Kidney sales: exchanges in desperation

My father-in-law went through a difficult period of dialysis before he died in 1999 at the age of 80.  My 78-year-old mother suffered from the same end-stage renal disease and died the following year. Both went through the same arduous course of daily peritoneal or thriceweekly hemo-dialysis, punctuated by recurrent infections requiring hospital confinement, and saw the pointlessness of it all. Watching them bravely deal with their condition with rapidly diminishing energy, I came to the conclusion that life on dialysis is a medical situation that was justifiable only if there was a promise of liberation through the eventual transplantation of a healthy kidney.  But, neither my fatherin-law nor my mother would even consider it.  Dialysis washed out every drop of hope from their bodies.

It was therefore with more than passing interest that I followed the report last week of a new directive from the Department of Health that introduces new guidelines and measures for handling the morally and legally vexed problem of organ transplantation.  It is an extremely difficult issue that requires great sensitivity and judgment, and one can therefore appreciate the DOH’s intervention in such a controversial question.  Every attempt to address a tangled issue like this is bound to give rise to new and even more difficult issues.

The situation we face has mainly to do with kidney transplants, of which approximately one thousand procedures are performed every year in about 15 medical facilities all over the Philippines.  The bulk of these, about 90 percent, involve the transplantation of kidneys harvested from live donors.  The term “donor” is interesting, especially in the Philippine context, where the practice of altruistic organ donation hardly exists.  Its usage is technical, referring more to the living source of the kidney than to the social role in which the act is embedded.

Even more interesting, from a news perspective, is the report that in 2006, foreign patients were the recipients of 41.4% of the live kidneys harvested from Filipino “donors.”  The foreign recipients were mostly rich patients from the Middle East, Japan, and South Korea.  Most of the “donors” were from impoverished farming villages of Eastern Luzon and the slum communities of Metro Manila.  This is a paradox that cannot be ignored by even the most insensitive government.  It drives home the point sharply that imperial plunder now reaches beyond our natural resources and labor to include our body parts as well.

We do have an existing law that explicitly bans the traffic in human organs.  There is also an existing order that sets the limit on the number of kidney transplants on foreign patients to 10% of the total. It is obvious from the available data and evidence that neither the ban on the sale of kidneys nor the 10% cap on foreign recipients is being enforced.

An underground Philippine kidney market has indeed flourished beneath an almost non-existent monitoring system, and this is confirmed by nearly every kidney-for-sale website on the Internet. The ease with which a healthy kidney can be found and the transplant procedure performed in our hospitals is attracting desperate patients from all over the world.  Our prices also seem to be among the lowest in the world.  From the outside, it is easy to see all this as a deliberate strategy to boost medical tourism in the country.

The health authorities seek to end the hypocrisy by putting in place a transparent mechanism that will maintain a central registry of donors and recipients.  This is based on the recognition that, whether we like it or not, there are some people who, for a variety of reasons, are ready to offer one of their kidneys in exchange for some form of assistance; and, on the other hand, that there are patients out there who badly need healthy kidneys to extend their lives and are willing to pay the costs. The language of commerce is explicitly avoided; in its place, the vocabulary of mutual assistance is adopted.  Our hope is that this is more than just a semantic shift, and that the situation of every potential donor will be carefully examined so that mere readiness to sell won’t be enough to qualify as a donor.

There is an immediate advantage to this open admission of a situation and putting up a regulatory body to oversee its sensitive handling.  Donors are protected against exploitation and hopefully their post-surgical health condition will be monitored.  In turn, patients are protected against being taken advantage of by unscrupulous kidney brokers and hospitals.

Welcome to capitalism, Marx might have told us, “… a time when everything that men had considered inalienable becomes an object of exchange, of traffic, and could be alienated… when everything, moral or physical, having become a marketable value, is brought to the market to be assessed at its truest value.”  Yet, in a society like ours, in a global era like this, it is difficult to imagine what a free market on human organs will do to our people.

The new conditions brought about by advances in biotechnology do challenge our existing legal and moral norms, and to ignore them would be unrealistic.  The DOH has acted correctly in proposing new measures for dealing with this problem, even as no one can fully know what new problems it will spawn in the process.  Contradictory as it may seem, I urge the government to match these new measures with a determined campaign to discourage Filipinos from selling their body parts.  Our leaders ought to know this is not the way to alleviate poverty.


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