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Buying a Pound of Flesh

People Who Sell Kidneys Get Poorer, Sicker
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Oct. 1, 2002 -- If you buy a kidney from a desperately poor person, you may get better. But the person who saved your life soon could get poorer -- and sicker as well.

You can't live without a kidney. That's why nature gave you two of them. When both kidneys fail, transplant is the only hope of a normal life. The demand for kidneys far outstrips the supply of kidneys donated upon death. But from the dark side of modern medicine comes another supply: desperately poor people.

Rich people who need kidneys often get them from brokers in developing nations. The practice is illegal in India. Yet a research team led by Madhav Goyal, MD, MPH, of Geisinger Health System, State College, Pa., was able to find and interview more than 300 Indian citizens who sold a kidney. All were very poor. Most were women, and some were forced by male members of the family to sell their organs.

The average price: $1,603 more than 10 years ago; $975 more recently.

People who buy kidneys might tell themselves they have saved the donors from poverty. Goyal's team explodes this myth. An average of six years after selling their pound of flesh, three out of four donors were still in debt. Average family income dropped by one-third. Nearly nine of 10 donors had worsening health. Nearly eight in 10 said that they wouldn't advise anyone else to do what they did.

"In developing countries such as India, potential donors need to be protected from being exploited," Goyal and colleagues write.

In an editorial accompanying the study, Columbia University researcher David J. Rothman, PhD, notes that buying organs is legal in several nations. Japanese citizens buy organs in the Philippines. Israeli citizens buy organs in Turkey and in former Soviet nations. Citizens of Middle Eastern nations often buy organs in India. Malaysian citizens buy organs in China.

"These countries can avoid addressing their own cultural attitudes and practices that discourage donation," Rothman writes. "Rather than pursue and debate them, these countries let their patients and even their surgeons enter and feed the marketplace for organs."

The World Medical Organization in no uncertain terms forbids payment for organs. Yet some justify the practice as good for the donor as well as the recipient. This simply isn't so.

"Sale of organs is a zero-sum game in which any advantage to one participant necessarily leads to disadvantage to one or more others," he writes. "Thus, for everyone except recipients, commerce in organs is a dead-end proposition."

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