DSQ > Fall 2008, Volume 28, No.4
Abstract

Limited attention has been focused on globalization and disability, and within this realm, the link between the black market organ trade and disability has been unexplored. Globalization as we know it, through its promotion of a competitive market-based economy and the resulting systems of national healthcare, is creating and exploiting an international community of disabled people. These disabled people are organ "donors," forced to stake their livelihood on internal organs that are sold through the classic hierarchical ranks of oppression. The goals and systems of globalization today must take these disabled communities into account, or the resulting poverty and lack of proper medical care will continue to fuel the trade in human organs.

Reflective Statement

Professor Elizabeth Wheeler
University of Oregon

Karen Hudson's essay on the global organ trade began life as her final research project for my Clark Honors College seminar on disability studies at the University of Oregon. This 25-student interdisciplinary colloquium included a diversity of majors, from hard sciences to the humanities. Many students had firsthand or familial knowledge of a broad spectrum of disabilities, and the course satisfied a University of Oregon multicultural requirement. There are important controversies involved in teaching disability as a cultural identity to fulfill multicultural requirements, as such courses can permit students to avoid education on race and thus reinscribe white privilege. I addressed this problem by assigning readings and films that show the intersections of disability with race, class, and gender identity.

These Honors College juniors and seniors entered the course already skilled at research, and I encouraged students to design research projects that would fill gaps in existing disability studies scholarship. Karen Hudson's essay provides an excellent example of research that broadens the scope of disability studies through attention to the literature on globalization. Her approach reveals a structural inequality between rich and poor people with disabilities. She differentiates between "the disability community entering the global organ trade and those who are products of it." Hudson humanizes the vast scale of the underground market through her focus on the organ donors and their acquired disabilities. Describing the donors' postoperative lack of medical and social support, Hudson highlights what could be seen as an important area for international disability advocacy.

Globalization and the Black Market Organ Trade: When Even a Kidney Can't Pay the Bills

Karen A. Hudson

In "Universal Design: The Work of Disability in an Age of Globalization," Michael Davidson links disability to the negative impacts of globalization. He considers the organ trade, in which bodies become commodities in an international market reflecting wealth and poverty, and comments on the silence about disability in literature on globalization (121). So how are people with disabilities involved in — or products of — the organ trade, and what aspects of globalization are creating and exploiting this international community of disabled people? The implications of the silence in regard to disability and the organ trade are significant, because aspects of globalization — particularly the spreading of a competitive market-based economy and the resulting privatization of healthcare — are perpetuating a hierarchy based on wealth and privilege that is exploiting poverty-stricken individuals for their organs. These exploited individuals are now disabled not only by the absence of an organ, but also productively within the community. This lowered productivity stems not from the state of disability itself, but rather from a lack of proper follow-up medical care that may result in further health complications. In turn, these health complications more often than not perpetuate the indebted state from which donors were hoping to free themselves in the first place.

Despite the condemnation of selling organs, which dates back to a 1985 World Medical Association statement and principles forbidding commercial transactions relating to "the human body and its parts" set forth by the World Health Organization in 1991, money still exchanges hands for harvested organs on the black market (Wilkinson 104; Garwood 5). It is estimated that 10% of the 63,000 annual kidney transplants involve payment to a non-related donor of a different nationality, and this statistic not only highlights the practice of paying for organs, which is illegal in many countries, but introduces the international aspect of the organ trade (Garwood 5). Considering that a kidney can be bought from a donor for $1,000-3,000, and can be sold for up to $40,000, it is apparent that a huge market-driven divide exists between those involved in a transaction on which livelihoods are based (Cohen 663; Scheper-Hughes 5; Garwood 5). This discrepancy between the donor's compensation and the ultimate market value of a kidney is a product of the competitive, profit-focused market economy encouraged by globalization.

Nancy Scheper-Hughes is a member of Organs Watch, a human rights group operating out of the University of California, Berkeley. The purpose of this organization is to investigate rumors, complaints, and allegations involving the trafficking of organs, human rights violations regarding the acquisition of organs, and related issues. In her report published on the Organs Watch website, Scheper-Hughes notes how organ transplantation follows "modern routes of capital," "from third world to first world, from poor to rich bodies, from black to brown to white bodies" (5). As globalization promotes a market economy, the competitive nature of this market is reflected in many facets of society, including a nation's healthcare system. The currency of the exchange, be it in dollars or organs, often flows as Scheper-Hughes describes. As an example, Davidson refers to when Bayer sold large quantities of a blood-clotting factor to Asia and Latin America, because the product was not fit for sale in the United States or Europe. The result of this transaction was an HIV infection rate of 90% among those targeted by the company, and a profit of four million dollars for Bayer (Davidson 121). This is an example of money flowing out of developing nations to wealthier ones in a global economy and at a cost to the developing nation. When this occurs in the context of the organ trade, the results are similar — the exploitation of those without money and resources by those with money and resources.

