Political economy of human organ selling

The debate on trade in kidneys for economic gain (1, 2, 3, 4) has become polarised between those who do not view this as different from any other economic gain (those not attaching any moral value to any economic transaction), and those who view this in the context of human realities, like poverty, that drive people to make a forced ‘choice’ of selling an organ for an economic consideration.

In this globalised and market-oriented world, there is a tendency to commodify everything and this includes human organs. Everything must be viewed in a detached and ‘objective’ manner and should not be adulterated with any values.

Unfortunately human life and living do not work that way, and more so in our part of the world. In the real world things are not black and white but there are many shades of grey. One example with which we have had experience for a number of years is blood donation. Professional blood donation was permitted and had become quite messy but it took the HIV/AIDS scare to put a stop to it, at least officially. Voluntary blood donation is encouraged and whenever a patient needs blood, relatives and friends must contribute without any monetary compensation.

Why can’t we follow the same principle for kidney donation? Encourage people to donate their kidneys on death to a public ‘kidney bank’. Anyone needing a transplant must get a relative or friend to pledge their kidneys on death. The option of a live donation from a compatible relative may also be kept open as an exception, but this should be subject to an ethical review to assure that no undue advantage is taken, or any payment made. And of course this should be only in the public domain. (By public domain I do not necessarily mean the government, it could also be an association of the concerned profession.)

This is not very different from the question of the misuse of amniocentesis. Just because the technology is misused, we cannot ban it since it also serves a useful purpose. There has to be control over the use of the technology by the profession. We know that legislation in the case of amniocentesis has not worked effectively. It can only work if the medical profession becomes ethical in its use and any misuse is dealt with severely by professional bodies. For example, the Federation of Obstetric and Gynaecological Societies of India (FOGSI) should take a lead and pressurise its fraternity to stop sex-determination tests. The fact that FOGSI has not done this shows the lack of ethical concern within the association. On the positive side, there has been a report from Bhuj that prescriptions and other stationery used by obstetricians and gynaecologists in that region carry a slogan that sex-determination is a crime. FOGSI must use such examples to advantage and get its members and other related specialists to become concerned and bring about a change in practice.

Coming back to the kidney trade, there is also the concern of inadequate access to dialysis facilities for affected patients. With increasing privatisation the situation is becoming worse. Access to such care for the poor, who are the majority in this country, is becoming increasingly out of reach. If we are concerned about equity — and we ought to be, given that we are a society with an exceptionally large population with insufficient access to basic needs including health care — then we ought to be concerned about the increasing commodification of health care. Public investment is declining and the private sector is booming. It was not very long ago that specialist care was largely in the public domain but today even that is being monopolised by the private sector. If things continue in the same vein then arguments in favour of allowing free trade in human organs will gain momentum.

Thus we must view the human organ trade in the context of this overall political economy of health care. If we allow the organ trade we will be favouring a small class of people who can buy out the desperate poor. It will also create its own economy of middlemen who will facilitate this trade. Experience teaches us that whenever such middlemen take over, the beneficiary is neither the buyer nor the seller.

In this case there is a third loser – the medical professionwhich is fast losing its credibility because of the large number of unethical practices which increasingly characterise it. We are fortunate that a large majority of the medical profession world wide is either against the human organ trade or at best ambivalent.

So we do have a hope that the banias can be prevented from taking over control of human organs. However, this will depend entirely on the ethical standards medical professionals set for themselves.