Chapter 24
Organ Selling, Organ Theft

"But obviously you do have to suspect something when the patient is a wealthy Rio socialite and her "donor" is a poor, barefoot "cousin" from the country."
Nancy Scheper-Hughes 163

You might have heard the "myth" about the man visiting a bar in a foreign country and being invited for a drink by a young woman. He wakes up next morning in a hotel room with a thank you note and two sewn up wounds from where his kidneys were extracted. This often repeated tale might have taken place in any exotic city in the world. Harvest promoters minimize and cloud the reality of the organ trade with these exaggerated tales. Their unreliability is used as proof that organ theft is of minimal concern.



The reality is that it is cheaper and easier to pay an impoverished person a few thousand dollars for a kidney than create an elaborate organ theft scheme. An organ seller doesn't need to be trapped or imprisoned but will wait patiently while disease and tissue matching tests are completed, and the organ tourist prepared. A vast network of organ brokers concentrate on Pakistan, India, South Africa, Peru, Romania, Bolivia, Brazil,164 and China as source destinations. Buyers arrive from the richer European countries and Israel, United States, Canada, Australia, New Zealand, Japan and some Arab countries. Buying an organ requires money and lack of conscience. Selling requires a sense of despair and hopelessness. Following are a few examples of the organ trade.

India

The police in Amritsar city in Punjab state, India unearthed what they call "the mother of all scandals in human organ trafficking in India."
Indian organ sellers were paid less than $US1000 for a kidney then didn't receive adequate post-operative care. They were threatened with imprisonment for breaking the law prohibiting organ selling if they complained to police. At least six died of post donation complications.

The police have arrested several doctors, middlemen, and donors, including the alleged main player. He is transplant surgeon, Dr Parveen Kumar Sareen, who works for Kakkar Hospital which is run by a private charitable trust. Also arrested was Dr O P Mahajan, principal of the Government Medical College and chairman of the authorisation committee that certifies that no commercial transaction has taken place.165

United States of America

Bart Wheatley of Intermountain Donation Services in Utah obtained the body of a young man who had committed suicide. He wasn't fazed that the body had lain in the victim's bedroom for nineteen hours without refrigeration. Twelve hours is the safe limit otherwise Clostridium sordelli bacteria might have broken through the intestinal walls and contaminated the body.

However, business is business and Wheatley sold parts of the body to CryoLife in Georgia for $10,500. CryoLife's cost cutting program had reduced testing for body parts bacteria, which was bad news for Brian Lukins, a patient at St. Cloud Hospital in Minnesota. He thought he was getting a simple bone transplant into his knee. So did Dr Mulawka, his surgeon.166 The problem was the dead guy's bone was infected by Clostridium sordelli bacteria. It entered the blood stream of Brian. He felt really bad, turned grey and then died.

Alistair Cooke did much better. He was the famous British/American journalist who died of cancer in 2004 at the age of 95. He was dead just twenty-four hours when morgue operators were already ripping out his bones, illegally. No one knew this until police discovered Cooke's funeral directors were involved in a stolen body parts racket. If this can happen to a famous dude like Alistair Cooke imagine what might happen to us less famous people.167

The United States Food and Drug Administration recently shut down body collector, Donor Referral Services in North Carolina. They said donor records did not match death certificates that listed cancer and drug use. It was a case of mutton dressed up as lamb so to speak.

The FDA and the Centres for Disease Control and Prevention recommended that doctors offer hepatitis B and C, syphilis and HIV tests to those having received corpse material harvested by the company.

Phil Guvett, spokesman for Donor Referral Services has denied any wrongdoing.


