The Market for Organs

By Fatos Karadeniz


[dropcap]I[/dropcap]n 2016, Steven Rosenfeld was diagnosed with a rare kidney disease that has since led to kidney failure.  In February 2018, his wife, Susan Harrold, wrote that “We have no answers as to why this happened, but we do know that the disease is progressing faster than we had anticipated, and he is now on dialysis three times per day.” Rosenfeld is currently on a waitlist, but he does not have the luxury of time. Harrold’s letter is a plea for help, attempting to spread the word in hopes that her message reaches someone willing to donate their kidney. This story is not unusual.


A nationwide shortage of organs has forced approximately 98,000 people to wait for a life-saving kidney transplant in the United States. Factors affecting transplant candidacy include region, age, blood type, and immune system activity. The entire process is complex and lengthy. On average, 3,000 new people are added to the transplant wait list each month. Each day, about 13 people die waiting for a donation that never arrives.


The increasing demand for kidneys far outstrips the supply. Faced with the limited prospect of obtaining life-saving organs legally–wait-lists are as long as 12 years in some regions–some turn to other options: the black market.


Organ trafficking encompasses all steps of the harvesting and transplanting process, from donor recruitment, organ removal, and transporting the organ to the buyer. According to the World Health Organization, organ trafficking accounts for 5-10% of kidney transplants performed throughout the world every year. The so-called “voluntary” nature of the transaction is  highly suspect. Illegal organ trade consists of an intricate web of deceit and manipulation that generally exploits impoverished individuals from low-income countries. Investigative journalist Scott Carney, who did extensive fieldwork in India to research illegal organ markets, explains that “when you mix medical ethics with profit motives, you often end up with some pretty terrible outcomes.”


The market for organs thrives in low-income countries where organ brokers, or “kidney scouts,” target individuals with limited work prospects and low income. Mohinder Lal, the police commissioner in Gurgaon, India, told the New York Times that “kidney scouts” would roam labor markets in India, offering individuals a payment of $1,000-$2,500 for selling a kidney. Often, donors never even received the promised payment in full. By preying on communities where the majority of the population is poverty-stricken, organ brokers exploit an individual’s desperate financial situation. In 2006, when a tsunami hit the coasts of India and Indonesia, many people were displaced and moved to refugee camps. Scott Carney described how “organ brokers descended on the camps and used people as raw materials for this organ trade. At one point there, I had 80 women lined up in a row with their kidney scars… they just sold their organs.” As Carney put it, “We are moving human tissue from the poor to the rich.”


Many people who agree to the exchange  do not have a background in anatomy or human biology, and thus are not well-informed of the operation that they will undergo. Sometimes, they are simply told that a piece of “meat” will be removed from their bodies with little to no side effects. In other instances, Scott Carney describes that people who go in for a simple appendectomy in a hospital will leave without a kidney.


This process negatively impacts not only the organ donors but the recipients as well. Dr. Kulkarni is a multi-organ transplant surgeon and the Director of the Kidney and Pancreas transplant program at Yale University and Yale-New Haven Hospital. He has had patients who come in after having had a transplant surgery abroad seeking post-transplant care. In one instance, an individual didn’t even know if they received a kidney from a deceased donor or a living donor. He explains that the immunological testing of the donors in other countries is subpar, “We’ve had people come in with Hepatitis C, for example, that they’ve contracted from a living donor.”


The dialogue concerning organ transplantation is at times much removed from the individuals who have to give up their organs. Illegal organ markets exploit the poor at the benefit of the rich. In order to advocate for living donors in the US, it is necessary to reduce the stigmatization behind donating a kidney. With a population of over 300 million, the need for the 98,000 kidneys in the US could be easily satisfied. As Dr. Kulkarni puts it, “[The solution for the organ shortage] has got to be a population health approach where we just educate the population at large about what living donation is all about and then you wait… you wait to see which people are interested and which people aren’t.”


Fatos Karadeniz ‘20 is a prospective Anthropology major in Hopper College. Contact her at fatos.karadeniz@yale.edu.