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The prevalence of end-stage renal disease requiring transplantation in india is calculable to be between 151 and 232 per million population (Modi and Jha 2011). If a mean of those figures was taken, it is calculable that nearly 220,000 individuals need kidney transplantation in india. Against this, currently, only 7500 kidney transplantations are performed at 250 kidney transplant centers in india (Shroff 2016). Kidney sellers in india hail from urban slums as well as from drought-prone farming districts close to the cities where transplant surgeries are performed (Cohen 2003). A study was conducted on 305 kidney sellers from Chennai in 2002, of that seventy one were females and the average age was thirty five years. in the case of forty seven participants, both spouses had sold their kidneys. In 70% of the cases, middlemen were also taking part in the commercialism of kidneys. 96% of them sold their kidneys to pay off debts that came from food, household expenses, rent, healthcare expenses and wedding expenses (Goyal 2002). According to Goyal (2002), “The amount promised for selling a kidney averaged 1,410 USD (range: 450-6,280 USD), while the amount actually received averaged 1,070 USD (range: 450-2,660 USD). Of the 292 participants who sold a kidney to pay off debts, 216 (74%) still had debts at the time of the survey.”
However, negative health, economic, social, and psychological impacts for victims of organ trafficking have become apparent according to studies released in 2002 (Goyal 2002) and 2003 (TT Bureau 2011). Results in these studies show that a sale of a kidney in India has not been linked to an improvement in economic status but rather with an eventual decline in household income. Only four victims (4%) of those interviewed whose debt led them to the kidney sale indicated that they were able to settle the debt from the payment. Interactions of experts with kidney recipients from India unveiled that not only the sellers but also the buyers are at risk. Having spent a huge amount of money on buying a kidney and the transplant procedure, many of them are not able to keep up with the long-term immunosuppressant therapy which is essential in preventing the rejection of the transplant by the recipients’ body. More often than not, recipients misjudge the long-term expenses and their monthly income cannot support these unforeseen costs, which eventually leads to kidney failure (Cohen 2011). According to Dr Lawrence Cohen (2011), “scandals of trickery and unfair payment to kidney sellers tarnished the reputation of many of the five-star hospitals in India and resulted in the passing of the Transplantation of Human Organs Act (THOA) in 1994.” THOA (1994) has significantly decreased organ trade in India. However, the Coalition for Organ-Failure Solutions India (COFS) has pointed out 1,500 victims of organ trafficking in Chennai and Erode in Tamil Nadu and regards this number as just “the tip of an iceberg” taking into account the flourishing kidney market in Chennai, Kolkata and Bangalore (Cohen 2011).
Individuals interviewed in the above mentioned study reported that debt was the main reason to sell a kidney (98%), and they had recoursed to the sale with the hope of putting an end to their debt and rise above poverty. Wedding expenses, healthcare, food, and household expenses were the most common origin of these debts as stated in the 2002 study in Chennai (Goyal 2002). Dr Cohen’s observations also support this. In his own interviews with social workers, journalists and 30 kidney sellers in Ayanavaram, one of the slums in Chennai, he discovered that people sell their kidneys to pay off their debts, but gradually fall back into the cycle of debt. He also noted that the remaining money after repayment of their debts is used for wedding expenses, healthcare costs, legal fees and education of their children.
Furthermore, he mentions “Kidney zones emerge through interactions between surgical entrepreneurs, persons facing extraordinary debt, and medical brokers. As a region becomes known to brokers as a kidney zone, their search for new sellers intensifies”. Hence, the decision to sell a kidney is not just due to a natural state of poverty, but also associated with a debt crisis alongside the availability of a kidney market (Cohen 2003). Unfortunately, none of the victims had information about the dangers resulting from the procedure, nor did they receive the full amount that was promised (Budiani-Saberi and Columb 2013).
In a sociological perspective, the concept behind human organ trafficking can be explained by Karl Marx’s theory of class. In Capital, Marx states that in a developed capitalist society there is only a capitalist class and a proletarian class. Capitalists, who are also called the bourgeoisie, are described in the Communist Manifesto as 'owners of the means of social production and employers of wage labor.' The proletariat are said to be 'the class of modern wage-laborers who, having no means of production of their own, are reduced to selling their labor-power in order to live.' (Ollman 1968). According to Rummel (1975), “Class is thus determined by property, not by income or status. These are determined by distribution and consumption, which itself ultimately reflects the production and power relations of classes. The social conditions of bourgeoisie production are defined by bourgeois property.” Class is therefore a hypothetical and institutional relationship among individuals. The modern economic system promotes high levels of poverty in India. The International Monetary Fund suggests that a third of the population in India lives below the government’s poverty line (International Monetary Fund 2012). Victims of organ trafficking who were interviewed in this study fair worse than the average Indian with a mean monthly salary of 3119 INR or 59 USD. The goal of organ trafficking is set on profit maximisation, which benefits the higher end of the hierarchy, but victimises the rest. This can be supported by Dr Cohen’s study. According to Dr Cohen (2003), “Given the complex scenario in India, the so-called ‘ethical’ organ trade may help the organ brokers and debt brokers, rather than helping the poor sellers.” Furthermore, impoverished people who live in the kidney-selling zones often regard their kidneys as a commodity, sometimes as the only valuable asset they own in order to bring themselves out of their debts (Farhat Moazam, Riffat Moazam Zaman and Aamir M. Jafarey 2009).
According to the international business literature, human organ trafficking has been accelerated by economic globalization. Goble (2000) mentions that “human organ trafficking has become the fastest growing type of organized crime under economic globalization.” Scheper-Hughes (2000) adds that economic globalization has encouraged the spread of human organs across national borders. Traffickers treat human organs as just economic commodities in a globalized economy (Goble 2000). Economic globalization may aggravate the illegal circulation of human organs around the world. Therefore, it is believed that economic globalization is closely tied with trafficking. Globalisation through the advancement of technology has also allowed for transplant tourism. “Transplant tourists” are traveling to well known destinations to receive easily accessible organs for transplantation, available from the impoverished people of that destination country who sell mostly kidneys, but in some cases, a lobe of the liver or a cornea (Delmonico 2009). Prior to this, organ brokers were restricted to harvesting organs from people in close proximity to them. But now, through the use of advertisements on the internet under the guise of a company selling consumer products or holiday packages, they are able to connect a recipient and a donor from two different countries and even arrange for the surgery to be done in an entirely separate country. This makes it difficult for governments to trace the individuals who are involved (Hill 2014).
Charles Hurst (2016) reveals an unfortunate reality on the commodification of human organs, “In the world of globalized capitalism, all objects lose distinction. They stand apart merely on the basis of their relative equivalence, each with a price, or rather an exchange value.” Each country needs an independent system of organ transplantation to cease the inequity that portrays the healthcare system presently. A transnational crime like human organ trafficking has shed light on the movement of resources from the Global North to the Global South, from the wealthy to the impoverished; and this movement must come to an end.
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