Over the past fifteen years, transplanting human organs has become a standard and remarkably successful medical procedure, giving new life to thousands of people with failing hearts, kidneys, livers, and lungs. But very few countries have sufficient organs to meet patients’ needs. In the United States, for example, some 50,000 people are on the waiting list for a transplant; fifteen percent of patients who need a new heart will die before one becomes available. The shortages are even more acute throughout the Middle East and Asia.
This lack of available organs arouses desperation and rewards greed. Would-be recipients are willing to travel far to get an organ and many surgeons, brokers, and government officials will do nearly anything to profit from the shortage. In India well-to-do people and their doctors buy kidneys from debt-ridden Indian villagers; in China officials profitably market organs of executed Chinese prisoners. The international commerce in organs is unregulated, indeed anarchic. We know a good deal about trafficking in women and children for sex. We are just beginning to learn about the trafficking in organs for transplantation.
The routes that would-be organ recipients follow are well known to both doctors and patients. Italians (who have the lowest rate of organ donation in Europe) travel to Belgium to obtain their transplants; so do Israelis, who lately have also been going to rural Turkey and bringing their surgeon along with them. Residents of the Gulf States, Egyptians, Malaysians, and Bangladeshis mainly go to India for organs. In the Pacific, Koreans, Japanese, and Taiwanese, along with the residents of Hong Kong and Singapore, fly to China. Less frequently, South Americans go to Cuba and citizens of the former Soviet Union go to Russia. Americans for the most part stay home, but well-to-do foreigners come to the United States for transplants, and some centers allot up to 10 percent of their organs to them.
All of these people are responding to the shortages of organs that followed on the discovery of cyclosporine in the early 1980s. Until then, transplantation had been a risky and experimental procedure, typically a last-ditch effort to stave off death; the problem was not the complexity of the surgery but the body’s immune system, which attacked and rejected the new organ as though it were a foreign object. Cyclosporine moderated the response while not suppressing the immune system’s reactions to truly infectious agents. As a result, in countries with sophisticated medical programs, kidney and heart transplantation became widely used and highly successful procedures. Over 70 percent of heart transplant recipients were living four years later. Ninety-two percent of patients who received a kidney from a living donor were using that kidney one year later; 81 percent of the cases were doing so four years later, and in 40 to 50 percent of the cases, ten years later.
Transplantation spread quickly from developed to less developed countries. By 1990, kidneys were being transplanted in nine Middle Eastern, six South American, two North African …