Posts for category ‘organ donation’

Wired on the Red Market (or: I’m a journalist, not an organ broker)
| February 15, 2011 | 2:54 pm

“The Red Market” had its magazine debut this month in Wired as an eight page info-graphic that divides the human body price. The model they used is a very hairy man who sort of gives me the heebie-jeebies to look at. But I guess that is appropriate since the topic itself can get a bit creepy. Think of this as a preview of what the book will be like with a few major differences. Reducing the book to a chart creates a few limitations that fuels my love/hate relationship with the format. On one hand, it’s an easy way for reader to digest an incredibly difficult and nuanced topic. Most people only know about illegal markets for human bodies through urban legends and movies like “Dirty Pretty Things”. Even fewer have given thought to markets for tissue outside of kidney transplants. The simplicity of price tags come at a cost. Since these are mostly illegal markets prices vary much more widely that I was able to illustrate. Just about every transaction on a red market is an individual negotiation that far more resembles the haggling process over a used car than it does a regular purchase in a grocery store.  As one reader pointed out in a post named “Damn You Wired!” putting price tags on organs makes the market look very regular and stable–and much to the author’s chagrin–that the US market for illegal organs is booming internally.

The truth, of course, is that there is a large market for transplant organs in the United States but most of the operations are done abroad. Americans fly all over the world for kidney transplants, egg donations, surrogacy, adoptions and questionably legal surgeries. Hospitals in America generally do not preform the operations themselves; instead it’s usually American  brokers who connect patients with foreign surgeons and hospitals. Either way it’s still huge business. And once the article came out I immediately started getting e-mails from US patients on the kidney transplant lists asking me to put them in touch with hospitals and brokers who could arrange transplants for them on the cheap. (note to would be transplant patients: please don’t contact me for an organ hookup. I’m a journalist, not an organ broker.)

The infographic form is also not really able to convey why these markets exist in the first place. Red Markets are not simply a fact of life in the world, or a simple expression of supply and demand. Rather they exist because of lack of transparency in the legal supply chains for human tissue. There are very few cases where anyone will ever know who donated blood that saved their life in surgery, or what specific person gave up a kidney after their car accident. The identities of donors are screened behind a wall of patient confidentiality. While there are legitimate reasons to keep these things anonymous,that very lack of transparency provides great cover for an organ criminal to ply their trade. This is something that I go into much more detail in in my book–particularly the way that the crooked history of the blood business has shaped all modern red markets.

In the meanwhile, click on the pictures above to see the article online. Or even better, buy Wired’s underworld issue in print. It’s on newsstands for a few more days.

The Bone Factory: India’s Underground Trade in Human Remains
| November 28, 2007 | 10:17 am
Manoj Pal: Dom and Cadaver Deflesher

It is pitch black and raining when I first meet Manoj Pal: a man who makes his living defleshing rotting cadavers. I am a hundred kilometers outside of Calcutta in a small village called Purbasthali where police confiscated more than 100 bright white human skeletons. The bones they found were on their way along a two hundred year old pipeline for human remains. The smugglers route begins on the banks of Indian rivers and ends in the sacred halls of medicine in Western countries. The skeletons Pal prepared could have fetch as much as $70,000 on the black market.

Manoj Pal is grunt labor for the industry. As part of the dom, or grave tending, caste his job is the most grim. Day and night he recovers bodies from a nearby cremation ghat. He binds the corpses in mosquito netting and soaks them in the river for a week. When the bodies are waterlogged and mostly consumed by fish and stray dogs he scrubs off the remaining flesh, dumps the bodies in a boiling solution of caustic chemicals and lets them dry in the sun.

Before he was arrested Pal’s boss, Mukthi Biswas would sell bones to a medical supply company in Calcutta called Young Brothers for a few thousand rupees. From there the bones were wired together into free hanging skeletons and sold both domestically and abroad.

I spent three months piecing together the path that human bones take from Calcutta to the Western world for WIRED magazine. I found suppliers and buyers in well respected companies and universities across the United States. When I brought this to the attention of police in Calcutta they told me that they do not view grave robing as a serious crime. On the rare occasions that the police catch a grave robber, they mostly just let them off with a slap on the wrist.

