Is Organ Bootlegging Inevitable?

Only markets and science will prevent it

An international ring of human organ bootleggers involving people in South Africa and Brazil was broken up earlier this month. Almost everyone thought that these transactions–even though they saved some people's lives, increased some people's options, and involved no force or coercion–were evil. Opposition to selling organs is visceral, so to speak, in most people, and is reflected in the laws of nearly every nation.

We've all heard the urban legend about some poor schlub who groggily comes to in a hotel room writhing in pain with a huge set of stitches down his back, usually in a bathtub full of ice. The last thing he remembers was sitting at the bar drinking with a leggy blonde. It turns out that he's missing one of his kidneys.

Poor countries are frequently swept with gruesome scare tales of hapless children being kidnapped and shipped off to Europe or the United States where their organs are taken for the benefit of rich kids. When I was working in Costa Rica in the early 1990s, a member of the National Assembly held a press conference where she declared that she knew the identity of a local kid who had been kidnapped and whose kidney had been taken. She promised to bring him forward in the next few days. She never did.

So far, there's no evidence these ghoulish scenarios have ever really happened. But they might happen one day. Circumstances are emerging that could make a black market in involuntarily obtained human organs easier and more attractive.

With transplants today, organs have to be genetically matched to the patient's immune system so that they won't be rejected. That means randomly acquiring organs by knocking people over the head won't do. However, scientists might soon create new drugs that are better at handling immune rejection. That would widen the range of organs that could be useful to any given patient. Such medical advances could tempt unscrupulous people to supply desperate patients with transplantable organs from anyone they can get their hands on, willing or not.

And more and more doctors around the world have received the specialized training needed to successfully transplant organs. Such doctors in poor countries might well succumb to the temptation to make a bit more money for themselves.

Not only the means, but also the motives exist to jumpstart an involuntary organ market: the shortage of transplantable organs continues to worsen worldwide. In the United States alone, the list of patients waiting for an organ continues to lengthen. There are, for example, some 83,000 people waiting for a kidney.

Despite all the above, involuntary black markets in human organs are not inevitable. Aboveground markets and science can keep those urban legends legendary.

Medical progress offers the prospect of several different ways to end the shortage of good transplant organs. Embryonic and adult stem cells might be used to repair or replace damaged organs and tissues. Other research underway now uses genetic techniques to "humanize" animal organs so that they would be compatible with human's immune systems. And researchers are also trying to create artificial organs for transplanting.

But until the march of science makes these or other means of supplying needed organs a reality, changes in the law can allow markets to help in the here and now.

The recently busted network of organ sellers operating in South Africa and Brazil was purchasing kidneys from healthy but poor Brazilians who were flown to a private hospital in Durban. Each of the Brazilians sold one of their kidneys, which were removed and installed in foreign transplant patients. The sellers received between $10,000 and $13,000, with all their expenses paid.

"They're mostly poor people just trying to make a better life for themselves," said Manoel Caetano Cysneiros, a police spokesman in Recife, Brazil. "They'll probably buy a house or a small business with that money." In fact, it has been reported that several people who sold one of their kidneys were sufficiently satisfied with the deal that they returned home and urged others to do the same.

The transplant patients apparently paid about $120,000 each for the operations. The patients–now freed of onerous and expensive dialysis treatments–can live relatively normal lives. On the face of it, this voluntary transaction appears to be another classic win/win market phenomenon. So what is so wrong with the voluntary sale of human organs?

In recent years many doctors and bioethicists have warmed to the idea that at least in certain circumstances it's all right to buy and sell human organs. Last April, a South African legal expert endorsed the idea that a person "should have the right" to decide to sell a kidney. Just the day before the South African story broke, the BBC reported on a doctors' conference in Britain that considered the ethics of buying and selling organs. Professor John Harris from Manchester University opined that people should have the right to sell a kidney, part of their liver, or bone marrow.

Jailing people for the voluntary sale of human organs helps neither those who need the organs nor those willing to sell them. Until medical science comes up with new ways to ease the growing shortage of transplantable organs, making the current voluntary black market into a white market with legally enforceable contracts could well forestall the development of an involuntary black market in organs. That would be win/win for us all.