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diggThe Philippines’ ethical time bomb
Filipinos have narrowly escaped the establishment of a legal market for organs. But will the new system work?
Healthy kidneys are a hot product in the black market. Growing demand and a lack of donors in developed countries have turned developing countries like India, China and Pakistan into quarries for unscrupulous businessmen and doctors. And until recently, it looked as though the government of the Philippines was going to deal with its own black market problem by effectively legalising it.
After intense international pressure was applied, the government has endorsed a more ethical stand. But there is great scepticism from observers about whether it can keep its high-minded promises.
Here is what happened. On March 3 the Philippine Department of Health issued an administrative order, "Revised National Policy on Kidney Transplantation from Living Non-related Organ Donor and its Implementation Structures". The proposed regulations sounded ethical, but the devil was in the detail. Donors would be allowed to specify a person to receive their organ or they could make a "non-directed" donation.
This was a loophole wide enough to drive a Mack truck through, permitting poor donors to sell their kidneys to unrelated foreigners.
| What type of person has a kidney to spare for a bit of cash? Poor people. And the Philippines has lots of them. In Basesco, on Manila Bay, about 3,000 of the slum’s 50,000 inhabitants are reported to have sold a kidney. |
Former health secretary Alberto Romualdez called this an "ethical time bomb." Harvard’s Francis L. Delmonico, of The Transplantation Society, the leading professional body for transplant surgeons, told MercatorNet that it "would have enabled rich foreign patients to use the Filipino as a targeted source of organs". The country’s Catholic bishops denounced it: "Human organ sale or trade, by its very nature is morally unacceptable. It is contrary to the dignity of the human person, his or her authentic autonomy and the essential equality of all persons... [The] body ought not to be treated as a commodity or object of commerce."
Under this barrage, health officials revised the plan. Late last month they closed the loophole and banned all kidney donations to non-related foreigners. Recent reports indicate that legislators are even contemplating on extending the ban to non-related locals.
Will a ban succeed?
But how likely is that awful business of selling kidneys will evaporate overnight? Organ trafficking has sunk deep roots in the Philippines. Between 1996 and 2006, according to the Philippine Society of Nephrology (PNS), the number of kidney transplants locally sextupled. Transplants from the living and related (ie, a family relative) donors flatlined while the number of non-related transplant donors ballooned out from 52 in 1999 to 473 in 2006. The number of foreign recipients in 2004 and 2005 increased by a whopping 62 percent.
What type of person has a kidney to spare for a bit of cash? Poor people. And the Philippines has lots of them. In Basesco, on Manila Bay, about 3,000 of the slum’s 50,000 inhabitants are reported to have sold a kidney.
According to the PNS, these donors are all male, with an average age of 29. A third of them have not even reached high school. Most are farmers or tricycle drivers with a US$90 average household monthly income. They received just US$2,800 for a kidney, which they used to pay debts, support their family or set up a business. In most cases, it turned out to be a bad deal. About three-quarters told researchers they did not improve their lives economically. Four-fifths felt their capacity to work was reduced. Almost none would recommend that others sell their kidney.
Despite a government-imposed cap which had restricted the number of transplants to foreigners to 10 percent of the total, wealthy foreigners, many from the Middle East, were the chief beneficiaries under the old system. At the moment, selling or exporting human organs carries a 20-year jail term and stiff fines – but prosecutions are rare. It is a lucrative business for enterprising surgeons.
Critics are sceptical
That’s why Amihan Abueva of the lobby group Asia Against Child Trafficking fears that the new guidelines will just be ignored, or that brokers will find loopholes. Dr Gene Nisperos, of the Health Alliance for Democracy (HEAD), notes that several administrative orders have been issued without ever being fully implemented. Nisperos told MercatorNet that the government’s privatisation of health care makes him question the seriousness of the virtuous new policy.
The government itself is sceptical. A report for the Philippine Organ Donation Program said last year that the health department was "unable to enforce rules due to the lack of capacity and ability to monitor accredited facilities… The organ donation program of the country has also no mechanism to adequately enforce ethical guidelines on accredited facilities… Compliance to regulations is poorly documented and enforced due to inadequately designed incentive structures, capacity limitations and non-coordination of efforts".