The bone business dates back to colonial times when British doctors needed a steady supply of human skeletons to stock anatomy classes in England. Before they had set up a reliable system for preparing human skeletons on a mass scale there was an extreme shortage of bones available for study. It drove some British doctors to rob graves in their own neighborhoods. Some cemeteries were so notorious for skulduggery that there were frequent fist fights between grieving families and shovel-carrying medical students.
A bag of leg bones confiscated on the Bhutan Border

But with the advent of colonialism doctors began to look to Calcutta for fresh body supplies. By the mid 1800’s Calcutta Medical College was sending hundred of bodies abroad every year. The trade continued to flourish until the 1980s. At its peak every aspiring doctor in the world bought a box of bones along with their first year’s medical textbooks for about $300. Calcutta was exporting more than 60,000 skeletons a year making it a multi million dollar business.

But it couldn’t last forever. In 1985 rumors began to surface that the bone dealers had run out of skeletons in Calcutta’s graveyards and were killing children for their skeletons. Child skeletons are rarer than adult skeletons and fetched a higher price on the market. A man was arrested for exporting more than 1,500 child skeletons. A member of the legislature accused him of murder and put the nail in the coffin for the legal industry. By 1986 exports had all but stopped. The 13 original bone exporters all seemingly shut their doors. Medical schools in the West began relying on model skeletons for their anatomy instruction needs.

What no one knew was that at least one company was still exporting human bones. They had rekindled factories across West Bengal and had clients all over the world.

The most active bone exporter is Young Brothers. It’s a medical supply company that sits between one of Calcutta’s most active morgues and its largest cemetery. In 2001 neighbors complained that the warehouse stank like the dead. Some people reported seeing bones drying on the roof. When the health department chief Javed Ahmed Khan heard the reports he raided the facility and found bones boiling away in cauldrons and export invoices for orders all over the world. It was proof that the business was violating the export ban. But when Khan took the case to the police the owner of Young Brothers, Vinesh Aron, only spent one night in jail. The case was thrown own over a jurisdictional dispute and the business given a subtle nod that it could continue.

Since then Young Brothers has been more discreet about its business affairs, but it hasn’t exactly shuttered his doors. In October I met Aron’s in law in yet another medical supply company in Chennai. He told me that Vinesh Aron is the only man in the family with “guts”. To prove it he pulled a fetal skull off the shelf and offered to sell it to me for $400.

In the meanwhile bones are still being smuggled though illegal channels in Singapore and Paris. I found a reseller in Canada who says that he still sells Indian bones across North America.

For more about the global trade in human bones check out this month’s issue of WIRED magazine in a story called “Inside India’s Underground Trade in Human Remains“. I have also produced a shorter radio segment for NPR titled “Into the Heart of India’s Underground Bone Trade“.

For more photos of the bone cache check out these two galleries: mine and NPR’s

National Geographic: Inside the Body Trade
| November 16, 2007 | 2:21 pm

National Geographic Explorer just aired an hour long documentary on the global market for human body parts. In the program they interviewed a Chinese doctor who helped remove organs from executed prisoners and transplanted them into foreign medical tourists. It also documented the painful lives of people awaiting organ transplant in the United States and flew out to Chennai to interview the donors and brokers who have made this coastal metropolis the worlds most famous organ farm. I worked with the documentary team for a month and helped coordinate the India piece of the puzzle. My job was to locate a donor and a broker who could give a personal look at the kidney trade. Much of the research I did was based on the WIRED News series that released in May. Here’s a clip from the documentary.

What isn’t mentioned in this clip, but is talked about in the larger documentary is that Mallika isn’t only the victim of a predatory broker and corrupt medical institution. Her son is a victim as well. A year after her surgery her son Kannan came down with a bad case of jaundice that destroyed his kidneys. Unable to giver her remaining kidney, now she has to watch her son suffer and possibly die because he has no way of getting a donor organ.

The program aired on November 11th and 15th at 8:00 PM. But I’m sure you will be able to catch a rerun some time.

And you didn’t catch it: The “National Geographic Safe House” in Chennai was my apartment.

