Organ donation is a gracious act that adds more years to a sick individual’s life. It allows them to live a longer and healthier life than what they have had before. Those with end-stage heart, eye, or kidney diseases live longer than those who receive other treatment methods such as dialysis or oral medications. Those who receive organs from a living donor are said to live 12 to 20 more years as compared with those who receive organ donation from a deceased donor. However, regardless of where the organs come from, the reality is that there is a shortage of organs for transplantation all over the world. The list of patients waiting for donors run in the hundreds of thousands, with about 100,000 of them waiting for kidney donors alone. This has led to questions about the possibility of purchasing organs for transplantation, which, in turn, has spawned debates in terms of the moral, ethical, and legal issues concerning the trade of organs. Selling and buying organs impinges upon the dignity of the most vulnerable. The sellers suffer a loss of dignity both in how they perceive themselves and how their neighbors perceive them.
MacKellar (2014) asserted that there is indeed a high demand for organs, but the issue is that demand is higher than the supply (p. 53). For instance, reports revealed that there is “an estimated 120,000 patients in the US [waiting] for an organ with this list growing at a rate of almost 5,000 individuals per year” (p. 53). As the demand is higher than the supply, the growing proposition from healthcare managers, physicians, and ethicists is to introduce a “regulated system of payment for organs” (p. 53), with the idea that when financial incentives are in place, more individuals will be encouraged to sell their healthy organs to address the organ shortage and help save sick individuals.
Based on a 2013 proposal, living kidney donors will be paid as high as US$10,000, which could help in increasing the number of transplant operations by 5% and reduce the number of patients on the waiting list (MacKellar, 2014, p. 54). Thus, this could help in increasing the number of organs available for transplantation. However, the condition is that this must be done using a “government or third party administered system of paying living donors” (MacKellar, 2014, p. 54).
This is where the issue of human dignity and commoditization of organs come in. While the idea of selling organs is supported by some in the medical industry, it is frowned upon by some ethicists who believe that this will initiate the illegal trading of organs for money. Moniruzzaman (2012) emphasized that “organ commodification is seriously exploitative and ethically reprehensible, as organs are extracted from the bodies of the poor by inflicting a novel form of bioviolence against them” (p. 70). He cites the People’s Republic of Bangladesh as an example where trading organs has become a way of living for some of the poorest members of society. Newspapers openly advertise the need for various organs that will be paid for by the patients’ families. This has attracted people from all walks of life to consider giving up their organs in order to save money and get out of poverty. Despite laws prohibiting the selling and purchasing of organs and body parts, it is undoubtedly a growing business in the country. Recipients usually are the locals or foreigners who eventually have their surgeries done in nearby countries like India, Thailand, Singapore, or other European countries (p. 71).
Some medical anthropologists are greatly against the commoditization of organs and body parts, stressing that this practice takes advantage of the underprivileged sector of society considering that mostly the poor are the ones in the “business” of selling their healthy, or even unhealthy, organs in exchange for money” (Moniruzzaman, 2012, p. 71). This is what Moniruzzaman (2012) calls bioviolence, which is the procurement of “fresh organs from a subset of the population” (p. 72) and the exploitation of the body, whether in parts or as a whole, as a means to an end (p. 72). It is masked in the belief that sellers are able to help prolong the life of another individual, but to the detriment of the seller’s health and dignity. In Bangladesh, for instance, it is difficult to connect with anyone selling their organs as it is outlawed and considered an underground bazaar. In most cases, individuals who sell their organs do not let their families know about it because it is considered a disgraceful or humiliating act.
Most of the time, sellers were forced to “vend” their organs out of poverty and most often, they are deceived and manipulated into believing false stories about how an individual can function even with only one kidney and still be healthy (Moniruzzaman, 2012, p. 75). They are usually promised good accommodations, given false guarantees that the operation will be safe, and that going abroad means sightseeing for a few days and eating out a lot, among others. (Moniruzzaman, 2012, p. 77). However, during the operative stage, that is when the sellers begin to realize the trickery and the effects of their actions, but they can no longer back out of the deal. Most sellers stay in dismal accommodations in India as they share a small room with about 10 other sellers. When they attempt to confront the buyers or the brokers, they experience threats and harassments instead. Additionally, when sellers ask for their payment, they are told they will get paid after the operation or in Bangladesh, where they return to their old life with a damaged body and troubled mind and soul (Moniruzzaman, 2012, p. 78). Upon their return, their psychological agony begins as they try to avoid questions about their long absence. They also hide their scars in fear of further questioning and avoid the social stigma of having sold their kidney (Moniruzzaman, 2012, p. 80). However, in cases when scars are revealed, they make up stories about accidents that caused the scar instead of disclosing the true events. Thus, many of them opt not marry anymore in fear of being ostracized by their families and society (Moniruzzaman, 2012, p. 79). In the end, the promise and the dream of leaving a life of poverty is not met as they return to Bangladesh scarred and unfit to carry on with their previous lives because of the effects of the operation or having just one kidney left. Still, adding to their psychological troubles is the fact that many of them do not receive the agreed amount for the organs. Whatever amount they receive they either use to pay off debt, buy some material things, or start a small business, among others (Moniruzzaman, 2012, p. 79).
Moniruzzaman (2012) stressed that many of the sellers feel ashamed of their actions as they become the laughing stock in their communities because either no one would want to marry them or it becomes a reason for marital conflict that sometimes leads to divorce (p. 80). Economically, they experience huge sufferings as well because most of them lose their jobs due to long absences from work or are no longer able to perform physical or manual work like they used to (p. 81). Health-wise, the procedure has also left them with negative impacts on their health as most experience dizziness, weight loss, high blood pressure, shortness of breath, fatigue, fever, and loss of appetite, among others (p. 81).
In an interview that Elizabeth Tadic (2007) had, the interviewee responded by saying he felt ashamed of what he has done to the body that God has given him (p. 1). They felt they have dishonored the body that was given to them and they have disgraced themselves before God and man. During the interview, most of the interviewees said they did it out of poverty so they could feed their children, although there were also some who said they did it for humanitarian reasons as they were not paid when they donated their kidneys. But, one thing that is common among those who sold their organs is that they still ended up in a state of poverty and sometimes, even worse than before selling their organs.
This perspective falls under the second quadrant that states, “Rethinking the dignity that humans can acquire (or lose) through a sense of self-worth” because the main thought here is how man loses their dignity because of their poor choices and decisions. They were taken advantage of by unscrupulous people who only wanted to make money out of them. Thus, they were led to believe that their financial problems will be solved after selling their organs.
References
MacKellar, C. (2014). Human organ markets and inherent human dignity. The New Bioethics, 20(1): 53-71. Retrieved from http://www.tandfonline.com/doi/pdf/10.1179/2050287714Z.00000000043
Moniruzzaman, M. (2012). Living cadavers’ in Bangladesh: bioviolence in the human organ bazaar. Medical Anthropology Quarterly 26(1): 69-91. PDF.
Tadic, E. (2007). The cruelest cut – Pakistan’s kidney mafia. Journeyman Pictures, aired on Dateline, SBS, June 13, 2007.
