Academic journal article The Hastings Center Report

Conversations with Kidney Vendors in Pakistan: An Ethnographic Study

Academic journal article The Hastings Center Report

Conversations with Kidney Vendors in Pakistan: An Ethnographic Study

Article excerpt

In theory, a commercial market for kidneys could increase the scarce supply of transplantable organs and give impoverished people a new way to lift themselves out of poverty. In-depth sociological work on those who opt to sell their kidneys reveals a different set of realities. Around the town of Sarghoda, Pakistan, the negative social and psychological ramifications of selling a kidney affect not only the vendors themselves, but also their families, communities, and even the country as a whole.

Until lions have their own "story tellers," tales of a lion hunt will always glorify the hunter.

--African Proverb

The growing concern about the shortage of kidneys available for transplantation has led some physicians, economists, and bioethicists to call for monetary inducements and "regulated" organ markets as a way of expanding the number of kidneys obtained from living, unrelated individuals. (1) Proponents of a commercial model for organs formulate their arguments in the language of supply and demand. They believe that "scarcity" of commodities--in this case, kidneys--can be addressed through the use of market forces. In this view, a vendor is an autonomous agent with the freedom to make choices, including the decision to sell a kidney, and depriving impoverished people of the option to sell a kidney makes their bad situation even worse. (2) In contrast, those opposed to the idea of organ sales believe that such practices lead to exploitation of the most vulnerable people in society for the benefit of the privileged. Concerns are also expressed about the negative repercussions of organ commerce on altruistic donations and integrity of the medical profession, and the weakening of efforts to initiate and sustain deceased donor programs. The potential for increased complications in recipients receiving bought kidneys is another consideration. (3)

These debates are taking place against the backdrop of expanding organ commerce and tourism. Private health care institutions located particularly in Asian countries are advertising "transplant packages" with kidneys bought from the most economically deprived individuals. In a business that runs into millions of U.S. dollars annually, such kidneys are being transplanted not only into nationals but ever more frequently into citizens of affluent countries who travel to the host countries specifically for this purpose. (4) Despite the increasing awareness of the international organ trade, there is a surprising paucity of original research and scholarly work on this issue. In his presentation in May 2007 at the Second World Health Organization Global Consultation Meeting on Human Transplantation in Geneva, Yosuke Shimazona said he had found only 309 "relevant" documents, of which 243 were media reports, in a review of the previous five years' worth of literature. He emphasized the need for "further medical and social scientific research," without which he thought this "global health issue" could not be addressed effectively. (5)

One of the crucial missing pieces in the literature is in-depth sociological work on the vendors--the men and women who opt to undergo nephrectomy for money--and the on-the-ground realities that frame their decision. Very little is known about the sociological and psychological effects on vendors and on the families and societies they belong to when faced with a situation in which the only way to address financial difficulties is to sell a kidney. The most outspoken anthropologist to focus on this issue is Nancy Scheper-Hughes, who provides ethnographic accounts of kidney vendors from countries as diverse as South Africa, Israel, Moldova, the Philippines, and Brazil. (6) A handful of empirical studies from India, Iran, and the Philippines also venture beyond the medical paradigm and quantitative data to explore the psychological repercussions on kidney vendors and their kin. (7)

No studies of this nature have been undertaken in Pakistan, a country that came to be known as one of the largest "kidney bazaars" in the last decade. …

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