Chennai Kidney Doctor Arrested in Mumbai
| October 10, 2007 | 1:30 am

Almost five months after authorities in Chennai abandoned any attempt at prosecuting the kidney scandal that has rocked this city, police in Mumbai have arrested a renowned kidney surgeon who has admitted to arranging organ transplants for patients from all over the world. Most of the operations took place at St. Thomas Hospital in Chennai. The Mumbai police say that Palani Ravichandran has preformed between 40 and 100 of the illegal operations every year since 2002.

KN Arun of The New Indian Express reported today that:

A large number of recipients on whom he had preformed kidney transplants were rich patients from abroad, especially the Persian Gulf countries and Malaysia, whom he charges Rs. 10 lakh to 15 lakh ($25,000 – $35,000) each.

Kidney transplants have been a huge problem in Tamil Nadu in the last few year. According to government statistics released by Tehelka, over 2000 people a year sell their kidneys in the city. In most cases brokers offer them several thousand dollars for their donations, but end up swindling the donors out of the lion’s share of the cash. I have written extensively about the issue on this blog and on WIRED News.

But Ravichandran is a different sort of kidney transplant surgeon. His methods are much more sinister than the typical Chennai doctor. It appears that for the last several years he has worked with two local brokers identified by my sources as Bandana Rai and Dipen Rai who rent a string of houses throughout the city to hold potential donors while they await their operations.

Ravichandran and the Rais have been able to escape detection for so long because they do not use local kidney donors. Instead they travel to Nepal and bring back young men and women who are willing to sell their kidneys for cheap. After trafficking the would-be donors across the border near Siliguri, West Bengal, they take a train to Chennai and spend about a week getting the necessary tests for surgery. Afterwards they are promptly send back to Nepal.

Deepak Adhikari who writes for Nepal Weekly, recently wrote a blog post about the Nepal end of the network.

This recent arrest should be a wakeup call to the Chennai authorities who have so far been lackadaisical about pursuing cases of brokered kidney transplants. Police claim that they do not have the legal authority to arrest brokers for violating the Transplantation of Human Organs Act of 1984–and claim that only the department of health and family services has that power. This is, of course, simply an excuse to maintain the status quo.

The truth is that the Chennai police and local government are perfectly happy to let the kidney trade continue because there is political pressure from across the medical spectrum to provide organs for people needing transplants. The government has sheepishly admitted that they are more concerned about wealthy patients than poor kidney donors who get scammed in the transactions.

There are also rampant allegations that members of the police and transplant authorization committee receive large bribes to approve surgeries. One source I spoke with who gave her kidney six months ago said the bribe was $25,000 per committee member–or about $700.

It is also telling that it was the Mumbai police who arrested Ravichandran–it appears that while he has enjoyed a startling amount of immunity from police while he has been working in Chennai.

Suspect Surgeons Advise Tamil Nadu Organ Transplant Future; Get Government Nod
| March 2, 2007 | 10:18 am
Health Minister KKSSR Ramachandran

This afternoon I attended a meeting held by the government of Tamil Nadu that was meant to be the beginning of an official response to the kidney racket. In the last thirteen years thousands of kidney have been sold on the black market with the tacit approval of the ethics board that is charged with monitoring organ transplants. A month ago I wrote a story for Wired News where a member of the ethics committee admitted to knowingly authorizing illegal transplants through brokers.

The meeting today was meant to be a step forward out of a ethical murkiness of organ transplants and call together a wide array of doctors, NGO-wallas and ethical savants for their opinions on live-donor transplants and the solutions that might lie ahead. But intentions are not everything.

“The kidney rackets have been operating in this community for a long time. . .90% of the donors we know about come from below the poverty line, and 90% of those donate for money,” said V.K. Subburaj Deputy Secretary of Health and Family Welfare during his inaugural address.

From a statement like that it would follow that the attendees charged with formulating Tamil Nadu’s future policy would decide to get tough on organ donations and look for positive solutions through cadavers.

Yet when K.K.S.S.R. Ramachandran, the minister of health, asked for people to introduce themselves from the audience, it soon became apparent that the agenda for the meeting was actually being set by the kidney brokers. Just about all of the doctors who came are currently under investigation by the police for assisting in illegal kidney transplants. Representatives from hospitals in Madurai, Coiambatore, Chennai and Trichy that have all been outed in the media for working closely with brokers sat self-satisfied in their easy chairs waiting for their chance to influence policy.

