The oddest thing about The Transplant Trade was that it essentially told you nothing that was revelatory and new about the world trade in kidneys. We are aware that many thousands of people in Britain are on waiting lists for kidney transplants; we know that there are many poor people in India only too willing to sell a kidney to drag them out of the gutter; and we also know that there are many people in need of a kidney who will gladly pay the asking price.
We know too that in some countries, such as Spain, the law dictates that organs from the deceased are compulsorily taken after death unless specifically told otherwise, meaning no organ shortage; and we know that while the trade is illegal it will be run much as the drugs trade where most of the profit goes into the pocket of the dealers (who are abhorrently referred to as ‘brokers’, as if more aligned with the money men of Wall Street than their squalid dealing in human despair).
What Kate Blewett and Brian Woods’ documentary did, and did very well, was to paint in the intricacies of this booming global business through giving every link in the chain a human angle. What made it more thought-provoking was an ostensibly equivocal endorsement of the trade, perhaps to contradict what the majority of their audience’s initial opinions would be, that of blind revulsion towards the whole business.
Beginning in Britain, the first case featured was 11-year-old Amber, who has suffered renal failure for five years but is not on the primary list for a kidney transplant. Her daily trials of draining the build-up of liquid from her body through tubes attached to her abdomen and throat was heart-rending. Her mother said she would gladly pay the $125,000 necessary for Amber to receive a kidney illegally if she could afford it.
This set up the most cogent argument for allowing the trade to go ahead – that without a transplant people will die. The next stop was India where both sides of the trade were addressed. Former lawyer Munsamy frittered away the last of his savings on dialysis to keep him alive, while aiming to sell a plot of land he hoped would raise the funds to buy a new kidney. Meanwhile, Kumar, who picks through the refuse tips for £12 a month is contemplating selling a kidney to pay off his debts to money lenders.
Both stories had tragic outcomes. Despite being conned by a number of brokers Munsamy eventually found a match and arranged a transplant, but before the operation could take place his condition deteriorated and he died. Kumar was just as unfortunate in his own way after selling his kidney for £600. His debts had increased through interest and he was unable to settle all that he owed, and his situation was made worse as the operation had left him in excruciating pain and unable to work.
The case against the organ trade was led by Professor Nancy Shepherd-Hughes who decried the ethical implications, saying that if trade in kidneys was legalised, where would the line be drawn and cited examples of people willing to sell their eyes and parts of their liver, too.
But her argument that the trade was inherently reprehensible was undermined by the prominent focus on the victims of the trade – the donors and the sick. Their struggles to live or escape from a damning poverty were far more powerful than a professor’s ethical misgivings.
What was identified as the real source of the misery was the role of brokers, who ranged from former organ donor cartels in India to respectable internet businessmen, who often took the lion’s share of the fee. Orr, an Israeli woman needing a third kidney transplant, paid $125,000 in total: $20,000 went to the donor; the hospital took $40,000; and expenses accounted for $10,000. This left the broker with $55,000.
A solution suggested by the documentary was to legalise the trade as this would ensure that a greater proportion of the money went to the donor, so Kumar could have paid his debts, while the overall cost would be more affordable for people like Amber and Munsamy. And while there is a glimmer of light for Amber as the government debate adopting the same policy as Spain on organ donation, for people like the late Munsamy there is no such hope. As he despaired at the financial and legal barriers that impeded his search for a kidney Munsamy said: “Is it unethical to want to live?”