Kidney for sale
A National Geographic Special “Taboo” opened with a shot of a group of men from Baseco Compound in Tondo, Manila raising their shirts to expose surgical scars near the hip. These marks are reminders that desperation and poverty had once driven them to do what’s unthinkable: sell their kidneys.
Selling the kidney is still considered taboo in many societies where organ donation is viewed as a humanitarian gesture, price tag-free. That “Taboo” episode raised ethical issues on the legalization of the organ trade in the Philippines, particularly “non-related or non-directed kidney donations” where one sells his kidney to a middleman who earns commissions. In much of the world kidneys may only come from the deceased who had “pledged to donate” his organs upon death, relatives of those that need a kidney transplant, or voluntary and referred donors.
The episode further raised the questions on how far a person should go for a short term reprieve from poverty and how far should the government go in allowing these practices.
No less than the World Health Organization had tagged the Philippines as a “global organ trafficking hotspot.” Our country which, in 2007, was among the top five kidney-trading countries in the world had modified its organ donation system by allowing the “open” kidney trade.
At first, the country didn’t mind the notoriety. The practice eased the shortage of kidneys and benefited those in dire need of transplant and healthy people in dire need of money. This symbiosis between the poor-and-healthy and the sick-and-wealthy has resulted in brisk kidney “sales.” The open trade was also pivotal as the country positioned itself as a major player in the medical tourism field some years ago.
The kidney trade prospered in depressed communities such as Baseco Tondo or extremely impoverished rural areas, and hogged national headlines due to the many abuses of the trade. The sale often passed through a broker who rips off the donor via commissions of as much as 50 percent of their agreed “price”. This prompted the government to enforce a ban on non-related kidney donations. Backed by conservative doctors and religious groups, the ban was also intended to end what they called “unethical” medical practices.
The ban on non-related donations resulted in a shortage in kidneys. The National Kidney and Transplant Institute (NKTI) perform at least 500 kidney transplants in a year, while several other government and private hospitals perform the same procedures throughout the country. The sheer number of patients in dire need of a transplant continues to grow while the number of donors has declined.
Based on NKTI projections there are only about 30 donations from dead donors each year and only about six of these are viable for transplant. Living Non-Related Donors (LNRD) used to be more readily available and accounts for over 200 transplants a year.
Patients in need of a kidney transplant found an ally in the Philippine Medial Association (PMA) which recently appealed to the Department of Health to review and lift the ban. According to PMA President Oscar Tinio, the lifting of the ban is critical in saving the lives.
“There are numerous patients in the country who are fighting for their lives, in a death row-like queue, waiting for this life saving procedure to be performed on them,” Tinio said.
The PMA in its recent statement acknowledged that abuses were committed in the past as it condemns these unscrupulous acts. “However, the fact remains today that there is not enough supply of donor organs that can save the lives of our patients,” Tinio added.
Because of the DOH prohibition on LNRD who accept rewards or incentives, the number of transplants has dropped significantly. At the NKTI alone the average Filipino kidney transplants (about 300 procedures a year) is down by 20 percent in 2010, while demand is up 10 percent annually.
“There are almost 12,000 dialysis patients in the country today. Of these, at least half are suitable transplant candidates. If there are 6,000 transplantable patients and only less than 500 get a kidney, then only 8 percent of the need can be supplied,” Tinio said.
While the PMA appeals to the DOH to lift the ban on LNRD, it also encourages the government impose safety nets to prevent abuses. These include greater surveillance and implementation of regulations by the DOH assisted by the private sector; the elimination of organ brokers; a regulated system of donor recruitment and allocation guarded by the private and religious sector; a supervised post-donation follow-up of donors; and the promotion of deceased (brain dead) organ donation.
According to Tinio, a purely altruistic organ donation has not worked anywhere in the world. Even with a good deceased donor program, the problem still persists as the number of patients in the transplant waiting list gets longer.
“Life is priceless; therefore the kidney that saves it is priceless. What the organ provider donates is whatever infinite value we assign to “priceless” less the amount given,” Tinio said.*