Liberal ideologues
One reason why government officials may not be taking the kidney market seriously is that it actually seems like a good idea to starry-eyed economists. The Economist, for instance, is a consistent supporter of legalising an organ market: "Many people will find the very idea of individuals selling their organs repugnant. Yet an organ market, in body parts of deceased people, already exists. Companies make millions out of it. It seems perverse, then, to exclude individuals. What's more, having a kidney removed is as safe as common elective surgeries and even beauty treatments (it is no more dangerous than liposuction, for example), which sets it apart from other types of living-organ donation."
In an ideal setting, there would be proper medical examinations to determine a donor’s suitability. But in the slums of Manila, the broker is not interested in ensuring the donor’s health, and the donor is not interested in telling the truth. It is easy to fake urine samples or to normalise blood pressure with drugs. Newsbreak, a local news and affairs magazine, recently featured the case 50-year-old Doming Umandap, a resident of Quezon province, who died of a heart attack a few months after donating a kidney.
In the Philippines and in other poor countries there is no level playing field. Family men without a dime are selling their organs because they have nothing else to sell. The Philippines needs another John Steinbeck to update The Grapes of Wrath for contemporary organ trafficking.
Only if there is a resolute political will to enforce the law, will there be no more Domings. Unfortunately few Filipinos believe that a new set of government regulations is going to change anything.
Dean Menchavez is a freelance journalist from the Philippines.
Since the 1980s, many countries have passed legislation prohibiting monetary compensation for organ donation. Organ donation for transplantation has become altruistic worldwide. Advances in immunosuppressive therapy has led to greater success in transplantation and to increased numbers of patients on transplant waiting lists. Unfortunately, the altruistic supply of organs has been less than adequate, and severe organ shortage has resulted in many patient deaths. A number of transplant experts have been convinced that providing financial incentives to organ sources as an alternative to altruistic organ donation needs careful reconsideration.
In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, an increased in number of transplant were established. such that in 1999, the renal transplant waiting list was completely eliminated. In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists. There are so much lessons that we can perhaps adopt from the organ transplant of Iran given the fact that we can mobilize our NGOs and other non profit agencies in the country to supervise or perhaps serves as the channeling agencies towards establishing a non profit institution that will serve the need of the Filipinos. the Philippines is reach with people who are willing to serve as a guardian of truth in establishing a non-coercive yet altruistic way of looking at the life of the poor in general. i think we have to set back and take into consideration, that while Filipinos are doing altruistic act towards those who can afford to have an organ transplanted yet left the organ donor a life of suffering due to a belief that he has to act altruistically towards his fellow creatures. i would like to suggest that we have to look at the case of the poor Filipinos from below, i suppose social justice has come to play here.
I remember one of the documentary news presented by a famous network here in the Philippines. It goes to show that not only are the Filipinos “willing” to sell their kidneys but also their eyes, teeth and etc. I can hardly remember the figure paid to those poor individuals but it’s too little and dehumanizing that it would trigger your heart so badly- realizing the poverty level here in the country.
Selling of kidneys shouldn’t be an option as the means to survive. There are other ways to come up with solutions. I agree with what you said “Prayer, vigilance to abuses, support for causes, coherence, and a change in one’s own consumer lifestyle always do contribute to the solution. “
I suppose it is logical for the Government, particularly the Office of the President through the Dept. of Health and the Dept. of Justice to take a good look into this matter and ferret out the culprits by providing financial assistance to the victims and anyone who could disclose perpetrators of the crime and forthrightly prosecute the guilty. Should the law be found wanting, introduce appropriate amendment thereto.
Thank you for that article.. Given the situation, what do you think the government must further do to stop or minimize or, at least, regulate the sale of human organs in the Philippines in favor of those who sell their organs?
thanks.
Thank you all for sharing your thoughts. Each comment has opened new horizons. The last one suggested a good solution (offering incentives and protection to victims) to track the culprits. The first post by Ser is a keen warning about worse scenarios of unreported cases in this gamut world of organ commerce. Armand had reminded that the crux of the issue involves the lack of education.
Shagga acknowledged the evil of selling an organ (and, I would add-- although from a lucky country--could hopefully do something to help those in need). James has pinned this idea (not to exclude culpability and responsibility of wealthier countries) underscoring the complexity of the situation, and stressing likewise the important role of the Church in the moral field.
