A woman reveals a scar left after her husband’s kidney was re moved without
his consent in a private clinic in Bangalore, India.
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The
quality, not the longevity of one’s life,
is what’s important.»
Martin
Luther King,
U.S. civil rights leader (1929-1968)
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Be
quiet, be pure,
toil not your body, perturb not your vital essence, and you will
live forever.
Chuang-tzu,
Chinese philosopher (350-275 B.C.)
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In
terms of transplants, the kidney has emerged as the ultimate fetish, promising to
satisfy the most basic of human desires—that for life, vitality and élan. |
Modern
medicine has given rise to a booming trade between poor and rich countries—the trade
in human organs. But what of the bodies that are being plundered?
During the summer of
1998, I was sitting at a sidewalk cafe in downtown Sao Paulo with Laudiceia da Silva,
who had just requested a legal investigation into the large public hospital where
she had “lost” a kidney during an operation to remove an ovarian cyst.
The young woman’s family doctor had discovered the kidney was missing during an examination
soon after surgery. When confronted with the information, the hospital representative
told a highly improbable story: that Laudiceia’s missing kidney had been embedded
in the large “mass” around her cyst. The hospital, however, refused to produce either
their medical records or the evidence—the diseased ovary and the kidney had been
“discarded,” she was told. To make matters worse, Laudiceia’s brother had been killed
in a random act of urban violence several weeks earlier, and the family had arrived
at the hospital too late to stop his organs being removed on the basis of Brazil’s
new “presumed consent” law.
“Poor people like ourselves are losing our organs to the state, one by one,” Laudiceia
said angrily.
“Follow
the bodies”
Hers
is but one of several credible stories of “kidney theft” that anthropologist Lawrence
Cohen and I have encountered in South America, India and Bangladesh as part of our
work for the Berkeley Organs Watch, an independent human rights organization seeking
to investigate allegations of medical abuse in the harvesting, distribution and transplantation
of organs.
The project stems from experience on a prestigious international taskforce set up
to investigate the organ trade and develop ethical guidelines to prevent abuses.
Soon after reaching the conclusion that the trade was far more extensive than previously
thought, the Bellagio taskforce was disbanded. In the absence of any other institution
of its kind, Organs Watch was conceived as a stop-gap measure, offering a frontline
response to reports of illegal organ and tissue sales or theft anywhere in the world.
Our simple mandate is to “follow the bodies.” We follow transplant patients from
dialysis clinics to surgery, and donor bodies from township shabeens [bars] to police
stations and public mortuaries and from there to the various eye banks, medical clinics
and research laboratories where their parts are harvested and redistributed. At times,
the surgery theatres feel more like theatres of the absurd, as a few scenes plucked
from our fieldwork will show.
In a Chennai (Madras) slum in South India, my colleague Lawrence Cohen met five local
women, each of whom had sold a kidney for 32,500 rupees (about $1,200 in 1999). Each
had undergone their operation at the clinic of Dr. K.C. Reddy, India’s most outspoken
advocate of the individual right to sell a kidney. Unlike the more seedy “organs
bazaars” of Bombay, Dr. Reddy prides himself on running an exemplary clinic: his
kidney sellers are carefully screened, fully informed about the medical risks and
provided with free health care at his clinic for two years after kidney removal.
The women Cohen interviewed were mostly low-paid domestic workers with husbands in
trouble or in debt. The kidney sale was usually preceded by a financial crisis. Did
the sale make a difference to their lives, Cohen asked. Yes, for a time, but the
money was soon swallowed by the usurious interest charged by the local money lenders.
Would they do it again if they could? Yes, the women answered.
Several months later, I sat next to Rosemary Sitsheshe at her home in Guguletu township
outside Cape Town, South Africa. Her only son, 17-year-old Andrew, had been caught
in the crossfire of township gang warfare just before the end of apartheid. He died
of a chest wound under police surveillance. The next day Rosemary went to the local
police mortuary to claim his body, but officials turned her away. Two days later,
when the family was finally allowed to view Andrew’s body, they were shocked: the
blanket over it was covered with blood and there were two deep holes on either side
of his forehead. Rosemary protested, saying he had been killed by a single, clean
bullet to his chest. The state pathologist treated her and her husband abusively.
Later, accompanied by her own private pathologist paid for by the African National
Congress, Rosemary learned at the morgue that her son’s eyes had been removed and
that inside his abdominal cavity the organs had all been severed and carefully replaced.
“But were those my son’s organs?” she asked. “I know my son’s eyes but not the colour
or shape of his heart or kidneys.” At the local eye bank, Rosemary was told that
her son’s corneas had been “shaved” and given to two “lucky patients.” The remains
of Andrew’s eyes were being kept in the refrigerator and the director refused to
return them to Rosemary for burial.
“Although my son is dead and buried,” she said, “is it good that his flesh is here,
there, and everywhere, and that parts of his body are still floating around? Must
we Africans be stripped of every comfort?” Rosemary Sitsheshe has since taken her
complaint against the police mortuary and eye bank to South Africa’s Truth and Reconciliation
Commission. She asked that her case be treated as one example of a practice that
was widespread in police mortuaries under apartheid and which continues in some instances.
Transplant
tourism
In
the most bizarre fieldwork expedition of my career, I went under cover to the grounds
of Montes de Oca state mental asylum in the province of Buenos Aires in January 2000,
accompanied by a private detective. We went there to see what, if anything, we could
discover about persistent reports of blood, tissue, and organ stealing from the bodies
of profoundly mentally retarded, but otherwise physically healthy, inmates. The reports
first surfaced in the early 1990s following the “disappearance” of a young psychiatrist,
Dr. Gubileo, who had lived on the grounds of the institution. She was apparently
on the verge of revealing the illicit practices by the director of the asylum. A
court-ordered search of the grounds of Montes de Oca did not recover the remains
of Dr. Gubileo, but did recover a few bodies of unidentified missing patients.