Presumed Consent in Los Angeles

Governments rarely broadcast their presumed consent laws. Why panic the population who might rush to become organ keepers. Governments instead harvest body parts surreptitiously without prior permission of either the deceased or next of kin. They don't even inform relatives that harvesting took place. This quiet process was interrupted in Los Angeles when Doheny Eye and Tissue Bank was caught harvesting the corneas from the body of shooting victim, Ralph Frammolino. Ralph's sister and parents registered their objections to donation the morning after his death, but the harvesters rose earlier and had already grabbed his corneas. They paid $250 then sold them to a transplant institution for $3400.168

The American states using presumed consent are California, Florida, Hawaii, Kentucky, Louisiana, Maryland, Michigan, North Carolina and Wisconsin.

In one group questioned in Kentucky just 6.6% knew that presumed consent laws existed despite being enacted for ten years.169

The American Red Cross was caught stealing the bones of Arizona woman, Heather Ramirez who died in a car smash. Heather’s parents had agreed to give her eyes to an Eye Bank and heart valves, veins and skin to the Red Cross, but not her bones. The Red Cross took them anyway. An employee forged Heather’s father’s initials on a bone consent form. After this discovery the Red Cross still refused to return the bones. Greg and Lucinda Ramirez sued the Red Cross but it was not until two years after Heather's death that the bones were returned. Red Cross spokesman Mike Fulwider said, "We are certainly deeply saddened by this," He didn’t say whether the sadness was due to the theft of the bones or from being caught.170

Lack of Respect

17,500 bodies are donated for medical and research testing in the United States annually. This is on top of 5500 "brain dead" and 20,000 cardiac dead donors. The bodies donated for medical research are used by surgeons and students for practice sessions and as surgery models at conferences. Four thousand bodies go for experiments including putting heads in helmets and then dropping them from a height to test the helmet’s strength. Other bodies are strapped into cars that are smashed against walls to test air bag strength. Arms are tied to snowboards then dropped to test wrist braces. Relatives are rarely asked permission because, as Russel Sherwin of the University of Southern California says, too many objected.171

Funeral home owner John Vincent Scalia bought nine bodies from the Louisiana State University and the Tulane School of Medicine for which he paid the latter $8640. Scalia resold them to the United States Army for $37,485. The Army used them for testing ballistic body armour in land mine experiments.172 The Army video of the testing could be titled, "Whatever happened to Grandpa?"

Back in 1996 the University of California Los Angeles suffered a class action by donor families whose relatives' bodies had been donated for research. The University had promised when finished with the bodies to either bury the remains or scatter the ashes after cremation in a rose garden. Donor families were unhappy when they discovered UCLA had burned them in piles alongside medical waste then sent the ashes to a landfill.173

China

"The bodies were thrown into the boiler room at the hospital,"174

Most people understand that China sells organs from executed prisoners to wealthy foreigners. You simply locate a broker, pay the money and fly to China. Why wait four years for a kidney when you can get one in two weeks. You undergo immunosuppressive treatment while they choose the right prisoner. Two living humans enter the surgical theatre and one comes out alive.

Harry Wu, the Chinese political activist, speaking at a conference at Berkeley’s Department of Anthropology, University of California said,

"I interviewed a doctor who routinely participated in removing kidneys from condemned prisoners…she had even participated in a surgery in which two kidneys were removed from a living anaesthetised prisoner late at night. The following morning the prisoner was executed by a bullet in the head." 175, 175a

Testimony is also emerging that members of the Falun Gong religious movement are the latest source of organs for the Chinese transplant industry. Young Falun Gong prisoners are allegedly initially beaten then suddenly treated like hospital patients undergoing tests. Organs are also harvested daily from prostitutes, Tibetans, political dissidents, and criminals.176

China doesn't have an organ donation system like the richer countries. There are rare instances of kidney donation within families plus a dozen voluntary "brain dead" donations have been performed overall, but this is from a population of 1.3 billion people. The Chinese believe that being a voluntary organ donor sounds as logical as becoming a voluntary prisoner: it doesn't make sense.

