Free The Red Market by Scott Carney Page A

through mediation. He gathered the state’s top transplant doctors in a room in a spur-of-the-moment conference and made them swear to stop selling organs and try to use more cadavers instead. Resolved to let the doctors police themselves, he let the community off with only a token slap on the wrist.
    But he had to make some concessions to a public that was out for blood. To show that he was tough on crime, the ministry closed two of the smallest and most ill equipped nursing homes that were tangentially linked to illegal transplants. The rest of the city’s transplant teams breathed a sigh of relief. Even though clear paper trails linked dozens of surgeons to the previous year’s more than two thousand illegal kidney transplants, within a few months Chennai was back to business as usual.
    For Selvam and thousands of other poor Tamilians who never got their equal share of India’s rising fortunes, selling organs still sometimes feels like their only option in hard times.
    “In other parts of India people say that they are going to Malaysia or the United States with a glimmer of hope in their eyes. In Tsunami Nagar people speak that way about selling their kidneys,” he tells me.
    Tsunami Nagar is far from unique. The ample supply of available organs in the third world and excruciating long waiting lists in the first world make organ brokering a profitable occupation. Not only has demand for kidneys risen steadily over the last forty years, but poor people around the world often view their organs as a critical social safety net.
    Since the inception of antirejection drugs like cyclosporine, international cabals of doctors and corruptible ethics boards have slowly transformed slums in Egypt, South Africa, Brazil, and the Philippines into veritable organ farms. The dirty secret of the organ business is that there is no shortage of willing sellers.

     
A nephrectomy taking place at a hospital in Chennai, India. In 2006 and 2007 almost all of the women in a tsunami refugee camp nicknamed “Kidneyvakkam” sold their organs to a cabal of brokers and middlemen. Patients from India and abroad flock here to buy human organs at a discount and to escape long wait times in their home countries.
     
    For someone living on less than a dollar a day, $800 is almost an unthinkably large sum of money. The payment offers an unfair incentive, coercion that pits abject poverty against a global capitalist enterprise.
    If the organ shortage could be reduced to numbers and figured like an algebra problem, it would not be difficult to find living donors for the one hundred thousand people on the United States’ organ transplant waiting list. Third world sellers are easy to find, and they offer a cost-effective solution to the problem. A transplant at an Indian hospital costs about one-twentieth of what it does in the United States.
    The economic logic is so persuasive that several American insurance agencies want a piece of the action. Two of them, IndUShealth and United Group Programs, estimate that it is cheaper to cover the cost of a cheap kidney transplant abroad than paying for years of expensive, and ultimately lethal, dialysis treatments at home. These and other companies have relationships with hospitals in India, Pakistan, and Egypt that can arrange organ transplants almost on demand. Outsourcing plans like theirs were so persuasive that in February 2006 the West Virginia legislature considered a formal health-care plan for state employees that offered rebates to patients who chose to get their transplants done in a foreign hospital. By the time of publication the law was still pending, and yet little seems to have changed in the overall situation. (It should be noted that IndUShealth’s website states that while the company will pay for the transplant, patients seeking live-donor tissue have to arrange for their own donor, something relatively easy to do with the right hospital contacts.) For recipients, the red market has a