excellent follow-up care and fair payment.

The free-market solution is seductive. It speaks to a belief in personal liberty and an inherent right to decide our own fates. It also adds an economic incentive that cuts out speculation by middlemen. However, real-world success stories are hard to come by. The bioethicist Arthur Caplan wrote that market solutions to the kidney shortage put vendors at a disadvantage, saying that their “choice is imperiled by high compensation, not because the sellers are rendered irrational by the prospects of money, but [because] for those in need of money certain offers, no matter how degrading, are irresistible.”
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In other words, there’s always someone willing to sell their body parts for less than they are worth.

Legalization proponents often tout Iran as an example of a state that legalized sales and now has an abundance of organs. In Iran organ sales are legal as long as they are regulated by a central state agency. Donors are paid for their sacrifice and looked after by doctors during their recuperation. In turn, there is practically no waiting list for a new kidney.

When I called up the anthropologist Nancy Scheper-Hughes to talk about their solution, she turned sour. “When Iran legalized live donations, they bought the argument that the short supply of kidneys was really only a marketing problem. But when the government took over responsibility for managing the black market kidney trade, the so-called brokers and kidney hunters were rebranded ‘transplant coordinators.’ But they’re still just thugs who troll the streets and homeless shelters for people to donate on the cheap.”

In other words, legalization didn’t change the motivations of the people in the business, only legitimized their illicit tactics. The situation is even worse in China, where the state assumes total control of the organ market. Since 1984 China has harvested organs from prisoners on death row. In 2006 David Matas, a UN delegate, and David Kilgour, a retired member of Canada’s Parliament, released
Bloody Harvest: A Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China
. In it they interviewed dozens of former political prisoners, transplant hospital administrators, and people who had direct knowledge of postexecution organ harvesting. It’s riveting if disturbing reading.

Between 2000 and 2005, they state, there were 60,000 officially recorded kidney transplants in China; of those, 18,500 came from identifiable sources that could be tracked to specific individuals and events. The remaining 41,500 were unaccounted for. Kilgour and Matas believe that many were harvested from Falun Gong religious practitioners—who were declared political dissidents in the late 1990s. Over the years thousands of practitioners have gone missing in Chinese prisons.

One of their sources, who used the pseudonym Annie, was the ex-wife of a transplant surgeon who performed more than two thousand cornea harvestings from living prisoners. Over the years he told her about the day-to-day goings-on at what can only be called an organ factory. She described underground networks of holding cells at Sujiatun Hospital that housed at least five thousand prisoners in pens. Doctors there fed the prisoners only meager rations. Every day doctors removed three prisoners from their cells.

She says that the captives were then “injected with a shot that caused heart failure. During the process they would be pushed into operation rooms to have their organs removed. On the surface the heart stopped beating, but the brain was still functioning because of that shot.” Her husband would then receive the patients and quickly slice out the corneas and send the patient on a gurney down the hall where “their organs were removed while alive, and that it was not just cornea removals—they were removing many organs.”

People have critiqued the Matas and Kilgour report for possible discrepancies in Annie’s testimony, as well as the possibility that the execution spree may not have been levied only against the Falun Gong. And yet Falun Gong message boards contain a virtual tidal wave of photos of executed prisoners and bodies emptied of organs that are continually leaked out of China through surreptitious means.

Harry Wu, one of the foremost activists against human rights abuses in China and founder of the Laogai Research Foundation in Washington, DC, says that he interviewed a transplant surgeon who removed both kidneys from an anesthetized prisoner during a late-night surgery. The next morning the surgeon learned that the guards later shot the prisoner in the head.

In another case, plastic surgeon Guoqi Wang testified in front of the US House of Representatives in 2001 that he had harvested skin from prisoners while another transplant team of surgeons harvested internal organs. He claimed to be present at more than one hundred such operations between 1990 and 1995. The prisoners had been executed with either bullets to the head or shots of heparin.

“Then, after the execution, the body would be rushed to the autopsy room, rather than the crematorium, and we would extract skin, kidneys, livers, bones, and corneas for research and experimental purposes. The skin was subsequently sold to burn victims for $1.20 per square centimeter.” Sometimes, he said in front of Congress, the prisoners were still alive during the procedure, and writhing in agony after their organs had been removed. The government paid Wang a modest sum in cash ($24–$60) for each successful harvest.

Until recently it was easy for Americans to get kidneys from executed prisoners. In 2006 the website for the China International Transplantation Network Assistance, a government-sponsored body, advertised a straightforward price list: kidney, $62,000; liver, $98,000–$130,000; lung, $150,000–$170,000; heart, $130,000–$160,000; cornea, $30,000. The organs averaged one-fifth the price of an American cadaver organ—and a match could be made with as little as two weeks’ notice.

Kilgour and Matas argue that the short wait time clearly indicates that there is a prison system–wide catalog of tissue type. They believe that when a customer orders a kidney doctors are able to search the catalog for as close a match as possible and then schedule the execution on demand. From the recipient’s perspective this would provide the best possible clinical outcome—a perfect match from a living donor. However, the price of the transplant for the donor is death.

TO VERIFY THE EXISTENCE
of such a catalog I traveled to Flushing, Queens, a thriving Chinese community a few miles outside of Manhattan. Main Street is a collage of cramped billboards full of Chinese characters and restaurant windows hung thickly with glazed ducks. Boxy concrete buildings recall the uninspired but durable architecture of East Asia. Here English is a distant second language to Mandarin.

In the late 1990s the Chinese government calculated that the total membership of Falun Gong exceeded the membership of its own Communist party and deemed the spiritual organization a threat. While most of the practitioners are content to simply practice their spiritual exercises, which resemble tai chi routines, it is one of the few groups to actively resist the Chinese government’s injunctions. In one notable incident in 2002, members of the group raided and took control of nine television stations as well as a satellite uplink during the World Cup finals. During the hijacking they broadcast their own antigovernment propaganda. Sensing that Falun Gong could be a major political threat, the government cracked down. Hard.

Saturating the state media with accusations that the group practiced black magic and brainwashed its membership, the government banned the group from organizing in both public and private. There were steep penalties for violation. Starting in 1999 the central committee devised a cunning plan for their arrest.