be careful when you sell that kidney

Back to vital organs with three more posts...

First, from Anuj Chopra in U.S. News and World Report on the seamy side of a (legal, extra-legal, or illegal) market for vital organs...

Tears well up in Guna Ponraj's rheumy eyes as he stares at the hideous scar running down his side. A year ago, he consented to a practice he assumed would be the swiftest way to escape his mounting debts: swapping a kidney for cash.

An organ procurer promised Ponraj, 38, an auto rickshaw driver with a fourth-grade education, $2,500 for one of his kidneys. "Humans don't need two kidneys, I was made to believe," he says, now lamenting his decision. "I can sell my extra kidney and become rich, I thought." But he was swindled and received only half that much. And since the operation, Ponraj often misses work because of excruciating pain around his hip, pushing him more deeply into debt.

Many Indian cities, such as Chennai in southern India, are becoming hubs for the illicit kidney business, despite a 1994 ban on such trade in human organs. Organized rings of hustlers, working in cooperation with some doctors, prowl slum neighborhoods for vulnerable donors like Ponraj to supply a growing number of mainly foreign patients seeking kidney transplants.

In Gurgaon, an upscale Delhi suburb, the Indian police in late January dismantled an illegal organ racket—which authorities described as the largest ever broken up in India—that allegedly removed kidneys from about 500 laborers, the majority of them abducted or conned, and sold the organs to wealthy clients over a period of years. Police allege that the doctor, Amit Kumar, 40, drove around looking for possible donors, sometimes testing them on the spot with equipment in his car and other times luring them to an apartment where he has surgical gear....

Analysts say the kidney business thrives with foreigners drawn here for many of the same factors that have made India a top destination for medical tourism: low costs and highly qualified doctors. An illegal kidney transplant here can cost a third of the $70,000 price of the operation in China, not to mention avoiding the kind of strict organ-donation rules that apply in western countries.

Corrupt doctors in India work in tandem with organized middlemen adept at circumventing Indian law. The 1994 Transplant of Human Organ Act permits only relatives of patients to donate kidneys for transplantation (or a reciprocal arrangement between two needy families). But middlemen manage to masquerade donors as relatives or otherwise find ways to elude the rules, with little interest in the well-being of kidney providers....

Although kidney trade is banned in most countries, including the United States, the Brussels-based International Society of Nephrology has suggested expanding the pool of kidney donors by legalizing payment of about $40,000 to donors. "The choice before us is not between buying or not buying organs," says Ravichandran. "This is happening regardless of the law. The choice is whether transplant operations and the sale of organs will be regulated or not."

Getting rid of the fraud-- promising one thing and delivering another-- is a no-brainer. If so, this could be reduced to a standard market. (Because it involves the human body, it is more complicated theologically-- as I'll cover in the next post.) In any case, however one thinks about this issue, it does reduce to market analysis-- at least to the extent that a required price of zero (i.e., a prohibition on trade) results in a shortage and thousands of people dying every year.