Vaniver wrote:The thought that the poor would suffer more with a legal organ market than they do now is murderous idiocy. Remember, about a dozen people on the kidney wait list die every day. There's more at stake here then posturing or envy.
Let's look at the small number of studies that have actually been done on kidney sellers (or "vendors") worldwide. There aren't very many, and there are huge gaps in the literature, but there are enough- with remarkably consistent results- to be able to make some solid conclusions.
There's a LOT more information in these than I mention, and it all supports my case, but I'm going to be as concise as possible.Large studies with over 100 participantsGoyal et al- Economic and Health Consequences of Selling a Kidney in India
A cross- sectional survey of 305 vendors in Chennai, India, with a 100% participation rate. 86% of participants reported a deterioration in their health status after nephrectomy. Vendors were typically worse off financially as a result of vending- average family income declined by one third, even as the average family income in the area increased. The negative financial effects became more pronounced over time. 79% would not recommend selling a kidney to others.Zargooshi- Quality of Life of Iranian Kidney 'Donors'
A study of 300 vendors in the Iranian, regulated, system. 97% participation rate. 65% experienced negative effects on employment. There were increased marital conflicts in 73% of vendors, and 70% felt isolated from society. 71% had severe depression, and 60% anxiety. 80% were dissatisfied with postoperative physical stamina, and effects on general health were somewhat (22%) to very (58%) negative. 79% of vendors did not attend followup visits due to poverty. Half of the vendors would lose greater than 10 years of their life and 76% to 100% of properties to regain their kidneys, and 85% would definitely not vend again.
This article has some very interesting- and moving- quotes from vendors.Navqi et al- Health Status and Renal Function Evaluation of Kidney Vendors
A study of 104 Pakistani vendors. It found a very high rate of hypertension and compromised renal function, suggesting that vendors are at risk of renal impairment and failure in the long term. The only other large study that has measured the (objective) health status of vendors is currently unpublished (Tanchanco et al, cited in Padilla, "regulated compensation for kidney donors in the Philippines"), but it has had similar results.Codreanu et al- The Long- Term Consequences of Kidney Donations in the Victims of Trafficking in Human Beings (BTHBS) For the Purpose of Organ Removal)
Actually, I'll include this, too. It's a conference paper based on research among 30 Moldovan kidney sellers/ victims of organ trafficking. There was a substantial incidence of CKD and hypertension, and the renal function of the remaining kidney deteriorated much more rapidly than what would be expected from physiological aging. This could have some pretty serious long- term health consequences for vendors.Navqi et al- A socioeconomic survey of kidney vendors in Pakistan
98.8% believed that their health had declined in some way since nephrectomy. 88% reported no postvending economic improvement. Many vendors remained in bondage post- vending.Budiani- Saberi and Mostafa- Care for commercial living donors- the experience of an NGOs outreach in Egypt
82% of participants believed their health had deteriorated since nephrectomy. 90% felt socially isolated, and 94% of vendors regretted selling their kidney. Negative financial and psychological impacts were also revealed through interviews and peer support groups, but these were not surveyed.
Budiani- Saberi also presented results from a similar Egyptian study at some conference (can't be bothered looking up the details), and they were very very similar.Mendoza- Kidney black markets and legal transplants- are they opposite sides of the same coin?
A study of 131 Filipino vendors. 60.9- 68.9% believed vending did NOT improve their financial condition.Mendoza- Price deflation and the underground organ economy in the Philippines
61.3- 69.3% of vendors reported lingering issues performing labor- intensive work. The results from these two studies are consistent with that found by Yea in a smaller, ethnographic study of Filipino vendors ("trafficking in part(s): The commercial kidney market in a Manila slum) Yea reports some incredibly serious difficulties continuing to do labor- intensive work post- nephrectomy, due mostly to stamina problems but also the stigma associated with vendors. Mendoza- Columbia's Organ Trade: Evidence from Bogata and Medellin
Over 80% believed they did not realise any material or lifestyle improvements from selling an organ. Two- thirds reported lingering physical problems performing labor- intensive work, and 40% reported deterioration in health status due to problems or complications such as hyptertension or infections. Only 13.9% reported mental issues, and only 21.9% reported emotional issues. Malakoutian et al- Socioeconomic status of Iranian Living Unrelated Donors- A Multicenter Study
This is the only
large study of vending populations I'm aware of that claims vending improves the economic situation of vendors, and that the majority of vendors do not regret their act. These conclusions are based on questionnaires filled out BEFORE vending, and BEFORE the health/ financial/ psychological/ social impacts would have been felt. Smaller ethnographic studies
I'm not going to go into depth here, but there are some very good, small ethnographic studies that should be read by anybody that wants to give an informed opinion on the experience of vending a kidney. These are:Moazam- Conversations with Kidney Vendors in Pakistan: An Ethnographic Study
Cohen- Where it Hurts: Indian Materials for an Ethics of Organ Transplantation
A lot of what Scheper- Hughes has written, but there's so much, and a lot of it overlaps, so it's hard to recommend a single article.
Being qualitative rather than quantitative, these studies can go into greater depth about the actual experience of selling a kidney, and the depression, trauma, social isolation, and stigmatised life that follow. Moazam also gives a very compelling explanation of why vendors almost NEVER receive follow- up care, even when they are offered it (and this point comes up again and again, everywhere around the world)- it's because, subsequent to vending, they are angry at and distrustful of the doctors who would do such a thing to them.
There are counter- arguments and counter- examples to the conclusions outlined above, but these are anecdotal and based on individuals, not groups. And at least one well- known counter- example, from the New York Times, has been proven
to be an outright fabrication. (see Scheper- Hughes, "Parts Unknown")
So no. The experiences of kidney vendors are NOT trivial.
Legalising a market would very seriously harm the most vulnerable people in society- people who are already suffering from poverty and structural violence.tl;dr Selling a kidney has negative effects on the physical health, physical stamina, psychological wellbeing and social wellbeing of vendors. This is a big deal.