Anatomy Classes

The University of New South Wales has apologised to families of people whose bodies had been donated for anatomy classes. Allegations have risen that breasts were fondled and a head used for degrading purposes.
Chris Game, speaking for the National Tertiary Education Union, said a laboratory supervisor had long tried to alert authorities about his concerns.

The university's Deputy Vice-Chancellor Professor Richard Henry has denied there was a cover-up.181

Forensic Crime Tests

Professor Hilton repeatedly stabbed one body at the Glebe Institute of Forensic Medicine in Sydney to gain knowledge for a crime trial. Other employees belted the head of a crime victim with a hammer for investigative purposes. They also removed spinal columns for use elsewhere and performed nose jobs on bodies for practice. These were reasonable forensic and medical activities but next of kin weren't sought for permission.

Other Glebe Morgue employees stole clothing, shoes and personal affects from fresh bodies brought in from car smashes. The Morgue now employs non-doctors to remove bones from cadavers and sends them in cooler boxes to Australian Bio-technologies in Sydney for processing into bone paste and transplantable bone shapes.

CONTROVERSY
Debate
Commentary. An ethical market in human organs

J Radcliffe Richards

Centre for Bioethics and Philosophy of Medicine, Department of Medicine, University College London, Gower Street, London WC1E 6BT, UK; j.rr@chime.ucl.ac.uk

Accepted 17 March 2003

Keywords: human organ donation; ethics of human organ donation; ethical markets

This paper offers a positive suggestion for the management of a market in organs for transplant; and in doing so provides a useful opportunity for clarifying the structure of the Great Organ Sales Debate.

The issue is in constant need of clarification, because it is usually aired as a political question of the For and Against variety: should organ selling be legal or not? This format usually encourages protagonists to collect into an unsorted heap whatever arguments look as though they might have any persuasive force on their side, and because people may be on the same political side for different moral reasons, or have the same moral principles but reach different political conclusions, the political arguments tend to obscure both the real issues and the logical structure of the controversy.

Although attitudes to organ selling seem to have relaxed somewhat since the subject first came to light about a dozen years ago, most professional and political opinion is still against it. But what is the moral basis of this opposition? If you think organ selling should remain illegal, what exactly is your reason? Is it that you regard selling body parts as wrong in itself, irrespective of consequences? Or is it because you think that although it is not wrong in itself, in practice the harms will usually or always outweigh the benefits? Either of these quite different views might support the same political conclusion.

In practice, it is not clear that many opponents of organ selling have ever recognised the distinction. Most of the individual arguments are of a kind that implies the second view, because they are about anticipated harms of allowing the practice: coercion, exploitation, shoddy standards, profiteering, misinformation, undermining altruism, deterring donation, and the like. But the overall structure of the debate makes it pretty clear that most opponents are totally against the buying and selling of organs on principle. One indication of this is the astonishing speed with which the practice was denounced and prohibited when it first came to light. There was no agonised weighing of pros and cons, as you would expect if what mattered was to balance good and bad effects; indeed the rather striking prima facie benefits of allowing the sales—saving lives, and allowing would be vendors to decide for themselves about their own best interests—were not even mentioned. Another indication that most opposition is rooted in the idea that organ selling is simply wrong in itself is the fact that whenever an argument on the Against side is demolished, others immediately appear to take its place. If the vanquished argument were the real basis of the objection, the objection should disappear. Since it does not, it is clear that most opponents have objections other than the ones they offer.

To the practically minded it may seem that moral division—or confusion—among the politically united does not matter much. But in fact the division between these two kinds of reason for objecting to organ sales is much more significant than the all-things-considered political conclusion. It is of crucial importance to the conduct of the debate. If you regard organ selling as wrong in itself you may well embrace all suggestions of dangers and difficulties with relief, because they seem to strengthen the political case for prohibition. But if you start with the idea that what matters is to weigh harms and benefits, and that there is a prima facie case for allowing transactions that can save the life of purchasers and give vendors something they value more than their kidney, you will look at the objections raised in quite a different way.

