The body part that accounts for most sales of organs throughout the world is the kidney. As entire populations have become older, the number of patients with kidney disease that can lead to death has dramatically increased. Dialysis machines extend the lives of many of them. But some patients for medical reasons are unable to continue on dialysis or, as is often the case in developing countries, they do not have access to such expensive machines. To survive they must undergo a kidney transplant—if they can get a kidney.
The shortage is acute almost everywhere. For example, despite vigorous educational campaigns, Americans are very reluctant to agree to donate their organs after they die. (They may distrust hospitals or believe that people should be buried with their organs intact.) People of other cultures, particularly some Asians, Muslims, and Orthodox Jews, are even more hostile to such donations. Hence the waiting list to obtain a kidney from a cadaver is long. The average wait in the US and in Britain is two to three years; in Singapore, six to eight years. Residents of the Gulf States and most of Asia may have to wait for many more years, if a waiting list is kept at all.
The only other way to obtain an organ is from a living donor—usually from a sibling, a spouse, a relative, or a friend. In the United States and Europe, living donation is now the source of 20 to 40 percent of kidneys. But what if relatives are unwilling or unable to donate? Many people will then try to purchase a kidney, with the result that there has for years been a flourishing and unregulated international traffic in organs.
The trade is so extensive that just as we are being forced to assess the consequences of global financial markets for less developed countries, so we must consider the effects of global markets in medical technologies and organs. In the early 1990s, most people who bought kidneys were either residents of the Gulf States who traveled to India to buy them or they were Asians who bought them in India and China. Now the routes crisscross the world. India remains a popular destination, despite laws prohibiting organ sale there; buyers come not only from India’s middle class and from the Middle East but also from England, Canada, and the United States. China continues to deny that its surgeons remove organs from executed prisoners, but in fact it runs an extensive transplant business, with overseas Chinese from many countries, including Singapore, Malaysia, and the United States, traveling there to purchase kidneys. The Philippines also has large numbers of kidneys available for purchase, and its hospitals actively try to sell them to the Japanese. In the same way, Turkey, Moldova, and Estonia sell to Israelis, and Bulgaria and Romania sell to them and to other Eastern Europeans as well.
Although it is technically possible to pack kidneys in ice and send them by air between countries …