The most obvious among them was Dr. K.C. Reddy of Devaki Hospital–who allowed a broker named Dhanalakshmi to operate for years outside his hospital and in the past has been a vocal proponent of live-donor donations. He was practically jovial. Though he wouldn’t say a word to me.

When the opening remarks were over the press was kicked out and the doctors began to discuss their recommendations in private.

It was like putting the inmates in charge of the prison. The very people who were implicated in creating the organ racket in the first place were allowed to chart the course for the future. Allowed to set the clock backwards and make it seem like all their illegal actions over the last dozen years were actually for the best.

So it was no shock when the results came in and the doctors had reached a consensus that 1) Live unrelated donor transplants should be legal and that people should be allowed to buy and sell kidneys on the market. 2) Foreigners should be allowed to buy organs in India, but need to seek approval from the committee 3) All of the committee’s authorization decisions should be final and not open to appeal 4) Members of the ethics board in charge of overseeing that the system is not abused cannot be held accountable for coercion between brokers over donors or forged documents. And, to put it in the speakers own words, “should not be harassed by the police or press”.

So lets just throw transparency out the window and start an open-air-organ bazaar in Nungabakkam why don’t we. If the committee’s statements get taken up by the government (which is a real possibility) then we can look forward to thousands of completely above the board organ thefts. There were no stipulations to properly look after the rights of the people donating kidneys (except for one proposal for 5-10 years of free health insurance) and no mention of brokers at all.

But some people, thankfully, were not completely taken in by the committee’s organ mafia. V.K. Subburaj said that there was still need for further debate, and that cadaver donations were still the only real option. The same went for members of the MOHAN Foundation, who have organized 200 cadaver donations in the last three years.

To top it off, no people from the press were permitted to ask questions or attend the closed door sessions with the gang of doctor-criminals discussing how to divide the spoils if the laws change.

At this point it is in the hands of K.K.S.S.R Ramachandran ,the health minister, a DMK appointee who’s claim to the ministerhood seems to rely on his loyalty to the party and an incident in his past when he was burned by acid during a political rally. I don’t know much about Ramachandran except that he has endorsed cadaver programs in the past and that he doesn’t speak much English. Though one quote that he said during the meeting (which was translated for me) ran a chill though my veins:

“If there was a situation today where I needed a kidney I am sure that my son wouldn’t offer up his own, instead he would say that he would pay any price for one.”

And the price today is the blood of the poor.

Before he left a reporter from the Hindu asked if he would prosecute hospitals that had preformed illegal transplants. He said he would when the investigation turned up evidence. So far, it seems, he hasn’t looked very hard.

Indians Buy Organs with Impunity
| February 9, 2007 | 1:53 am
For the last week I have been covering the kidney racket scandals here on my blog and occasional posts on Bodyhack, but I was saving some of the juiciest bits for an article on Wired News. And now it’s out. When I first started reporting on this story I spoke with several women in Ernavoor who sold their kidneys to brokers and were cheated out of the majority of what they were promised. From there I followed the leads until I ended up in the office of someone who sits on the Transplant Ethics Committee who told me that they had unofficially sanctioned the organ trade for the last 13 years. I have a series of stories due out on this issue later this month on Wired News. Keep tuned in on this blog for updates. – Scott

Indians Buy Organs With Impunity

WIRED NEWS. CHENNAI, India — Police raids here last month that led to the arrests of at least three alleged dealers in human kidneys have thrown a spotlight on lapses by local medical regulators and recharged the global debate over legalized organ sales.

More than 500 people across the state of Tamil Nadu say they’ve sold their kidneys to organ brokers, in violation of a ban enacted in 1994. Since then, however, the agency responsible for enforcing the ban has frequently turned a blind eye.

“We do everything in accordance with the letter of the law on paper, but we know that almost all of the documents we see are false,” said a member of Tamil Nadu’s Transplant Authorization Committee, who spoke to Wired News on condition of anonymity. “It is an open secret. It is either, approve a transplant with forged documents, or a patient is going to die.”