Lawrence Cohen, in a discussion about "kidney zones" in India, illustrates how social hierarchy and corporate competition interact to produce areas where the organ trade flourishes. He hypothesizes that "kidney zones" (areas where kidneys are sold in large numbers) "emerge through interactions between surgical entrepreneurs, persons facing extraordinary debt, and medical brokers" (676). Globalization has brought the once rare procedure of organ transplantation, before carried out only in developed nations, to countries around the world (Scheper-Hughes 4). This set the stage for the competition between public and private healthcare entities, and in combination with surgeons willing to take risks for money and a pool of indebted citizens willing to do whatever it takes to keep their family afloat, the organ trade thrives.

In Brazil, the competitive economic pressures of a market-based economy have contributed to a healthcare system that fuels the supply and demand of organ trading. As discussed by Scheper-Hughes, there exists outside the free national healthcare system a private medical sector, resulting in a competition for organs between free health clinics and private ones. She also explains that the financial incentives are much higher in the private sector, and so it is the private clinics that are more aggressive about obtaining organs so that they can charge more — and thus profit more — from transplant surgeries (31). Of course, it is possible that the organs obtained are legitimately donated, but evidence exists of police investigations into the so-called "body mafia" that suggests otherwise. This group of criminals has links with hospital and ambulance staff, as well as within the police force in an underground ring designed to trade human organs (Scheper-Hughes 31). In this example, the flow of money remains in the country, but those who prosper are a select few, and those on waiting lists in public hospitals may be skipped over as newly available organs go to wealthy private clients (Scheper-Hughes 32).

In 2007, China introduced a new set of regulations in an attempt to crack down on the sale of organs (Watts 1917). China is a unique example of the hierarchical flow of organs and money, as it is the only country that uses the organs of executed prisoners for organ transplantation (Scheper-Hughes 21). There has been much advocacy against this practice by international human rights activists, but China has held out. Why continue the internationally rejected practice of harvesting organs from executed prisoners? Perhaps because China has become a mecca for wealthy foreigners in need of transplants and who are capable of paying up to $30,000 for an organ (Watts 1917; Scheper-Hughes 22). With the Chinese healthcare system becoming increasingly market-driven, hospitals are under significant pressure to generate income, and therefore ask fewer ethical questions about the sources of the organs (Watts 1917).

To better understand Scheper-Hughes' flowchart model of organs and capital, one must differentiate between the disabled parties involved in the organ trade. Effects of globalization affect two separate categories of people, both of which may identify as having disabilities. The first category consists of those in need of an organ, which can be further divided into wealthy private clientele and the locals who are often skipped over to serve these wealthier individuals. The second category is composed of those who sell their organs. This group of "donors" is most drastically exploited by economic and healthcare systems. These people are impaired due to the extraction of an organ and disabled because they are often left in debt and may be unable to be a productive member of society due to a lack of proper medical care, both preceding and following the removal of an organ.

The wealthy, often foreign, recipients of organs cannot be left out of the disability discussion as it relates to the organ trade. They provide a striking contrast to the situation of "disabled" when compared to the donors, and they are a causal link in the situation of the neglected local recipients. The wealthy foreigner is literally buying his or her way to the front of the waiting list, taking an organ that should have gone to a local with the same chronic condition. This is a big problem in China, where 1.5 million Chinese wait for various transplants (Watts 1917). In South Africa, a nurse expresses her hostility towards those foreigners arriving in local hospitals in search of organs: "[A]s far as I am concerned South African organs belong to South African citizens. And…before I see a white person from Namibia getting their hands on a heart or kidney that belongs to a little Black South African child, I myself will see to it that the bloody organ gets tossed into a bucket" (Scheper-Hughes 11). Her statement encapsulates the flow of organs from the traditionally marginalized to the privileged and highlights a social aspect of disability. Though both the wealthy foreigner and the local might identify as having a disability due to the chronic condition for which organ transplantation is necessary to treat, there are social aspects that affect available options for both parties. The wealthy foreigner is in a position to travel long distances and pay large sums of money for an organ, while a local relying on public health care lies in a hospital bed on a waiting list. Able to pay at least double what the local insurance allows for locals, the wealthy foreigners are a target market for competitive companies in the healthcare industry (Scheper-Hughes 11). This inequality is not addressed by globalization; rather, it is exacerbated by the expansion of the international competitive economy as reflected in healthcare systems. Disability exists, to an arguable degree, when society instills it in an individual. The already trying conditions of the local on the waiting list are worsened by social support for the current systems of globalization.

