Over the course of 15 months, anthropologist Monir Moniruzzaman infiltrated and tracked the illegal organ-trafficking networks of Bangladesh.
In America, if you need an organ transplant, you wait. You wait patiently, with a grim clock ticking away, for some generous stranger who died and happened to mark "organ donor" on his driver's license. The other option is asking a family member or a friend to donate a piece of their being, knowingly taking on medical risks but with full and honest cooperation.
But what if you could forego all of that? What if you could buy an organ?
It may sound reasonable, paying for an organ from someone who could use the money more than an intact anatomy. But the real picture is grim. In a research paper published last week in Medical Anthropology Quarterly, Michigan State anthropologist Monir Moniruzzaman recounts the nearly 15 months he spent doing fieldwork in Bangladesh, where he infiltrated the illegal organ trafficking network. What he saw there he describes as nothing short of exploitation.
"The service of transplantation fulfills the needs of fewer than one percent of the population, the wealthy minority," Moniruzzaman writes in his paper, "while the majority of Bangladeshis die in silence, knowing they could have saved their lives through this modern technology."
As of 2007, the World Health Organization (WHO) estimated that there are about a dozen countries involved in organ-trafficking networks. For obvious reasons, hard data on the trade is difficult to come by, and it often takes investigative fieldwork like Moniruzzaman's to uncover how organs move through the underground market. A 2008 paper in the American Journal of Transplantation estimated that organ trafficking accounts for roughly five to 10 percent of all the kidney transplants performed in the world. Even in America, organ trade is not unheard of. In October, a Brooklyn man admitted to brokering kidney sales between Israeli donors and New Jersey recipients. He reportedly earned $410,000 from the transactions.
Curious about the existence of an organ trade network in his native Bangladesh, Moniruzzaman began contacting friends and journalists while working on his masters degree in the early 2000s. But phone calls are only so enlightening; he says he had to see it with his own eyes. "There is no way I can open up this underworld without being there," he told me.
During his fieldwork, Moniruzzaman interviewed 33 poor Bangladeshis who decided to sell their kidneys, many of whom initially didn't even know what a kidney was. Burdened by debt and with mouths to feed, these sellers were lured in by newspaper classifieds which imply a bounty to those willing to donate. In his research, Moniruzzaman collected more than 1,000 classifieds in popular newspapers, like the ones shown below, asking for organs and making impossible offers such as citizenship in a foreign country.
On the left (translation): Kidney Wanted -- A kidney is needed for a seriously ill patient. Blood group B+. The patient is living in Italy. If a good-hearted person donates a kidney, s/he will be amply rewarded or offered a job and citizenship in Italy. Contact within three days to Dr. ABM Eyahia, between 10 a.m. and 12 p.m. or 5 p.m. and 8:30 p.m. Telephone: 8116010 (Chamber).
On the right (translation): Kidney Wanted: Blood Group B+, O+, and O- (female preferable). Contact phone: 00492203358922 in Germany (can be called through the Internet) between 2 p.m. and 1 a.m. Bangladeshi time.
To entrap the potential sellers, organ brokers tell them that they have two kidneys, but one of them is "sleeping" in the body. During the operation, doctors "awaken" this dormant kidney and take the old one out for donation. In this view, the second kidney is just baggage, a cash reserve buried in the lower back. Furthermore, sellers are told that their second kidney is no use to them if their first one fails, which quiets thoughts of "what if I need that second kidney in the future?" They're also told the surgery is 100 percent safe. "It's the same story the sellers told me again and again," Moniruzzaman says. "I couldn't believe how much of a dirty trick it can be."
After they agree to donate, sellers are tissue tested, and if there is a match, the broker will offer the seller around $1,150. But in most cases, the sellers do not receive anywhere near that amount. The organ brokers tack on extra fees for travel and other logistics, and the sellers make sometimes only half the initial amount -- and even then only after the surgery is completed.
The brokers forge fake passports and legal documents to make it appear plausible that the seller is donating to a blood relative. In one case, Moniruzzaman found a 38-year-old Hindu seller who had to get circumcised to donate to a Muslim recipient. The circumcision was done crudely and only with local anesthesia. "When I was coming back home, the anesthesia stopped working," he told the anthropologist, "and I felt like it was a nightmare."
Most of the sellers Moniruzzaman spoke to were taken to India for the surgery, and upon arrival they had their passports confiscated so they could not leave. "One case I found [was] a 23-year-old college student," he says. "He went to India and realized that he was making a mistake. So he wanted to come back without giving his kidney. The broker hired two thugs -- Indian thugs -- and they basically beat him and forced him to go to the operation room."
This man, like all the other sellers, woke up from surgery with a 20-inch long scar around his torso -- a constant reminder that he sold part of his body for a few hundred dollars. "We are living cadavers," another told Moniruzzaman. "By selling our kidneys, our bodies are lighter but our chests are heavier than ever."
All but one of the sellers Moniruzzaman interviewed were Muslim, and in Islam there is a strict taboo against body mutilation. After the surgery, feelings of remorse and shame would set in. "They wanted to get rid of their poverty so they got entrapped in that system," he says, "but then they realized that they sold God's gift and when they go back in the afterlife, God would ask them 'Where are your body parts, where are the missing body parts?' And that creates a state where they are living with shame and disgrace."
When they returned to their daily lives, the kidney sellers reported that their economic conditions deteriorated, despite the small influx of cash. Only two of the 33 sellers used the money responsibly. Others were handicapped by the experience, and found themselves unable to do the manual labor they were used to. In the end, the brokers won, earning about $5,000 per transaction.
In Bangladesh, organ trafficking is illegal, but Moniruzzaman finds that it happens more or less out in the open. The classified ads all imply cash exchanges, but never directly say it. At one point in his fieldwork, he even confronted a nephrologist who had a kidney donation ad pinned in the lobby of his office. "I asked the chief nephrologists, 'These ads are everywhere. Why are the state officials not taking a stand and intervening?' And I was told, 'Donation is happening, but it's not buying and selling.' And they claim most of these transactions are happening in other countries, like India, so this is not their problem."
The solutions to the exploitation aren't clear or easy. For one, Moniruzzaman suggests there needs to be a more extensive cadaver-donation program. But cultural taboos about body mutilation present a roadblock: If people feel bound to keep their organs intact into the afterlife, cadaver donation is not an option. Regulating the market isn't a good solution either, he contends; such a market will only mean more rich people will live at the expense of the well-being of the poor. "It is not going to change corruption; it's not going to change equality and the fairness in that system," he says.
Because there is a supply of organs, the rich recipients do not even ask their family members for donations. "If there is a market out there, why are they going to put their family members at risk, taking organs from a loved one?"
Moniruzzaman calls it commoditized kinship. The recipients are thankful for their kidney sellers, but don't quite empathize with their situation, cutting emotional ties after the payment. "If you buy it from the market, it is a product, a commodity," he says. "And even though that commodity saves your life, it is still a commodity."