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While we giggle over the dining table about having to sell our kidneys to afford the new Tesla, naive Kenam Tamang from Hokshe, the ‘kidney village’ in Nepal is duped into selling one to make ends meet. The harsh reality sets in when we dive deeper to explore the Red Market- a term coined by journalist Scott Carney for the lucrative global marketplace for blood, bones, and organs. Scott figures he’s worth about $250,000, but that number isn’t based on his savings or assets; it’s what Carney thinks his body would fetch if it were broken down into individual parts and sold on what he calls the “red market.”

In a manner similar to a mechanic swapping out worn car parts for new ones to get an engine running again, a surgeon can prolong someone’s life by trading broken pieces for newer ones. Every year the technology barriers get lower and the process cheaper. However, there are no scrap heaps for organs. The human body is too complex to be artificially manufactured in labs or factories. Hence, when the demand arises for a new organ, the solely available resort for raw materials is other fellow humans, lucrative amalgamations of organs, tissues, and plasma!

The organ trade like any other trade is driven by the market forces of ‘demand and supply’. The incongruence between the skyrocketing demand and the inadequate supply of the same has been one of the driving forces for the thriving illegal market. The body is treated as a commodity making all red market transactions ethically troubling for the pivotal role social classes play in the entire process. The organs from the market are often directed to the affluent section of the society or to people from other countries reducing the entirety of the process to commerce rapidly. While exact figures are difficult to come by, the illegal trade of all organs generates between US$840 million and $1.7 billion annually and accounts for an estimated 10 percent of transplanted organs, according to a 2017 report from Global Financial Integrity (GFI), a non-profit research and advisory organization focused on illicit financial flows.

Before the performance of the first successful kidney transplantation, the only solution for people suffering from ESRD was either death or haemodialysis. However, in 1954 Murray along with his team performed a path-breaking kidney transplant on identical twins. This placed another problem on the map of finding an identical twin to avoid a negative immunological reaction. What followed in the 1970s was the discovery of an immunosuppressant, the wonder drug ‘Cyclosporine’ capable of suppressing adverse immunological reactions in patients. It made the process safely possible for not only related but also unrelated individuals. This medical success paved the way for increased demand for transplantations.

This when coupled with the rising trend in underlying morbidities took the Red Market to newer heights. Data provided by ECPR from 54 countries show that at least 80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension, or a combination of the two. Over the past decade, the global age-standardized prevalence of diabetes has seen a nearly double increase from 4.7% to 8.5% in the adult population. An estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. When a failing heart, liver, or other vital organ proves resistant to all available forms of treatment, a dying patient’s only shot at survival may be an organ transplant. The data indicates the propensity of increasing demand of organs for transplantation and even with the best organ harvesting systems and procedures in countries (such as Spain and the USA), there is likely to be a wide gap in the demand and supply of organs. In Western Europe, as a whole 40,000 patients await a kidney but only 10,000 kidneys become available. This gap is ever increasing in most countries, particularly in developing countries. In India, around 2,00,000 people need a kidney every year, but only around 3% of the demand is met. Of these 2,00,000 in need of a kidney, around 15,000 can afford treatment but only 7,000 of these can afford transplants.

The response to the worldwide organ crisis was an international black market of organs. Cyclosporine further opened doors for global organ traffic. This illicit trade also manages to bring strangers from different ethnic groups, classes, religions, political affiliations and nations under the same umbrella for transplant of organs and tissues. The popular trajectory of this traffic is directed from South to North, East to West, poor and low-status men to more affluent men. The Red Market has led to the identification of a source of organs in the bodies of the poor, the medically illiterate, the displaced and the desperate. The transactions range from being consensual contracts both formal and informal, to coerced deals, to criminal trafficking verging on transnational kidnapping by local and international brokers involved in a multi-million-dollar business. It is the disparities in the economy, health care, and regulatory policies that have created organ donor vs organ recipient nations.

A globalized world when garnished with the aforementioned disparities paves way for ‘transplant tourism’ which is more or less akin to illegal organ trade. In this, the patients who are potential recipients of the organs travel to another country to facilitate the transplant process. This procedure is usually carried out by intermediaries and health-care providers who arrange for the travel and the donors. Despite active efforts to curb transplant tourism and promote altruistic donation, the implementation has been ineffective considering how convenient and accessible the former is. A latent con of the process has to be the varying infectious disease profiles that differing countries have and the medical history of organ vendors not being examined properly.