Even if a local on a waiting list is fortunate enough to receive an organ, there are other factors that may make that individual's situation worse than that of the line-cutting foreigner. While waiting for a transplant, dialysis might not be available due to a general lack of infrastructure in the area or because of financial concerns (Hoyer 1367). The recipients may also not be fully informed that they are not "exchanging a death sentence for a new life, but that they are exchanging one mortal, chronic disease for another" (Scheper-Hughes 9). This refers to the complications following transplantation and also to the medically-related maintenance required to maximize the benefit of the new organ.

Donors often have little or no access to hospital care following the extraction of an organ, which is necessary to prevent complications after surgery (Cohen 668). A woman in Pakistan donated a kidney to support her family after her husband was unable to work after an accident, but her health became worse after the donation because she received no post-operative care (Garwood 5). Documentation on poor organ recipients in Brazil showed that they were unable to afford the costly immunosuppressant therapy to prevent organ rejection, and had to pool and taper their doses prematurely, as one month of the immunosuppressant drug costs more than most of those families earn in a month (Cohen 678). These impoverished recipients are forced to choose between maintaining their health and plummeting (possibly further) into debt. Though the donation of an organ in itself might not constitute a disability, being unable to work and live a healthy life because of a lack of available medical care following organ extraction does.

The "donors" of the organs going to those wait-listed locals and wealthy travelers are the crux of disability and the black market organ trade. I will refer to these individuals as organ "donors," but note that such a term denotes a voluntariness that is brought into question with the following arguments, as well as a false implication of no compensation for the "donors." However, I will use "donor" as a critical commentary on the continual denial of the role globalization is playing to worsen the situations of those in a position to "donate" their organs; primarily, how globalization is failing to address the issue of debt on the part of the donor, and the resulting acceptance of the use of body parts as currency to pay off these debts.

Cohen, in his time spent in India studying the organ trade, summarizes the plight of kidney donors. The theme running through each story he heard was that of debt and poverty (666). Scheper-Hughes makes the statement, "A market price — even a fair one — on body parts exploits the desperation of the poor" (19). This is a desperation coming out of debt-ridden and poverty-stricken situations, even culminating in newspaper ads offering to sell body parts. A major paper in Brazil ran an ad "offering to sell any organ of my body that is not vital to my survival and which could help save another person's life in exchange for an amount of money that will allow me to feed my family" (Scheper-Hughes 30). A woman in Bangladesh placed an ad in the Sunday paper to sell one of her eyes in order to pay rent and feed her daughter (Zora 1). This problem of debt drives organ donations, but does not disappear once a body part has been sold (Cohen 676). All of the donors with whom Cohen spoke were back in debt despite having sold a kidney, possibly related to issues linked to their social status (676). Problems relating to social status are often related to oppression within a given system, reflecting less on the struggling individual and more on the system in which he or she lives.

The organ trade has also changed the way bodies are seen by debt-collectors. The image of the mafia breaking the legs of someone who borrowed money is a familiar one, but in places like India, organs are seen as another form of collateral for debt-collectors (Cohen 676). This expectation that body parts can and should be traded for currency is also reflected in the thought processes of those in debt, as evidenced by the newspaper ads and the information compiled by Cohen about poverty as a common theme of donors. In Pakistan, often those who donate kidneys have no other way to make money because they live in a bonded labor system, tied to property owned by those financially better off (Garwood 6). Without the means of production, these Pakistanis sell their organs in an attempt to liberate themselves from this oppressive debt bondage.