Humanitarian arguments excusing black-market organ sales may seem a stretch given the stark danger of exploitation that led to the ban in the first place. Given the failure of India’s official system, however, some medical policy experts say some form of legalization may be the best solution.

Under India’s 1994 legislation, a state-appointed ethics committee must approve all transplants. The committee must interview all prospective donors before approving each transplant. On average the committee hears 20 requests a week and approves 15. The anonymous committee member said brokers routinely produce forged documents so that the transaction takes on the appearance of legality.

“The major issue as far as India is concerned is getting rid of the brokers. This would mean government regulation or administration of any compensation policy that would be developed,” said Transplant News editor Jim Warren, who advocates compensating people at a standard rate and providing state-sponsored health insurance for life.

Such a system, however, might not work if the state is offering less than the global market, says Nancy Scheper-Hughes, a medical anthropology professor at the University of California at Berkeley and founding director of Organs Watch.

“Free health care sounds good on paper, but the problem is that when a country goes legal then it enters into competition with the international market in organ transplant tourism,” says Scheper-Hughes. “When the state offers incentives along with a lesser pay scale, but a broker from another country offers slightly more cash without the medical benefits, most people opt for the cash and you run into the same problems you had before legalization.”

The Tamil Nadu agency has unofficially sanctioned the illegal organ trade for the past 13 years, the unnamed committee member said. Without illegal organ trade, he says, patients have no hope because in India, organ donation after death is extremely rare. Without incentive, donors are practically nonexistent.

The committee member denies that brokers bribed members of the transplant committee. But local police believe there’s more behind the Tamil Nadu organ trade than altruism.

“These brokers are not rich people,” said police superintendent Chandrabasu (his only name) of the Crime Branch Central Investigation Department in Chennai. “Out of the (several thousand dollars) they took as their commission from the operation, most of that went to bribes. They would only make about ($300) per transaction in the end.”

Flouting the law may have saved lives; but, by allowing brokers to operate with impunity, the Transplant Authorization Committee has allowed poor people to fall victim to organ brokers — the same problem that was rampant before the 1994 organ donation law.

In January, a group of poverty-stricken women living in a tsunami refugee camp 7.5 miles north of Chennai confessed at a public meeting that they sold their kidneys through brokers.

“When I went to the ethics committee, there were four other women sitting next to me who had also been arranged by the broker,” said one of the refugees, known as Rani (her only name), in an interview with Wired News.

She said she received only about $900 of the $3,300 she was promised by the broker who arranged her transplant. “We went up one at a time and all (the committee) did was ask me if I was willing to donate my kidney and to sign a paper. It was very quick.”

With no viable solution in sight, the Tamil Nadu Transplant Authorization Committee took matters into its own hands, and authorities are scrambling to respond.

The police have three brokers in custody for forgery, according to superintendent Chandrabasu. The director of Medical Services says his division is investigating reports that 52 hospitals may have been involved in illegal transplants.

Tamil Nadu’s health minister last week suggested possible ways of strengthening the government ethics committee. He did not return phone calls requesting comment for this story.

- – -

Scott Carney is a freelance contributor to Wired News and writes for the Bodyhack blog.

Enforcing the Kidney Case
| February 6, 2007 | 10:36 pm

On Monday I had a chance to get a sneak peek at the inner workings of law enforcement in Chennai. I was tracking down the story on the organized mob of kidney brokers that have been preying on poor people in chennai for the last 13 years and I was at the Crime Branch Central Investigation Department office in Thenampeyt speaking to the superintendent of police about how they are going to charge the three alleged brokers that they have in custody. While the brokers are clearly in violation of the Transplantation of Human Organs Act (1994) they claimed that they were not empowered to prosecute the brokers under it. The police instead are opting to charge the men only with forgery. To charge them under the act the superintendent told me that only Bava Fathurudeen, the Director of Medical Services was empowered by the government.

So 20 minutes later I was in Fathurudeen’s office asking him about what his department was doing to prosecute the kidney brokers. The act reads that anyone caught selling organs, offering organs, advertising for organs, operating as a broker, or makes and financial transaction that offers cash for kidneys is punishable for between two and seven years in prison.