In the first place you will look at them critically, rather than rushing to accept them—and will soon find that a good many have no force at all, because they involve logical fallacies or invented facts.1 And then, when you find real dangers and difficulties, you will try to devise techniques for avoiding the harm while keeping the good. This is, after all, what we automatically do in other contexts. The existence of rogue builders and medical quacks does not lead us to try to stop building or medicine altogether: obviously, we aim for controls that will minimise the bad but keep the good. (When possible dangers of organ selling are treated as objections to the whole idea, rather than as problems to be overcome if possible, that is further evidence that they are not the real objection.)

It is in this context that the Erin and Harris proposal should be understood. The authors recognise that there is a prima facie case for allowing organ sales, but they also recognise that a totally free market could do a great deal of harm. What they propose, therefore, is a restricted market, designed to allow the benefits while preventing these harms.

So how good a proposal is it? Once you get beyond the idea that organ selling is wrong in itself, you are into the terrain of highly complex empirical questions, and there is no point in philosophers’s (or anyone’s) engaging in armchair speculation about them. Recognition of how this proposal fits into the debate as a whole does suggest, however, the kinds of question that should be raised about it.

If it is presumptively bad to prevent sales altogether, because lives will be lost and adults deprived of an option some would choose if they could, it is for the same reason presumptively bad to restrict the selling of organs. Once you recognise that the default presumption is in favour of any such transaction, you should be reluctant to prevent any more sales than necessary. The Erin and Harris proposal, if viewed as representing the only circumstances in which buying and selling should be allowed, is restrictive in many ways. Is there good enough reason for ruling out the many potential sales it would prevent? Here are one or two questions about it.

For instance, the idea of achieving equity of distribution by limiting purchases to public bodies, is obviously attractive. But in countries where there is no such service, or where it is generally accepted (as here) that people who find the public service inadequate to their needs should be allowed to go outside it, is there any justification for providing special restrictions on the freedom to make private arrangements to find a kidney? It would probably be best to have public bodies that supplied all needs—but until all needs are supplied in this way, is there any good reason to prevent (properly controlled) private arrangements?

And how good is the justification for keeping the market within a "self governing geopolitical area"? Of course there is something undesirable about a one way international traffic from poor to rich; but that is not enough to settle the all-things-considered question of whether it should be allowed. Much international trade is currently objectionable on the same grounds, but simply stopping it would be worse for the poor countries. It is much better, for them, to improve the conditions of trade than to prevent it altogether. Is the case different with organs?

These questions are not intended as rhetorical: they may have answers. Or even if they have not, perhaps the proposal is restricted to give it greater chance of political success. But the matter does need to be checked. It is clear that strong feelings against organ selling colour every aspect of the debate, giving apparent weight to arguments whose inadequacy nobody could miss in neutral circumstances. Could such feelings be influencing even this proposal, making it more restrictive than it should be? Whatever the answer, it is morally essential to ask the question.

REFERENCE

1. Radcliffe Richards J. Nephrarious goings on: kidney sales and moral arguments. J Med Philos 1996;21:375–416. (For a detailed account of the familiar arguments and their shortcomings.) A summarised version also appears in Radcliffe Richards J, Daar AS, Guttman RD, et al, for the International Forum for Transplant Ethics. The case for allowing kidney sales. Lancet 1998;351:1950–2.[Abstract/Free Full Text]

Pope Benedict XVI on Friday lamented the shortage of organs for transplants but denounced any selling of organs as immoral.

"The problem of availability of organs for transplant, unfortunately, isn't theoretical but dramatically real," the pontiff said in a speech to participants of a Vatican-sponsored meeting on organ donations.

But any "buying and selling of organs ... would go against the meaning of donation" and would be "morally illicit," the pope said.

A few years before he was elected pontiff, Benedict said in an interview that he carries a card identifying him as an organ donor.

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