There have been a number of suggestions to improve conditions for organ donors in attempts to prevent individuals from becoming a disabled product of the organ trade. Cohen notes that no data exist on the long-term effects of kidney extractions, despite doctors insisting that risk is minimal (674). If studies could be done to examine the longitudinal effects of donating a kidney or other organ, donors could be more informed about their decisions. These studies would be particularly beneficial if conducted in situations outside the typical medical model of affluent white donors altruistically giving up kidneys to relatives in developed nations, as this typical situation is not the "typical" experience of those exploited by the organ trade. Knowing the risks, both physically and in regard to ending up back in debt, might not realistically make a difference for someone in as desperate of a situation as Cohen and Scheper-Hughes describe, but the effort going into such a project would raise awareness of pertinent issues. This process would work towards combating the silence Davidson describes between globalization and disability.

There has also been significant effort put into developing measures that can be used to aid in the decision-making of an organ recipient that includes five supposedly quantifiable measures representing "burden of disease," and this measure is designed to help a possible organ recipient decide if he or she wants to go through with the transplant and to further educate the recipient about the nature of his or her situation and possible outcomes (Krakauer 1555). The development of this measure illustrates the amount of focus placed on the organ recipient instead of the donor, despite the fact that such research could be used as a framework for donor decision-making as well. The constant refusal to acknowledge the needs of the organ donors — from simply investing time in gathering and conveying accurate and comprehensive information to addressing underlying societal problems of class hierarchies — is a significant problem.

It is today's system of globalization that disregards the needs of impoverished individual donors both before and after organ transplantations, in turn creating an international community of disabled people. The imposition of economic structures that fuel competition between private corporations and public entities (such as hospitals) only compounds already present inequalities and hierarchies in developing nations. Experts advocate developing clear regulations for healthcare systems on a global scale and shifting the focus to preventative medicine to avoid problems that lead to organ failure, but if these changes are made under the same systems that are praising globalization as we know it, then they might not really be changes at all (Hoyer 1367; Garwood 5). The disabled community entering into the organ trade, and those who are products of it, would greatly benefit from structural changes in society that work to break down class hierarchies, providing support for those in poverty and making healthcare available that is of the same quality as that received by the wealthy. Such changes could very well be brought about through the process of globalization, but not as globalization is progressing today. The black market organ trade itself could be curbed with proper advancements addressing the conditions of the donors, because, as an Indian report on the ethical considerations of the organ trade noted: "In the final analysis, poverty and deprivation sustain the trade in human organs" (Hoyer 1367).

Works Cited

  • Cohen, Lawrence. "Where it Hurts: Indian Material for an Ethics of Organ Transplantation." Zygon 38.3 (2003): 663-688.
  • Davidson, Michael. "Universal Design: The Work of Disability in an Age of Globalization." The Disability Studies Reader. Ed. Lennard J. Davis. New York: Routledge, 2006. 117-128.
  • Garwood, Paul. "Dilemma Over Live-Donor Transplantation." Bulletin of the World Health Organization 85.1 (2007): 5-6.
  • Hoyer, Peter. "Commercial Living Non-Related Organ Transplantation: A Viewpoint From a Developed Country." Pediatric Nephrology 21 (2006): 1364-1368.
  • Krakauer, Henry, R. Clifton Bailey, and Monica J.-Y. Lin. "Beyond Survival: The Burden of Disease in Decision Making in Organ Transplantation." American Journal of Transplantation 4 (2004): 1555-1561.
  • Scheper-Hughes, Nancy. "The End of the Body: The Global Traffic in Organs for Transplant Surgery." Organs Watch 14 May 1998. <http://sunsite.berkeley.edu/biotech/organswatch/pages/cadraft.html>.
  • Watts, Jonathan. "China Introduced New Rules to Deter Human Organ Trade." The Lancet 369.9577 (2007): 1917-1919.
  • Wilkinson, Stephen. Bodies for Sale: Ethics and Exploitation in the Human Body Trade. London: Routledge, 2003.
  • Zora, Parwini. "Poverty Forces Bangladeshi Woman to Turn to Organ Trade." World Socialist Web Site 18 May 2005. <http://www.wsws.org/articles/2005/may2005/bang-m18.shtml>.

Bio

Karen A. Hudson is a recent graduate of the University of Oregon Robert D. Clark Honors College. Always a fan of merging disciplines, she completed an undergraduate thesis in the area of psychology and law, analyzing the effect of expert witness testimony on the perceived fairness of the legal system. Currently, she is teaching youth undergoing psychological and behavioral treatment before attending graduate school for clinical psychology.

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Copyright (c) 2008 Karen A. Hudson, Elizabeth Wheeler



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