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INSIGHT
Organ Trafficking in the Middle East
Aired August 3, 2004 - 23:00:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
JONATHAN MANN, CNN HOST: A pound of flesh. Poor people around the world are selling their organs for transplant. It isn't always legal. Is it always wrong?
Hello and welcome.
People sell their time and their labor. They sell their ideas and expertise and though most of us don't know much about the trade, dead people's organs are routinely sold for education, research and transplant.
Is it really any surprise, then, that the poor of the world are selling their own organs while they're still alive? Most of us have two functioning kidneys, for example, and can live without one of them. For people who don't have functioning kidneys, that one can make all the difference.
On our program today, the flesh trade.
We begin with Ash-har Quraishi in Pakistan.
(BEGIN VIDEOTAPE)
ASH-HAR QURAISHI, CNN ISLAMABAD BUREAU CHIEF (voice-over): Four years ago, Mohammad Ashraf (ph), desperate for money, sold one of his kidneys to repay a debt. The payoff: 104,000 rupees, just under $1,800 U.S.
MOHAMMAD ASHRAF (ph), ORGAN SELLER (through translator): My health is suffering. I'm in a lot of pain.
QURAISHI: Now too week to stand, Ashraf (ph) is out of work and ill. He shows us all that is left of the debt relief he thought he was getting.
ASHRAF (ph) (through translator): Anyone who has asked me if they should do it, I have told them no. But people like us don't have any other choice.
QURAISHI (on camera): It's a common story in small rural villages like (UNINTELLIGIBLE). People living in abject poverty looking for an easy way out. In this village alone more than half the people living here have sold one of their kidneys.
(voice-over): In countries like Pakistan, where the futile system still prevails, many like 40-year-old Nazu Mohammad (ph) sell their kidneys hoping the money will bring a better life.
NAZU MOHAMMAD (ph), ORGAN SELLER (through translator): No one does this for fun. We have all sold our kidneys to pay off a debt so that we can save our families from indentured servitude.
There is nothing here. Not even water. The land owners keep us suppressed.
QURAISHI: Mohammad says more than 20 of his relatives, men and women, have also sold their kidneys.
UNIDENTIFIED FEMALE (through translator): She has sold her kidney, and so has her 17-year-old son and her husband. But they are still just as poor as they ever were.
QURAISHI: For foreigners and wealthy Pakistanis in search of a transplant, Pakistan is fast becoming a center for the organ trade.
Pakistani transplant specialists estimate thousands of live kidneys are sold here each year. Many hospitals even advertise on the Internet, this one offering a transplant to anyone who can pay. The price tag: $14,000 U.S.
Unlike much of the world, the are no laws restricting the sale of organs in Pakistan and no regulation requiring informed consent of potential donors.
At Pakistan's busiest transplant hospital just a few miles outside Islamabad, the buying and selling of kidneys is a regular practice. The hospital's founder insists that while the majority of donors are paid, ethically the transactions are justified.
UNIDENTIFIED MALE: I feel that it is not the cost of (UNINTELLIGIBLE) so that their economical problems can also be solved and they are encouraged to donate their kidneys.
QURAISHI: Shah (ph) says regulation, not on outright ban, is the key for a country where 15,000 people sustain renal failure each year. Without live donors thousands, he says, could die.
Like 16-year-old Rebal Israr (ph). At the age of 11, both her kidneys failed. Through public donations and help from the hospital, her family was able to raise enough money to arrange for a transplant. Her father says he was prepared to do whatever it took to save her life.
UNIDENTIFIED MALE (through translator): If someone had come to me and offered to sell their kidney for $10,000, I would have found a way to buy that kidney, whether it was wrong or unethical or even against the law. I would have done anything to save my daughter's life.
QURAISHI: Opponents of organ sales, like transplant surgeon Adibel Hassan Rizbi (ph), call the buying and selling of organs the worst form of exploitation.
ADIBEL HASSAN RIZBI (ph), SURGEON: The only people who are benefited are the middlemen and the doctors who are involved with this business. The poor vendor, at the end of the day, he is the same that he was minus a kidney plus (UNINTELLIGIBLE) entirely broken down.
