What price a human kidney?

How much does a human kidney cost on the black market? It depends on who you are in the transaction.

Buyers can pay between £60,000 and £150,000. But donors only receive between £1,000 and £7,500, if they are lucky.

Where does the rest of the money go? The lion’s share goes to the organ brokers: criminal organisations who act as middlemen between donors and buyers.

These syndicates are sophisticated, exploitative, and international.

“One racket, operating from Israel, brought together Brazilian donors with American buyers, with the transplant taking place in South Africa.” So says Dr Saradamoyee Chatterjee, Bye-Fellow and Director of Studies in Land Economy at Lucy Cavendish College.

Chatterjee unpicks the illegal trade of human organs. She gives voice to the desperate players trapped inside its transactions, and suggests ways to stamp it out.

The organ bazaars

Beginning in the 1950s, science radically improved the success rate of human organ transplantation. Researchers found ways to suppress the immune response of the recipient, so that new organs are not rejected. Transplants now have a high degree of success between strangers, provided that donors and recipients match in blood and tissue type.

Kidneys are by far the most commonly transplanted organ, but transplants of heart, lungs, liver lobes and corneas are also possible.

In countries like India, Pakistan and the Philippines, these advancements initially led to completely unregulated human organ markets. Whichever country had the fewest regulations attracted international patients.

“In the 1980s, these countries were like an organ bazaar,” Chatterjee says. “Patients from the Middle East, UK and USA flocked to get their transplants done.”

Since the 1990s, most countries have brought in prohibitions on the organ trade. The famous Istanbul Declaration took a stand against transplant tourism, and the World Health Organization called for a global prohibition on cell, tissue or organ purchases.

Currently, only Iran has a legalised system for paying donors for their organs. Everywhere else relies on legal means, like organ donor lists, or illegal ones, which are still rampant in some countries. The persistence of organ trafficking reflects the desperation on all sides of the transaction.

The need for healthy organs is ever-increasing. Modern ‘lifestyle’ diseases such as diabetes and hypertension lead to kidney failure. Among the 2 current treatments – dialysis and organ transplantation – the latter significantly enhances the quality of life. Many people wait decades on donor lists and will do anything for a healthy organ.

Among slum-dwellers and asylum seekers, there is both a supply of valuable organs and the desperation required to part with them.

Here is where the middlemen come in, servicing an unsavoury gap in the market.

The sellers

Chatterjee travelled to Mumbai, Delhi, Chennai and Kolkata to seek out people with first-hand knowledge of the organ trade. In these cities she found a network of medical professionals, transplant coordinators, buyers and donors willing to share their views.

“Slums are a goldmine for organ traders,” Chatterjee says. “The brokers exploit people who are trapped in poverty and debt, and lure them into selling their kidneys.”

Many people are in need of a lump sum to escape dire circumstances – the organ traders supposedly offer that.

Once a broker gets a kidney, the sellers seldom receive the promised compensation and the vital post-operative care. Even the nominal fee would not provide any relief from poverty.

“One woman I spoke to was a cleaner for weddings,” recalls Chatterjee. “She sold her kidney to save the life of her husband. He’d fallen into debt after buying a tuktuk via a money lender, and couldn’t afford the interest payments. In the end, she only received half the offered price for her kidney.

“She was left weakened, deeply disappointed, and regretful of the whole organ-selling experience.”

In matching sellers with buyers, the syndicates respond to pleas for organ transplants on social media.

To dodge India’s prohibitions, the syndicates exploit loopholes in the law, including the forging of fake backstories. They generate false documents and testimonies to convince doctors and clinicians that 2 strangers know each other.

The transplant can then take place as if it were happening legally – as an agreement between friends or family, without money changing hands. These tactics make it difficult for doctors to detect potential exploitation.

The buyers

Organ trades are a bad deal for buyers too. Both the buying patients Chatterjee interviewed died shortly after their operations.

“In one case, the broker took payment before providing a mis-matched donor,” Chatterjee says. “In the second case, a female doctor saw that her new husband’s kidneys were failing. She placed an advertisement in the local newspaper, and a broker responded. But on the day of the planned transplant, the donor ran away.”

Operating with no regulation, the middlemen don’t uphold medical standards. They often don’t screen donors for existing conditions, exposing recipients to blood diseases like HIV or hepatitis.

The proliferation of lifestyle diseases in massive populations means that the organ trade isn’t only for the super rich: buyers only need to be rich relative to the poverty-stricken sellers.

Both of the buyers Chatterjee spoke to came from the middle class. They were compelled to borrow money from their relatives to pay the broker.

How can we make things better?

Meaningfully reducing the illegal trade of human organs requires action on many fronts.

Reducing the gap in supply means encouraging more legal donations. Other countries have focused on deceased donations, where people donate their organs after death. In Spain, everyone is an organ donor by default, meaning they have the world’s highest deceased donors rate (49 per million people; by comparison, India has only 0.77).

India claims to be tackling the black market with increased regulations and harsher sentences for perpetrators. Information campaigns targeting potential sellers should warn people about the dangerous middlemen. Further exposure of the black market by researchers like Chatterjee and Dr Sean Columb may also prevent people from being dragged into it.

On the demand side, societies need to properly fund their citizens’ healthcare. More successful countries focus on the prevention of lifestyle diseases that are leading causes of renal failure.

Encouraging people into healthier lifestyles – with fewer carbohydrates and more exercise – would decrease the prevalence of conditions like diabetes. Better screening programmes would also encourage patients to adjust before their condition deteriorates, reducing the demand for new organs.

“Organ traffickers exploit the vulnerabilities of both the donors and buyers,” says Chatterjee. To wipe out the middlemen, we need to make people on all sides of organ transplantation less vulnerable and more resilient.