J.A. offered her first-hand experience that corroborated the data presented. I hope, aside from awareness, the article had helped many, like Buger, to consider “a change of mind.” In first-world countries, this could possibly translate to helping build a more altruistic society. The decisive factor to this specific problem is that there are very few kidney donors.
The question pitched in by Nike “what are the Filipinos doing about it?” in the end, is something to think about. I feel that bottomline this will have to start on a personal basis. Prayer, vigilance to abuses, support for causes, coherence, and a change in one’s own consumer lifestyle always do contribute to the solution.
Let’s hope and pray the Government will take swift action on this nefarious practice taking place, victimizing the hapless poor once more. Indeed, there is more to expose and learn. On one hand it was good there was positive reaction from the gov’t when it banned sale of kidneys to non-related foreigners. Perhaps health authorities should offer incentives and protection to victims just to help expose the perpetrators of this crime. We can also focus on the poor sectors of society, to identify clearly the specific tasts to be undertaken to help alleviate the poverty related issue. Local govts and non-govtal organizations including business sectors can also be tapped for this endeavor. Kudos to Dean.
It is wrong to sell your kidneys under any circumstances. I hope more people like Tagoniyo Akosapangalang Buger, from Myanmar, realize that they only have two kidneys, before it is too late. I for one, wouldn’t sell my kidneys for all the tea in China. But then, I guess I live in the lucky country.
I have actually met some of these young men who undergo renal CT angiograms as part of the process of screening to become donors. The CT-scan staff usually refer to them as “kidney sellers”. Here in my part of the country, they are rumored to be offered approximately P60,000.00 plus the hospitalization expenses and insurance. I guess they are not properly made aware of the health consequences they may suffer in giving up one kidney for the sake of putting food on the table.
We are also among the top countries for kidney trading. Something to be ashamed of. Thanks for the article.
Everything and anything under the sun is for sale in the Philippines just to have food. If not food they buy a rugby cement to inhale, get toxicated so that they don’t feel the hunger. What are we Filipinos doing about it???
It’s indeed an eye opener. I’ll not sell my kidneys anymore.
I am very grateful to Dean for his eye-opening report on the organ transplant black market in the Philippines. It’s a complex scenario that does not admit of any ready-made solution, given the difficulties of law-enforcement and the vulnerability of the extreme poor. Yet it’s a concern that should weigh more heavily on the consciences of those individuals from wealthier countries who either exploit the practice or justify its legalization.
What poor soul would give up the chance of some “easy money” when his everyday existence is anything but easy? But that is the nub of the problem. Poor he may be, but he’ll never cease to have a soul. No black-market or free-market organ sale will honour his dignity as a person, nor benefit him economically in the long run.The elasticity of the concept of “elective surgery” that enlightened “liberal” opinion (e.g. The Economist) is prepared to justify in the name of the equality of individuals is repugnant.
Nevertheless, it is consoling to note that not all public organs have exchanged robust moral discourse for the kind of pseudoscientific biotechnological babble that justifies anything from human organ sale to human embryo research. Once again the Catholic Church is present as a champion of bodily and spiritual integrity when others have fled from the public square.
The law against organ trafficking may help solve the problem if properly implemented. But, the main issue here, however cliché it is, remains to be poverty. The poverty that I am talking about is not just material poverty but intellectual and doctrinal poverty as well. I know of some poor people who will never do such a “desperate” act of selling one’s kidney because they are doctrinally and spiritually formed.
The burden of solving the problem does not just lie with the government but with the Church and those who are more informed, doctrinally and intellectually, as well. We can still do more to address the problem.
Indeed, the above article is an eye-opener. In the context of unequal power relations, this emerging blackmarket for human organs becomes another concrete example of how poor countries are being exploited by the rich. What’s disturbing is that Dean’s article only covers voluntary cases, those where people simply agree to part with their organs for a price. The article hasn’t even touched on the more shocking cases where people are actually abducted and butchered for their body parts. I could imagine that with millions of anonymous poor people to choose from, it would be easy for a foreign organ trafficker to just get away with murder.
It is clear to me that the move to completely legalize an organ market without the firm resolve to institute/enforce proper regulatory measures would be another default by the Philippine government on its responsibility to take care of its people, most of whom are poor and are thus more easily enticed by the fleeting rewards of organ donation.
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