August 01, 2004
By Raffique Shah
BACK in 1983, when I visited India as a journalist covering the Commonwealth Heads of Governments meeting, a story in the local newspapers that attracted my attention was one about poor Indians who would queue up at hospitals and blood banks daily across the country to sell their blood. It was thriving trade. The price paid for a pint of blood was more than the equivalent of a month's earnings by those in the lower strata of India's hundreds of millions of poor people. But some men and women were so desperate for money just to survive, they would try to sell their blood more frequently than was considered safe, and had to be turned away from the buying institutions, while others simply died from a depletion of blood supply.
That almost macabre trade is not confined to India. Right here in Trinidad one can find volunteers who are willing to sell their blood, mostly drug addicts, and more-then-willing buyers whose relatives or friends are unwilling to donate the life-saving fluid. The local blood bank is always short of blood, and almost every private or public clinic insists that patients in need of blood get their own before they could have infusions or surgery. It's a thriving underground trade that survives because gone are the days when the blood banks could rely on a virtual army of voluntary donors, and when members of one's family or one's relatives or friends thought nothing of "giving a pint".
Today, the world has graduated from the simply unethical practice of selling one's blood to a worldwide trade in organs. With the advent of organ transplants as medical science evolved, kidneys, livers and even lungs have been added to the list. But the organ that is in highest demand and therefore commands the highest price, is the kidney. Recently, it hit home when a Pakistani organisation openly advertised such transplants at a price that is irresistible to those who are in crying need of a kidney or two, and who face death as their only alternative.
Indeed, what brought this dastardly trade to light was the fact that several recipients of such organs died shortly afterwards. It was only after these high profile cases came to light that the Ministry of Health issued advisories against desperate people falling for the Pakistani option. In fact, I can tell those patients who are in need of such transplants that Thailand, not Pakistan, is where it's at these days. It's cheaper, no-questions-asked, and more recipients who have the surgery done there survive. But ethical questions, and even criminal connections that are connected to this international organ trafficking mafia, will not disappear whether you choose Pakistan or Thailand.
Look at the countries where such "procedures" are carried out, mostly with the authorities turning a blind eye to it: Pakistan, Thailand, India, Turkey (where the "donors" come from the poorest parts of the former Soviet Union) and South Africa. In almost every instance it is abject poverty that drives the "donors" to sell their organs to eager recipients. In 1991, the WHO issued guidelines to avoid the coercion or exploitation of organ donors. Some 192 countries endorsed them, more than likely Trinidad and Tobago being one. But because the guidelines are not binding, they are ignored almost at will.
Recently, investigative reporter Larry Rohter of The New York Times tracked the illicit trade from the slums of Brazil to upscale clinics in Durban, South Africa, and came up with some startling revelations. It involved two retired police officers, one an Israeli and the other Brazilian, who procured organ "donors" in Recife, where poverty is rampant beyond belief. There, the Brazilian would induce persons willing to sell kidneys at US$6,000 to make a trip to Durban where the organ transplant was done. The two have since been jailed on organ trafficking charges, and investigations are continuing in South Africa. But because of Jewish religious injunctions that prohibit "desecration of the body", many Israelis who are desperate to have transplants pay handsomely for them.
There are several very pertinent questions that arise out of this murky world of organ transplants. In countries like Pakistan or Brazil, for example, who is to say that the "donor" was not bludgeoned into giving up an organ, and possibly his life, so that some wealthy person could survive? Do the people who opt for such transplants ever think of the plight of their "saviours"? And equally important, does it matter to a Jew that his new, functioning kidney comes from a poverty-stricken Palestinian or a Muslim from Pakistan? Or would the white racist from the USA think once (not twice!) about accepting an organ from some poor, black Brazilian?
The other facet of this organ transplant trade is even more pertinent. There are hundreds of people in this country who suffer with kidney problems that would eventually lead to them going on dialysis, and ultimately making the choice between transplant or death. The poor will have no choice in the matter: they will simply suffer and die. The rich will be able to exercise their options, and maybe they will survive. But with tens of thousands of people here suffering with kidney ailments of one kind or other, have we given thought to how best such conditions can be avoided? Have we examined the deadly fast foods business that will inevitably lead us down the road to obesity, multiple health problems, and myriad other negative health consequences? Indeed, has the medical fraternity looked at what has become the latest diet fad worldwide, the Atkins diet, which, by the very foods it recommends for losing weight, can trigger kidney and heart problems?
We may think we are a wealthy country and pretty soon we, too, can saunter off to Brazil or Pakistan or Turkey and have a new organ installed-like putting a foreign-used engine in one's vehicle. But prevention is always better than cure. And doctors who practice their professions with ethics can and should advise the government (and their patients) how best to avoid the unnecessary deterioration of these organs. It's not that they are gods who can stop the degeneration that comes with aging. But they know that they can help people (who want to be helped) live relatively healthy lives until the inevitable comes around.
But we have become a society in which we create the problems, then look for the solutions. Crime is the perfect example: we buy "hot" goods, avoid paying taxes, hire criminals to recover bad debts. Then we complain about runaway crime. We promote unhealthy lifestyles with a flourish. Then run to Pakistan-or Thailand-seeking foreign-used kidneys. What fools we are!