The only witnesses to the doctor’s kidnapping were two asylum patients, who said
they saw her being pushed into the back of a van belonging to the asylum. But declared
mentally incompetent, the witnesses could not give testimony in court. The allegations
of other nefarious goings-on at Montes de Oca led, ultimately, to the arrest of the
medical director, followed by his unexplained death in a prison cell the day before
he was to give testimony in court. The case was then closed.
Human strip mining of the dead for usable parts is not limited to former police states
in South Africa, Brazil, and Argentina. Similar practices can be found in one of
the wealthiest communities of the United States. In the fall of 1999, I sat in a
diner in Hollywood with Jim C., notorious “organs broker” who solicited international
buyers and sellers from his home. “There’s no reason for anyone to die in this country
while waiting for a heart or a kidney to materialize. There are plenty of spare organs
to be had in other parts of the world.” Though Jim is operating in a grey netherworld,
he insists that what he does is not illegal. “Don’t think of me as an outlaw,” he
said. “Think of me as a new version of the old-fashioned marriage broker. I locate
and match up people in need.”
Organ transactions today are a blend of altruism and commerce; of science, magic,
and sorcery; of voluntarism and coercion; of gift, barter, and theft. In general,
the organs flow from South to North, from poor to rich, from black and brown to white,
and from female to male bodies. Today, affluent transplant tourists can travel to
select medical sites in Turkey, Eastern Europe, Cuba, Germany and the United States
in search of transplants that they cannot arrange quickly or safely enough at home.
These special clinics can resemble four-star hotels or even as in Cuba, health spas
for the rich and famous.
Israel has recently become something of a pariah in the transplant world. Without
a strong culture of organ donation and under the pressure of angry transplant candidates,
the Ministry of Health has refused to crack down on the country’s multi-million dollar
business in transplant tourism that arranges junkets from dialysis clinics in Jerusalem
and Tel Aviv to medical centres in Europe and the United States.
“Why should we Israelis be made to travel to third world clinics to get the kidneys
we need to survive from the bodies of peasants, soldiers, or guest workers who may
be in worse physical shape than ourselves?” a 71-year-old “kidney buyer” from Tel
Aviv asked me rhetorically. “Organs should be seen as a human, not as a national
resource.” It was good to see “Avirham,” an elderly gentleman, alive and happy with
his revitalizing 22-year-old “peasant” kidney. And his living donor? “A peasant,
without anything!” he replied. “Do you have any idea what $1,000, let alone $5,000
means in the life of a peasant?”
For most bio-ethicists, the “slippery slope” in transplant medicine begins with the
emergence of a black market in organs and tissue sales. For the anthropologist, it
emerges much earlier: the first time a frail and ailing human looks at another living
person and realizes that inside that other body is something that can prolong his
or her life. The desire is articulated: “I want that; I need that even more than
you.” In terms of transplants, the kidney has emerged as the ultimate fetish, promising
to satisfy the most basic of human desires—that for life, vitality and élan.
The sale of human organs and tissues requires that certain disadvantaged individuals
and populations have been reduced to the role of “suppliers.” It is a scenario in
which bodies are dismembered, transported, processed and sold in the interests of
a more socially advantaged population of organ and tissue receivers. I use the word
“fetish” advisedly to conjure up the displaced magical energy that is invested in
the strangely animate kidney. Avirham, who flew from Jerusalem to Georgia for his
kidney, explained why he would never tolerate a donation from a corpse: “That kidney
is practically dead. It was probably pinned down under the wheels of a car for several
hours. . . I was able to see my donor. He was young, healthy, strong. Just what I
was hoping for.”
In Brazil, the refusal of a corpse’s kidney was just as virulent. A surgeon in the
area of Copacabana Beach said that most of his patients refuse to consider an organ
from an “anonymous” dead person. “My patients do not trust the public health system.
They fear that the organ will come to them full of pollutants.” The ultimate fetish
is the idea of “life” itself as an object of manipulation. This fetishization of
life—to be preserved, prolonged and enhanced at almost any cost—erases any possibility
of a social ethic. Often when I speak of troubling issues in organs procurement,
I am accused of “taking a chance for life” away from someone. But I am trying to
underscore that there is another “body” of patients whose needs are being ignored
or violated.
Notions of bodily autonomy and integrity are almost universally shared today. They
lie behind patients’ rights movements, the demands of the wretchedly poor for dignified
burial and popular resistance to “presumed consent” laws. But for some of those living
on the margins of the global economy, the possibility of selling an organ seems like
an act of empowerment. “I prefer to sell it [my body] myself rather than to let the
state get it,” was a sentiment frequently expressed by shantytown residents in urban
Brazil.
In fact, it is in the West where the values of bodily autonomy and integrity are
most under assault. As commercialization has entered almost every sphere of life—from
markets in “beauty queen” ova and “genius sperm”—those in the North cannot claim
any moral high ground. Meanwhile, the new constitutions and bills of rights adopted
by democratic Brazil and post-apartheid South Africa are far more developed than
“ours” in recognizing human rights to bodily autonomy and integrity.
Organs Watch is seeking assurances that transplant practices include attention to
the needs and wishes of donors, both living and dead. We ask that surgeons pay close
attention to where organs have come from and the manner in which they were procured.
We want the “risks” and “benefits” of organ transplant surgery to be more equally
distributed among and within nations, and among ethnic groups, genders and social
classes. Finally, we want assurances that the so called “gift of life” never deteriorates
into a “theft of life.”
Organs
Watch website at: http://sunsite.berkeley.edu/biotech/organswatch/ |
