In the developing world, victims of poverty have willingly sold their kidneys for cash in hopes of bettering their financial standing. But, a new study appearing this week in the Journal of the American Medical Association, shows organ donors in southern India are worse off in the long run.
In a country where one person out of three lives in poverty, a huge organ transplant industry has grown giving people a financial incentive to donate one of their two kidneys. Madhav Goyal of the Geisinger Health System in State College, Pennsylvania, said supporters of this idea see no downside.
"They've felt basically that this would be a win-win situation for everyone," he explained. "That is, the person selling the kidney would get money. And the person receiving the kidney would benefit by receiving the kidney. Critics of this, however, have felt that, that this would just exploit the poor."
Dr. Goyal wanted to see if donors benefited from selling their organs, particularly in developing countries.
Dr. Goyal and his colleagues interviewed more than 300 kidney donors in the slums of Chennai, formerly known as Madras, in southern India. For their kidneys, the donors received what seemed like a large sum - a little over $1,000 dollars.
But six years later, Dr. Goyal said investigators found the kidney donors were not better off either financially or medically.
"A majority that sold were heavily in debt and had to pay off those debts," he said. "Despite having sold their kidney, they remained in debt. Their total income actually declined. Their health conditions worsened. And they would not recommend that another person sell their kidney under the same circumstances that they sold them."
One possible reason for the decline in health, according to Dr. Goyal, is that most donors had to resume physically-taxing work as manual laborers soon after selling their kidneys, weakening their health.
The study also found that nearly three-quarters of the donors were women, a trend that Dr. Goyal finds troubling. He said it may be that women in India are pressured into donating organs.
"Because our interviews were often done in front of other family members present, many women may have been reluctant to be honest about that and say 'I was coerced into selling a kidney,' he said. "I didn't really want to."
Most countries, including India, have outlawed the buying and selling of organs from live donors. But in India, Dr. Goyal said regulators at transplant hospitals routinely look the other way.
Part of this is a result of the ignorance and desperation of the poor, as well as the fact that donating a kidney isn't particularly risky. The body under normal conditions can function with just one.
Kidney Specialist Dr. Robert Metzger, who served as chair of an organ donor network committee in the United States, says the JAMA study points out that there may be a role for carefully selecting living organ donors in Third World countries like India.
"You know, it's a different environment and culture compared to the United States where if you have end stage renal [kidney] disease, for the most part, in India it's an assignment to death since there isn't any widespread dialysis like there is in the United States," he said. "And there's no, or very little, cadaveric [after death] organ donation. So, unless you can find a living donor, the individual with kidney failure has a short life expectancy."
Dr. Metzger notes that Iran recently provided funding to encourage people to donate organs, operating a program directly through transplant centers that carefully screened both recipients and donors. The program made a significant dent in Iran's organ shortage.
However, Dr. Metzger remains firm that Western countries oppose the buying and selling of organs.