Donate a Kidney, Get a Cheque

Last week a young woman came to the clinic with a strange request. 

When the twenty-year-old mother of two was asked what her presenting complaint was, she replied that she came to sell her kidney as things were very bad at home. Alarmed, the doctor approached me. Apparently, she was the third person he was seeing with the same request in a span of thirty days.

I asked her to see me.

Why are you here? 

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I want to sell my kidney, she repeated.

Where did you hear that kidneys are being sold?

In town, she replied, vaguely. She had heard rumours that kidneys were sold for as much as N5 million Naira. Her husband was a manual labourer who digs wells for a living. She, herself was not literate and had no marketable skills. Their rent was due and she had sold what little belongings she had. Her parents were destitute and I could see signs of malnutrition in her children. Selling her kidney seemed to be her last hope. Five million Naira would do wonders for her family. When I told her that selling kidneys was illegal and therefore, we (the hospital) could not be of any help, she broke down in tears.

That day, we both left the hospital dejected.

My feeling of sadness over her poverty was, however, overshadowed by the alarming thought that illegal kidney trade had finally found its way to Nigeria.

We have all heard the rumours. People being kidnapped and drugged on the outskirts of Lagos only to wake up on an abandoned road with a large scar on their abdomen and one of their kidneys missing. The stolen kidney would be stored in a cooler and smuggled across Cotonou through other West African countries. Some kidneys travelled as far as Asia to meet their donor, while some end up in African countries.

The fact that people are becoming aware of this trade and even bringing themselves willingly to the hospital, is an alarming thought.

Imagine if she had fallen prey to one of many doctors involved in trafficking human parts?

Globally, Kidneys make up 75% of the global illicit trade in organs. The rising rates of diabetes, high blood pressure and heart problems are causing demand for kidneys to far outstrip supply.

The illegal trade in kidneys has risen to such a level that an estimated 10,000 black market operations involving purchased human organs now take place annually, or more than one an hour, World Health Organisation experts have revealed.

Evidence collected by a worldwide network of doctors shows that traffickers are defying laws intended to curtail their activities and are cashing in on rising international demand for replacement kidneys driven by the increase in diabetes and other diseases.

Lack of law enforcement in some countries, and lack of laws in others, mean that those offering financial incentives to poor people to part with a kidney have it too easy.

Kidney disease is common, but treating it with dialysis is effective for usually a decade at most, not to mention very costly. While there were more than 17,000 kidney transplants performed in the U.S. last year, about 8,000 people became too sick to receive one or died waiting for a transplant. Patients, many of whom will go to China, India or Pakistan for surgery, can pay up to $200,000 (nearly £128,000) for a kidney to gangs who harvest organs from vulnerable, desperate people, sometimes for as little as $5,000.

The simplest solution which is paying healthy people for their organs quickly becomes complicated. Opening organ donations to the free market, even with robust regulations, invites some concerns. Would desperately poor people be forced into selling their organs? Yes. Would unwilling people have their kidneys forcibly removed and then sold? Oh yes. These nightmare scenarios are very real, and sadly already happening. 

The idea of selling organs is knotted up with the idea of sovereignty over one’s body. However, it’s a cause that many people advocate for. Alvin Roth, a Nobel-winning economist, has seriously considered what a kidney market would look like. “I’ve become interested in the fact that it’s against the law to pay for a kidney anywhere in the world, but it’s not against the law to remove financial disincentives.” Roth has noted that steps could be taken so that hospitals could easily reimburse donors’ costs, and then in turn be reimbursed through private insurance. He says that, in the big picture, this would pay for itself, given how many people it would exempt from the costs of frequent dialysis and hospitalizations. 

As distasteful as it seems to sell organs, the current situation is simply too catastrophic not to change something. Kidnapping people for money was once unheard of, a crime that we only heard happened in far off places like Columbia and Mexico, now however, Nigerians have become experts at it, far surpassing even our predecessors. Imagine what will happen when these criminals learn how lucrative it is remove kidneys and sell them in the international market? We will be done for.

Moreover, in the current unregulated system, the world’s poor are being exploited en masse. As of 2010, one in every five kidneys transplanted each year originated in the black market. The vast majority of people currently selling their organs are poor and live in developing nations—many do so in order pay off their debts. When one of these people sells his or her kidney, the World Health Organization estimates, it will go for about $5,000. The brokers who buy them can then turn around and sell them for as much as $150,000. Though it may seem cold and dystopian to use a market to incentivize poor people to sell their body parts, the truth is that some of them are doing it anyway.

So, what is the way forward?

Yes, there is a regulatory law that governs organ harvesting and donation in Nigeria. It is in the National Health Act of 2014. The Act also prohibits the commercialisation or commoditisation of human organs to the extent that if a person is involved in the sale, procurement, or distribution of human organs, he may run afoul of the Act, and the Act has made penal provisions for terms of imprisonment or fine. If you commercialise an organ, you are liable to N1m fine or not less than two years’ imprisonment. 

Hence, the essence of the non-commercialisation of organs is that a donor is prohibited by law from donating an organ as a commercial transaction. But if you have incurred some expenses in the process of donating, you might be reimbursed for those expenses. There are other provisions of the Nigerian law in the National Health Act relating to organ donation. The Act provides that there shall be no removal of organs or tissue without the informed consent of the organ donor.

Yet, even with this law, people are still hell bent on selling their kidneys. 

So, what can we do?

As unpleasant as compensation for live-organ donations may seem, we may have have to consider this in the near future. A highly-regulated global market with an emphasis on equitable compensation could allay these concerns, as well as ensuring that operations are performed safely. It would be important to make sure such a market doesn’t devolve into “transplant tourism,” but if orchestrated properly, it could simultaneously satisfy the needs of wealthy countries with long waiting lists and poorer countries with rampant poverty.

Its something worth thinking about.

And about the woman requesting to sell her kidney, she has been sorted out. A group of well-meaning individuals have since donated to her cause. 

May Allah make it easy for us, ameen.