But Fathurudeen didn’t seem to know that. Instead he said that his division was busy investigating hospitals across the state and hadn’t even heard that the police had a few brokers in custody. In fact, when I told him that news reports are claiming that over 500 people have had their kidney taken by brokers he was a little shocked. “Really, that many?” he asked. Apparently the only people keeping on top of the investigation are the bloggers and reporters covering the case. The authorities just seem like they want it all to go away.

In addition to not really knowing what is going on, Fathurudeen’s incoherency extended into his own quixotic and confused way of talking. He was unsure of his words and at least three times during the interview crept–yes, crept–into a back office to confer with his office assistants about what to say. When he came back to speak with me he continued to stutter and looked to other people around him for answers. Incidentally, his secretaries looked quite competent. I have a feeling that they are the ones running the show.

It seems that while I have been able to track down multiple brokers simply by interviewing women who had their kidneys taken, no one in law enforcement seem to be taking the necessary steps to prosecute the crime. Instead, kidney sales are becoming defacto-legal.

I have a story coming out about this tomorrow in Wired News where I reveal just how complicit the government really is. Later in the month I should have a series of articles about the kidney racket.

Photo: Bava Fathurudeen has been blindsided by this case.

Some Thoughts on Poverty
| February 3, 2007 | 11:04 pm

Yesterday I traveled up to Ervanoor to speak with a group of women who chose to sell their kidneys to brokers. It occurred to me that even after living in India off and on since 1998 that I can still barely grapple with understanding the lenghts that extreme poverty can drive people to.

I will save the salient details for an article I am working on. But I would like to raise a question for my readers.

What would you do if you became a mother at the age of 13 and 13 years later your daughter began having children? How would you respond when your daughter attempts to commit suicide by taking rat poison because her in-laws were harassing her for dowry she couldn’t afford? When your daughter had medical bills she couldn’t pay and the hospital threatened to kick her out on the street how far would you go? Would you sell a kidney to help her? How would you feel if after the procedure the broker you contacted absconded with most of the money she promised you?

Indian Organ Mafia Busted
| February 2, 2007 | 8:38 am

Police have begun to make arrests in tightly knit ring of organ smugglers who have been operating inNurse_in_hallway Tamil Nadu, India for the last two to ten years. In the last month there have been a slew of media reports about the organ racket, and while many of the details are still a bit fuzzy the implications are clear.

The first reports came during a public meeting of disenfranchised tsunami survivors in the village of Eranavoor who were airing their disappointment with government efforts to find them shelter and alleviate some of the more crushing aspects of poverty. In that meeting a group of 35 women admitted to having sold their kidneys to brokers and that they were put up in posh hospitals in nearby Chennai for a few days before being cast out on the street without after care. They women were primarily upset because the brokers offered them large sums of money, but ended up cheating them out of the lions share of the rewards.

Since the initial report over 150 people have come forward as victims of kidney brokers. Police from around the state are estimating that the total number of illegal transplants edges closer to 500. There have also been reports that some of the brokers also dealt in liver and bone marrow.

Other reports have suggested that many of the buyers are medical tourists from the middle east who have come to Chennai in order to skip over lengthy waiting lists in their home country while also saving a great deal of money on the surgery.

The police have already begun investigations into some of the hospitals that preformed the operations, yet the magnitude of the racket threatens to destabilize the medical administrations across the state. After a slew of illegal transplants in the 1990s, the government issued a law making it illegal to perform an operation without a thorough review from an ethics board.

The rules specifically state that no transplant should be undertaken if there is payment involved, and that all live transplants should be donations, preferably from family members. The organ mafia seems to have been able to provide false documents for the would be patients.

But it now appears that the state level ethics committee chaired by the Director of Medical Education in Chennai was complicit in the illegal dealings and authorized surgeries that they knew were about to be preformed under sham circumstances.

As one reporter I spoke to today said, “The ethics board would have to have been mad to think that all of these people flying in from around the country for transplants had poor, illiterate tsunami survivors for relatives living in the vicinity of the hospitals.” Members of the local ethics boards maintain that they did nothing wrong.

Tomorrow I am going to take a trip up to Eranavoor to see what local people can tell me about the racket. Feel free to send any tips or good wishes to me at sgcarney@gmail.com