Kenya: Human Kidneys Up for Sale

Alex Ndegwa

April 28, 2007

Fifteen-year-old Silas Agwata resolved to sell part of himself to pursue his ambition of being a pilot.

"If the kidney would enable me to achieve my dream, I am ready to sell it," Agwata said in February as he offered his vital organ for sale. He desperately wanted to raise money for his secondary education.

The startling pronouncement by the third-best student in Naivasha in the 2006 Kenya Certificate of Primary Education (KCPE) examinations stunned the nation.

Seven months earlier, 44-year-old Alfred Soi, a father of eight, too had vowed to auction his kidney to raise fees for his two sons in high school.

The decision by the mechanic last July was another stark reminder that most vulnerable people, regardless of age, cannot resist the temptation to sell a kidney for a song.

But this, says Dr Anthony Were, head of Renal Unit at the Kenyatta National Hospital (KNH), is a bluff.

Were says Kenya does not have a law to facilitate kidney donation to unrelated person.

"We do not have a legal framework to facilitate live non-related kidney transplantation. We have lobbied for such a law since 1978 but in vain," he says.

Commercialism and transplant tourism

Legally speaking, one cannot receive a kidney donation even from a spouse.

The doctor also acknowledges the inherent risk of pushing the operation underground.

"Non-existent or lax laws on organ donation and transplantation encourage commercialism and transplant tourism," notes Dr Luc Noel of the World Health Organisation.

Were says there are three types of kidney transplantations; live-related, live non-related and cadaveric.

The first transplantation means the donor is related to the patient. Relation could either be first degree - mother to child - or second degree, such as a first cousin.

The Kenyan laws recognise this type of transplantation. Indeed, patients who opt to undergo the operation in India, a popular destination, must seek clearance from the Ministry of Health.

Were says one must present an affidavit to the Director of Medical Services proving the donor and the patient are related.

This conforms to the World Health Assembly (WHA) regulation requiring that live donors should be genetically related to the recipient.

Donations should be purely philanthropic

Live non-related kidney transplantation patients benefit from organs donated by "emotional donors" like a spouse or friend.

Were emphasises donations should be purely philanthropic to discourage the likelihood of financial transactions. Indeed WHA rules also prohibit "giving and receiving money, as well as any other commercial dealing."

The doctor maintains that unless legislation is enacted, transplants involving unrelated individuals are deemed illegal in the country.

But does the absence of a law criminalise the procedure? Were says the medical fraternity was split on the issues since the law was silent.

He, however, adds: "But why would authorisation be required from the Director of Medical Services to prove relations between a patient and a donor if not to check organ donation by unrelated persons? This simply means live non-related kidney transplantation is illegal."

Cadaveric transplantation involves harvesting of organs and tissues from deceased donors or patients deemed as brain dead.

Once the organ is obtained, a Rapid Tissue Typing Machine is used to match it with a suitable patient and the operation must be conducted immediately.

The procedure is expensive since it requires a high degree of organisation and logistical support given that the human organs cannot "stay alive" for more than 24 hours.

"Such investment is simply not within the reach of our country hence we do not harvest human organs from bodies for transplantation," he explains.

Bound by strict cultural practices

Even then, experts have made a much stronger case for cadaverous (deceased donors) over live donors.

In 1991, WHA adopted guiding principles on human organ transplantation: "Organs should be removed preferably from the bodies of deceased persons."

But this maxim has widely been ignored, particularly in Africa where there is widespread resistance to the use of cadaveric organs, or those from dead bodies.

Most African communities are bound by strict cultural practices that revere the dead and consider harvesting their organs an abomination.

The case for cadaveric organs over live donations is strengthened by experts who argue that such donors do not require follow-up because they are dead anyway.

Transplantation is increasingly seen as the best solution to end-stage organ failure. End-stage kidney disease, for instance, can only be repaired with a kidney transplant.

Without it, the patient will die or require dialysis for years, which is an expensive procedure and often out of reach of many patients.

World Health Organisation classifies kidney as the most sought after organ.

Rising trade in human organs

In 2005 alone, 66,000 kidneys were transplanted, representing a paltry 10 per cent of the estimated needs. In the same year, 21,000 livers and 6,000 hearts were transplanted.

WHO says both kidney and liver transplants are on the rise but demand is also increasing and remains unmatched. The demand for transplants has surpassed the supply of donated organs.

As a result, an alarm has been sounded over an increase in international trade in human organs. Last month, WHO raised concern over increasing cases of commercial exploitation of human materials.

"Human organs are not spare parts," said Dr Howard Zucker, WHO assistant director-general of health technology and pharmaceuticals.

"No one can put a price on an organ which is going to save someone's life."

The health body blamed the worrisome situation on loopholes in the legal framework and called for joint efforts to regulate the field.

Noel, while calling for legislation, added: "If all countries agree on a common approach and stop commercial exploitation, then access will be more equitable and we will have fewer health tragedies."

Reports on 'transplant tourism' show that it makes up an estimated 10 per cent of global transplantation practices.

A resolution adopted at 2004 World Health Assembly urged governments "to take measures to protect the poorest and most vulnerable groups from 'transplant tourism' and the sale of tissues and organs."

Luckily for Agwata - in spite of putting up his organ for sale - in the end kept his treasured body part after a Naivasha leader came to his rescue and donated about Sh50,000 to fund his education.

Copyright © 2007 The East African Standard. Distributed by AllAfrica Global Media (allAfrica.com).

This article posted May 28, 2007.