QURAISHI: Rizbi (ph) heads the SIND (ph) Institute of Urology and Transplantation in Karachi, the only transplant center in the country that provides treatment and transplantation free of cost.
RIZBI (ph): In this (UNINTELLIGIBLE) nearly 1,500 renal transplants.
QURAISHI: He is pushing for legislation to outlaw the sale of live organs and for the government to allow doctors to use organs from the dead for transplant purposes, something that is currently not an accepted practice in many conservative Muslim countries, like Pakistan.
RIZBI (ph): After kidney, what else are you going to sell? Liver? Lungs? Eyes? Where is it going to stop?
UNIDENTIFIED MALE: When we compare (UNINTELLIGIBLE) and I think (UNINTELLIGIBLE) no society accepts that as the cost of ethics. That is accepting ethics as a cause of death.
QURAISHI: Until some sort of transplant legislation is passed, experts say, those desperate for money, like the poor workers of rural Pakistan, and those frantically in search of a transplant donor will continue to meet and deal in the organ trade.
Ash-har Quraishi, CNN, (UNINTELLIGIBLE), Pakistan.
(END VIDEOTAPE)
MANN: We take a break. When we come back, a look at where some of the organs are going.
Stay with us.
(COMMERCIAL BREAK)
MANN: Like many religions, Judaism reveres human life and the human body. It prohibits desecration of the dead. Major Jewish denominations support transplants from both living and deceased donors but many devout Jews believe that religious law prohibits it.
Welcome back.
Israel, like many other countries, has more people waiting for organs than donating them, and many of its citizens are reluctant to donate. At the same time, sick Israelis are as eager as anyone for help.
CNN's Alessio Vinci has this look.
(BEGIN VIDEOTAPE)
ALESSIO VINCI, CNN CORRESPONDENT (voice-over): He's a 22-year-old Israeli we'll call Michael. He has been dead almost 24 hours of a brain hemorrhage during a trip to California.
Michael's family offered to donate his organs for transplant, but only if his body could be returned home to Israel, a decision that put Israeli transplant surgeons in an unusual position.
UNIDENTIFIED MALE: Unusual because usually we ship organs to their target and here we have had to ship the donor to Israel.
A foundation paid $50,000 to fly Michael's body home, his organs destined to help save seven people in dire need.
UNIDENTIFIED MALE: Moving the entire body of the organ donor such a long distance to Israel could have well ended up with the total destruction of all organs, so we were lucky. I guess we were lucky.
VINCI: Michael's heart was transplanted into 43-year-old Jacob Misika (ph), victim of a massive stroke and a heart attack 2-1/2 years ago.
UNIDENTIFIED FEMALE (through translator): We read in the newspaper that there was a heart coming from California and we did not know if he would be the one getting it. We prayed, crossed our fingers, that it would be for him, because he would not have made it without it.
VINCI: Jacob's doctor says his desperately ill patient was not alone.
UNIDENTIFIED MALE: Right now, there are five patients that are hospitalized in the intensive care unit and are at imminent risk of death any moment if we don't find a suitable heart for them.
VINCI (on camera): What is the likelihood that a heart will come for them?
UNIDENTIFIED MALE: Unfortunately, very low. Very low.
VINCI: But Jacob is one of the few lucky ones waiting for a heart transplant. As everywhere else in the world, here in Israel there aren't enough donors and doctors here say between 10 and 15 percent of patients who need a new heart die each year waiting.
(voice over): Patients in need of a kidney, the most commonly performed transplant, sometimes decide to go outside the system, bypassing normal procedures.
UNIDENTIFIED MALE: As long as Israeli society cannot supply enough organs, I cannot blame any patient who decides to go abroad and get a kidney or another organ in any way that he sees fit.
VINCI: Hard statistics aren't available, but experts believe in the last three years more than 300 Israelis on dialysis, unwilling to wait for a transplant, paid between $60,000 and $150,000 to purchase a kidney. But paying for organs in Israel is against Health Ministry regulations, so patients who want to buy organ must travel abroad.