The availability of low-cost, commercial organ donors is not a challenge for a country like India where the majority of the population finds itself below the poverty line. Touts and middlemen dupe people and exploit their vulnerable positions to procure organs. They particularly prefer the slums, a goldmine for the organ traders, where the underprivileged surviving in appalling living conditions hoped to uplift themselves by selling their kidneys. For years, India was known as a “warehouse for kidneys” or a “great organ bazaar”, offering kidneys at menial cost and ensuring almost immediate availability.

It doesn’t stop at organs, tissues, or blood when the marketplace has customers for human hair as well! Hair or ‘Black Gold’ enjoys a market of about $900 million around the world, and around 40 percent of that hair is sold for human extensions. Many of the transactions of the ‘Black Gold market’ takes place at the Sri Tirumala Temple in southern India, where people give their hair to the god Vishnu as an act of devotion. The hair is collected, combed, sorted and sold at an auction to be shipped to the international markets. Hair collected in a single cut from a person’s head, known as “remy,” is used all over the world for hair extensions while the shorter hair often collected from men is sold to chemical companies and gets reduced to an amino acid called L-cystine to be used as a leavening agent in baking goods.

Public anxieties over organ harvesting have been diffused into a moralistic debate over organ sales, reducing a complex humanitarian issue into a narrow bioethical transaction, negotiating the ethical parameters of what can be considered good transplant practice (using organs sourced from altruistic donors) versus bad transplant practice (using organs sourced from commercial donors).

We have two sides of the coin here as well. Those in favour of the red market say that there is no clear illegal/legal divide here when lives are at stake. Organ markets exist to serve the surplus demand for organs fuelled by the commercial expansion of the transplant industry. This transfer of transplant technologies is contingent on the supply of organs. When the supply cannot be satisfied by legal channels, organs are sourced from commercial donors, or in some instances from individuals who have been coerced into having one or more organs removed. The informal networks that support the organ trade are not isolated units possessing a purely criminal modus operandi.

However, some argue for the market to be a perversely criminal phenomenon, a social aberration far removed from the ethical domain of transplant medicine and exploitation of the needy. A study reveals that it is not the commercial donors or the organ recipients who benefit the most from the trade. The maximum benefit, that is economic, is for members of the organized crime networks controlling the black market and sharing the maximum profit from the trade. A number of complaints from the donors such as unpaid compensations and uninformed kidney transplantations prompted the Government of India in 1994 to enact the Transplantation of Human Organs (THO) Act, prohibiting commercial dealings in human organs. However, the THO Act served to be counterproductive as the fear of law pushed many hospitals to withdraw from the trade. To keep up with the pace of organ demand, the country witnessed the rise of an illegal organ market.

By being the only country to legalize the sale of kidneys from living donors, Iran has been able to avoid these pitfalls of a black market. For other countries, complete legalization of the Red Market continues to be a distant dream tangled in moral and legal chains. The need of the hour is to take feasible steps to counter the problem of incongruent demand and supply. Transplant professionals suggest a stringent regulatory mechanism, a strong political will to increase the rate of organ donation, and early screening of diseases could reduce the demand for organs for transplantation and limit the organ trade. Public apathy and awareness along with the proper medical infrastructure to retrieve organs are pivotal to ensure optimum organ donation in India. With a history of high rates of road accidents, the concern could be majorly combated if even 50% of the organs from the victims are procured.

No ‘body’ escapes the market. Scott Carney in his book says that ‘Though we would ideally like to think that our bodies are sacred and above the hardscrabble logic of the market, the sale of human parts is booming. It doesn’t matter what our moral position is on the subject, bodies are unquestionably ‘uncomfortable’ commodities. However, before you write a cheque and pick up human tissue, someone needs to transform it from a tiny piece of humanity into something with market value. Unlike scrap, the price of a human body isn’t only in dollars. It is measured in blood, and in the ineffable value of lives both saved and lost. When we buy a body part, we take on the liabilities for where it came from both ethically and in terms of the previous owner’s biological and genetic history. It’s a transaction that never really ends.’ So, the next time you joke about selling a kidney to buy a Tesla – think of the grave, far-reaching implications!

By Ishita Jain


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