£20k for a kidney. £20 for blood. What is your body worth?

Beth Pearson

March 6, 2006

I am a 37-year-old mother of two. I would like to offer one of my kidneys or half of my liver for sale. I am trapped in a marriage in a foreign country -- my two children are not his. I want to return home with my children and start a better life for us. I don't know any other way to raise the money to do this, so am offering one of my kidneys and/or half of my liver for money plus all related medical expenses. I am A+ (blood type), don't smoke and rarely drink. I can be contacted at *******@yahoo.com but serious inquiries only please as I am very serious. Thank you.

Away from the gloomy statistics of organ shortages and campaigns for donor cards, transplant organs are in good supply. The kidney of the woman in this online advert could be bought for around £1500-£2000 and, with the help of an experienced broker, the transplant could take place quickly and professionally in a reputable hospital abroad.

Michele Goodwin is the author of Black Markets: The Supply & Demand of Body Parts, published by Cambridge University Press this month. "A clandestine system is spreading," she says. "There's the living donation market, where donors are being sought out by US and European citizens in Brazil, Pakistan, India, South Africa and other countries.

The internet is one of the most rapidly-expanding opportunities for people to connect with organ brokers, who connect people to the organs they desire. You won't find them on your first click, but if you search well enough, you will. The brokers are shielded because they'll say, 'I'm not selling a kidney. What I'm doing is, for a fee, to connect you to what you want'."

In short, the black market in live-organ donations is thriving, which is one of the reasons why, last month, two American doctors called for the legalisation of the sale of organs from live donors in the US. Writing in Kidney International, Eli Friedman, of the State University of New York, and Amy Friedman, of Yale, suggested a state-controlled market system be established whereby £23,000 would be paid to live kidney donors.

It's also a hot debate in this country. More than 5500 patients in the UK are waiting for a new kidney, while only around one-third of that number received a transplant last year. There are ongoing campaigns to encourage people to sign up to the donor-card scheme; however, many experts are calling for tougher action. Some call for a system like that proposed by the American academics, which would simultaneously close in on the organ shortage as well as stem the growing black market. But there is one considerable obstacle: the law.

"There's sympathy for that position," says Dr Graeme Laurie, a medical jurisprudence expert at Edinburgh University. "People think it's a defensible way to address the shortfall for transplantation. It's not a crude two-way process between individuals. People argue you could develop a brokering system within the NHS that could act as a third-party and control prices and make sure everything was safe and fair."

The law governing organ transplants operates on the basis that humans do not own their body parts and have no right to sell them. This would need to be changed if the system for organ donation were changed, but there is no sign of that happening soon. The government is moving in the other direction. The Human Tissue (Scotland) Bill was introduced on June 3 and is going through parliament. It is set to put the common-law tradition, outlined above, in statute form, and formalise the government's stance against sale of organs for transplant. It also embodies the opt-in donor system, which means that people must indicate their desire to donate organs in the event of their death. The alternative would be an opt-out system, which would presume consent.

The opt-out system, which operates in Norway, Portugal and Belgium, is generally less controversial than establishing a market for organs. However, the opposite appears to be the case in the UK, where the scandals at Alder Hey, the Liverpool children's hospital where the organs of dead babies were removed and stored, and Bristol Royal Infirmary, where doctors removed the hearts of children who had died in surgery, are still fresh in the public memory.

"I think the government feels it's too politically sensitive," says Laurie. "I don't see it as a realistic prospect for a long time, given we've just passed the Human Tissue Act. So, we still have the shortfall, hence discussions about buying organs."

Professor John Harris, a philosopher at Manchester University, is one of the loudest voices in these discussions. He believes he has developed a system, with his colleague Charles Erin, which answers most of the objections to selling organs.

"The market has to be confined to a nation state or a group of states that can manage their own affairs," he says. "There would be no direct sales, so individuals could not advertise organs or make an offer for organs. One purchaser -- such as the NHS -- purchases on behalf of the community and distributes organs bought according to some form of just system or medical priority. There'd be no people in rich countries buying from people in poor countries."

Harris believes the government is more likely to try an opt-out donor scheme before establishing a controlled market for organs, but he thinks it has a moral obligation to do both, and more. "There is a chronic shortfall in the supply of donor organs," he says. "It's not pragmatic. It's morally-driven. People are dying for want of donor organs. This pandemic has to be addressed. An opt-out system would be an improvement, but this would be one of many measures we should be taking. We should have an opting-out system. We should be creating a market. We should allow altruistic living donations between strangers in the UK."

Public and government resistance to paying cash for organs is likely to stem from several sources, but there is an obvious one. Organ donation has always had a veneer of altruism, which has been fostered by the opt-in system. The idea of asking for and receiving cash in exchange for something that is considered a "gift" to the dying seems impolite, at least. But this is changing. Private sales of sperm, eggs and even hair are common and even when we think we're taking part in a purely altruistic activity, like giving blood (bar the tea and biscuit), there are commercial forces at work.

"There is trade in derivatives from blood samples by the Blood Transfusion Service, but the market there hasn't undermined public trust," says Laurie. "When you're asked to donate blood, it's on the basis of gift, but the realities are that behind that there are markets, especially when there's research that produces intellectual property and big financial gains. So the public gives, the service takes. A lot of people don't realise there is a trade. They think altruism permeates the enterprise."

A black market that runs on exploitation

A recent report commissioned by the Council of Europe stated that around 40,000 patients are waiting for a kidney transplant in western Europe.

It further suggested that 15%-30% of these people would die while still on the waiting list. Meanwhile, the number of people suffering kidney failure is increasing and organ donations are falling.

American and European patients have been reported to spend up to £100,000 on a black-market kidney transplant. The market runs on exploitation of the poor, so much of this goes to the broker and not the donor.

Anyone seeking a transplant organ abroad, even in a reputable hospital, should exercise caution. "If people are going out of the country, it's not guaranteed that they're using the black market, but it is a grey market," says Michele Goodwin. "If they're purchasing an organ through a broker, the chances are it's a black-market one."

Copyright © 2006 Newsquest (Herald & Times) Limited.

This article posted March 21, 2006.