UNIDENTIFIED MALE: It's a quite complicated surgery. You can not do it in the backyard of someone. Sometimes they go -- we get Israeli donor and they will do it in South Africa, they will do it in Colombia and so on. Not in Israel. I don't believe that illegal transplantations, which are a result of sale of organs, trafficking of organs, is done in Israel.
VINCI: Israel's parliament is currently working on a new legislation that would make the trade in organs a criminal offense, punishable with jail time.
There is a lively debate in Israel about transplants.
UNIDENTIFIED MALE: Maybe it is mysticism, maybe it is something deeply rooted in the Jewish heritage that we have this will to reach our grave when we are whole, unaffected. When you analyze it logically, it is no logic at all. Even if you believe in resurrection.
UNIDENTIFIED MALE: Religious reasons are actually the main cause, although if you're going to ask rabbis in Israel, they're going to tell you that its not -- Judaism doesn't object to organ donation. On the contrary. It's considered what we call an mitzvah (ph), a good deed to do.
VINCI: 250,000 Israelis have signed cards to become organ donors, a little more than 5 percent of those who could; about the same percentage as Europeans.
At times, however, there is another issue that is more likely to come up here than almost anywhere else: whether the donor is Jewish.
UNIDENTIFIED MALE: It does come up. Not very frequently. And we do not accept it, by the way. There are so many Jewish Israelis who walk around with Arab organs from Israeli Arabs who've donated kidneys -- and kidney is the main living donation. And also from cadavers of Arabs and vice versa, that it's really unfair to discriminate.
VINCI: When Zohaba Vider (ph) lost her husband and daughter in the Passover suicide bombing in the spring of 2002, she agreed to donate his organs. His kidney went to this Palestinian woman from the West Bank.
UNIDENTIFIED FEMALE: Palestinian woman, Jew woman. It is the same for me.
VINCI: Not everyone feels that way. As he lay close to death, Jacob told his wife, Yafid (ph), he would not have wanted an organ from a non- Jew. His wife took a different view, telling us when it comes to life and death, such choices didn't matter.
Alessio Vinci, CNN, Jerusalem.
(END VIDEOTAPE)
MANN: We take a break. When we come back, what's right, what's wrong and what we should do about it.
Stay with us.
(COMMERCIAL BREAK)
MANN: For years, the University of California at Los Angeles has accepted donated human remains for use in teaching and research, but it announced it was suspending its willed body program in March when their were revelations that staff members were secretly cutting up bodies to sell individual parts for their own personal profit.
Welcome back.
Two men were arrested for grand theft in the UCLA scandal. Stealing human remains is clearly illegal. But depending on how it's done and why, selling bodies and body parts in the United States is not. And if body parts can be sold, why not allow the people who own them to do the selling?
Joining us now to talk about some of the legal and moral issues is Nancy Scheper-Hughes, a professor of medical anthropology at the University of California, Berkley, and founder of Organ Watch, a project which is studying the moral and market issues raised by organ transplantation and trafficking.
Thanks so much for being with us.
Let me ask you first of all, how many organs are being sold around the world?
NANCY SCHEPER-HUGHES, ORGANS WATCH: Well, I think the only organization that's trying to count that is Organs Watch. It is underground and it is covert behavior. I can tell you that there are thousands of organs that are sold between many parts of the world, India being an important area, sort of the ground zero, but also in South America, also in the United States, Turkey, in Iran.
You know, you have to look at this by tracking mainly the people that are willing to talk to you, either after they have sold or after they have purchased an organ, and that's the way we have been going about it.
My fieldworkers and I have gone to 12 countries and we can say without a doubt that in India there is roughly 2,000 people per year who sell a kidney --
MANN: Let me jump in on exactly that thought, because if you look around, if you look at what's written in the press or what you might find on the Internet, inevitably people who come forward talk about kidneys. Why kidneys? And how many organs are sold as well?
SCHEPER-HUGHES: Well, here we have to separate the dead body from the living donors.
