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Amber O'Brien is an 11 year old girl from London. She has had kidney failure since she was five years old and after one year on the NHS transplant waiting list, she underwent an unsuccessful kidney transplant. Due to poor health, Amber had been taken off the waiting list. It has been a long wait, but Amber is now being assessed by Great Ormond Street Hospital to see if she is fit enough to go back on the list.
The term 'waiting list' is somewhat misleading. The sad truth is, you may never receive a kidney if a suitable donor isn't found. Only patients deemed able to survive a transplant operation stay on the list and patients could be removed from it any time. If you aren't on the waiting list, there is no legal hope of getting a kidney transplant.
Amber's mother Belinda has always been honest with daughter about her illness. Without a kidney transplant Amber can only expect, at best, to reach the age of 25 years old. She has also been told she will never be able to have children. This doesn't seem to affect her too much now, but Belinda knows it will hit home as she gets older.
The transplant waiting list is run by a special health authority called UK Transplant, which, along with specialist advisory groups, determines organ allocation. A points system is used to decide which patients will be called up for each organ. The points are allocated on a variety of factors including age, health, tissue type and length of wait, amongst others.
Children are given priority due to the detrimental effects of dialysis on growth and development. Belinda hopes that she will be able to donate of her kidneys to Amber once her daughter's health improves.
Figures from five years ago placed the wait at 506 days for a Caucasian adult, and (due to a shortage of suitable organs) approximately four years wait for those from ethnic minority groups. However, the waiting list has increased every year since that point and some people have now been waiting as long as 10 years.
Brokers: The Right Price
In most black market organ deals the person making the profit is the broker. For a large fee, the broker will try to match a patient with a suitable donor and will arrange transport and a surgeon to perform the operation.
Prices vary for different countries. If you go to India, Pakistan, Turkey, or Egypt you may be charged upwards of £10,000. If however, you wish to go to Germany or South Africa, this figure will jump to around £80,000. The most expensive place of all in the human organ trade is the USA, where medical bills and the price demanded by a 'Transplant Coordinator' can exceed £100,000.
These organized criminals are seen by many as the real bad guys in the situation. Hamish McCulloch, Assistant Director of Trafficking at Interpol, finds it difficult to condemn the buyers and sellers:
"We have to look at these people as victims and focus our resources on those agents who are exploiting them. We focus our projects and investigations on the organised criminal groups who are making lots and lots of money out of the misfortunes of other people."
In poorer countries, brokers command teams of recruiters who themselves have donated and receive a small commission for persuading others in their community to donate a kidney, cornea, or part of a leg. The broker will match the donors to the buyers and pay off any bureaucrats necessary to pass a living donation off as genuine and above board.
In Israel, recipients such as Shimrit Orr pay in the region of £80,000 for a kidney with only a small fraction of this (around £17,500) going to the kidney donor. The rest is spent on the cost of the operation and travel expenses, with the majority of the sum (an estimated £30-40,000) going to the broker.
Some of the brokers and the surgeons cut corners to save money. As a result, many people who go to these clinics die unnecessarily during or after treatment. On the other hand, some of the clinics have standards equal to that of NHS hospitals in the UK. Patients choosing to go overseas have no choice but to enter this lottery.
Buyers: No Alternative
There are currently over 19,500 patients in the UK with kidney failure, struggling to stay alive on dialysis. Of these patients, 5,000 are considered fit enough for transplant and are currently on the waiting list for a kidney.
Patients waiting for a transplant know their chance of dying increases each day, due to the strain dialysis places on their major organs. They worry that their heart may even fail before the long awaited tissue-matched kidney becomes available. So what do they do? What would you do?
You may decide that this is your fate, that you trust the NHS system to find you a suitable kidney eventually and you are prepared to make the most of the life you have on dialysis. The majority of patients take this viewpoint.
However, there are a growing number of people who choose not to wait. They decide that the chance of dying whilst on a waiting list is too great and opt for the black market alternative. They are often fully aware of the risks of going overseas, but would rather take their chances than carry on living on dialysis.
Donald Coloff, a 66 year old British dialysis patient, has been waiting for a transplant for over two years. He is frustrated with the NHS waiting list system and has been investigating the option of going overseas:
"I am happy to pay money and go overseas. If someone wants to sell a kidney, then I don't see anything wrong with me buying."
Donald, like many westerners on kidney waiting lists, is prepared to pay almost any amount within his reach. If he re-mortgages his house he could have up to $100,000 to spend.
Donald was told by his doctor that his kidney would not be serviced on his return to the UK. He now knows this is not true and that on his return to the UK he can expect the same level of care any transplant patient would receive, regardless of the origin of the kidney.
Kumar : Little Choice
Kumar was born into poverty within a rural area of India. Abandoned from the age of five years old, he struggled to scratch out a life in Otteri, a slum area in the Indian city Chennai.
Kumar managed to forge a life for himself despite his difficult beginnings. He is now married to his wife Chandra and lives with her and his three children in a small room in Otteri. Kumar and Chandra built up their own business collecting plastic bottles from a rubbish dump everyday and selling them on to recycling factories. From this small enterprise, Kumar managed to eke out a small living and feed his family.
Things started to go wrong when Kumar decided to borrow money to pay for a traditional Indian feast to celebrate his daughter's coming of marriageable age. Shortly after the celebration, Kumar received some bad news - his father had died. Kumar had to borrow more money in order to cover the cost of his father's funeral.
Over time, the exorbitant interest rates on his debts became too much for Kumar to deal with and he fell behind with his payments. Fearing he would be unable to keep up repayments, the loan sharks started visiting his home daily, making threats to Kumar and his family. Kumar feared for his their safety.
Kumar heard about the growing number of people living in his community who had sold a kidney in order to make ends meet. He decided this would be the best option for him and his family.
The day after Kumars' operation, Chandra took the 55,000 rupees, (£700) Kumar had received for the sale of his kidney and paid off their 11 debts. The family gained temporary respite from their money worries.
However there is not a happy ending to this story, as is the case with 86% of kidney donors in India. Kumar suffered health problems following his nephrectomy. He returned to work only to have to take time off again due to pain and vomiting. Kumar is currently unable to work and he is not sure what he will do. In a survey of Indian people who had sold a kidney, it was found that their average family income declined by one third after the operation and the number of participants living below the poverty line actually increased.
Is it morally abhorrent for a dying person to buy a kidney from a person who needs money and wants to sell their kidney? The fact that lives are at stake in this illegal market puts the pressure on ethicists, lawmakers, the transplant community and the public to examine this difficult question in detail.
One of the main criticisms of the illegal market is its exploitation of the poor. Critics such as Robert Evans MEP believe it is immoral for a rich western dialysis patient to buy a kidney from a poor person living in a developing country. He would assert that, as they are in debt and poorly educated, they are not making an informed decision to sell, but are forced to sell due to thier circumstances.
Ethicist Janet Radcliffe Richards argues against this. She believes we are not helping a poor person by closing off their only available method of getting money. Why shouldn't people have the right to decide what they wish to do with their own bodies?
London based businessman Thor Andersen bought a kidney from a girl in Pakistan who used the money to pay off her debts and buy land. He is very certain about his views, sating "you can look at it as exploitation, but donors who may be starving in Pakistan can survive for a long time on the money, and the patients get their lives back. It works both ways".
However, the unregulated system poses real risks to both donor and patient. There is often inadequate screening and follow up care for donors, whilst transplant recipients may be operated upon when they aren't fit enough to survive a transplant operation. There are many casualties and in addition there are reports of cases where 'donors' have been coerced by various means to donate.