Kidneys is the gold standard for sale by living people, but there is a very disturbing and a small but growing market in half livers, and some of my fieldworkers have come across -- I have not -- persons who have said India is one of the places that they have actually sold a cornea.
In the Philippines, I have met people who have sold a kidney and are on a waiting list wishing to sell a half of a liver, and I've met people who imagine that they can sell almost anything and they have asked my help.
MANN: What happens to those people? How many people -- because in theory, we all have two kidneys, and you could in theory live without one. But how many people end up being crippled or killed or even if their health isn't suffering, how many end up being cheated in the process?
Well, you've raised three different questions. That is in terms of the medical consequences, they are serious for the population of sellers. They're not healthy people to begin with. They're not well-nourished to begin with. They're not properly screened. And so it's not surprising that in Organs Watch's studies and that of some of my colleagues working in India and Iran and elsewhere, we found that up to 80 percent, by self report, consider themselves sicker, weaker and many, which is very disturbing, unable to work after they've donated a kidney.
Now these people themselves, for the most part, don't have access to medial aftercare, and they are also people that tend to work with their bodies. They're stevedores and agricultural workers and construction workers and for them, the loss of a kidney and the very slow recovery they have from it without proper care, without proper medications and even, the truth be told, they're not getting laparoscopic removal of those kidneys. They're being laid down and within one day in and out of the hospital, break them open, break a rib, tear out the kidney and put them on a bus or put them on a plane back home.
MANN: Should this be flatly illegal to your mind in every place where it's practiced?
SCHEPER-HUGHES: Well, it is illegal right now. There is only one country that I know of, and that's Iran, where it is legal to buy and sell, and it's under state control. I heard about Kuwait, though I don't know that. I have an Organs Watch assistant who has worked in Iran. But everywhere -- now some countries don't have laws. Some countries have laws that are a big ambiguous because they didn't anticipate the sale.
But, number one, it is illegal. So the question is, should it stay illegal. Obviously the attempts to police the world in this regard, there hasn't been the will. In part because there are many people within the transplant profession that feel that this is a God send, it's a solution to the problems of a shortfall in organs.
Obviously, the recipients benefit. Obviously, the hospitals and the middlemen and the brokers benefit.
Right now, it's pretty much in the hands of the black market and aspects of this market in various parts of the world is very nasty, very dangerous. People get hurt --
MANN: Well, let me ask you about that, in fact, because there are reports, most infamously out of China, of prisoners being executed, either in a way that is timed to coincide with the harvest of their organs or in some cases it is reputed in order to harvest their organs.
These kinds of stories surface elsewhere. Has your research borne that out anywhere in the world?
SCHEPER-HUGHES: Yes, well, we know that in China executed prisoners are used for their organs. I think the allegation that they're killed for that purpose I think has not been borne out.
There is a very high rate of execution in China and it has been profitable to the country.
We know, for example, that many Chinese Americans come home to San Francisco, to New York City, they're quite open about the fact that they have (UNINTELLIGIBLE) that their transplant tour was timed so that they could be there during an execution, and they don't seem to be worried about it.
Some of the nephrologists who have to take care of them before and after and who counsel them not to go because perhaps they in some cases do have their own moral reservations about this. Some have even said they will not take care of patients coming back from China, they feel so strongly about it. I know of one surgeon who has posted a sign in his office in New York City to his patients, one of them that if they chose to take a transplant tour to China, they will not be taken care of in his office.
So there is dissent within the profession, but I would say there is more anger within the transplant profession about the use of executed prisoners than there is about desperately poor people being in some cases tricked and manipulated out of their communities and villages or lied to about what exactly they will be doing when they get to South Africa or when they get to Turkey.
I've spent quite a bit of time in Moldavia --
MANN: Professor Hughes, I apologize. This is a conversation that could go on a lot longer, the moral issues are cloudy, I suppose you could say, at best.
Nancy Scheper-Hughes of Organ Watch, thank you so much for talking with us.
SCHEPER-HUGHES: Sure, thank you.
MANN: That's INSIGHT for this day. I'm Jonathan Mann. The news continues.
END
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