The Philippine Online Chronicles

In a shantytown near the shores of the Manila Bay lies Baseco Compound – a settlement for poor urban migrants who are living below the poverty line. Aside from the grim conditions of sanitation and overall living standards of the area, there lies an even more sinister and harrowing side to the people living here.

According to some estimates by health and town officials, as much as 3,000 of the community’s 50,000 residents have sold a kidney. This is very high, considering that majority of the people in this figure are young.

A person who admitted to having sold his kidney said he was paid P160,000. The money is now all gone and they are still poor. He has not received any medical attention since then and the transaction was closed as soon as the kidney was removed from his body. He doesn’t even know who got his kidney.

The kidney

The kidney is an important organ that filters the blood and keeps the vital fluid free from unwanted toxins and harmful chemicals. It also maintains the right balance of water and electrolytes within the body through the different components of its filtration system. In patients with renal disease and diabetes, especially those in the chronic stages, the kidneys deteriorate and lose their functionality through time.

A person who has diseased kidneys would have to undergo repeated cycles of dialysis to cleanse the blood. Dialysis replaces the process which should have been done by the kidneys. Done two to three times a week and costing around P3,000 per session, dialysis is a very expensive burden for patients. It also takes quite a lot of time and would usually sap the person of energy for the hours following treatment.

A kidney transplant then becomes a better choice that dialysis in the long run.

A normal human being would have two kidneys. It is possible to live a relatively normal life with only one, given that the patient and donor were monitored and given proper medical attention for life by a medical practitioner who could give quality advice.

The high incidence of kidney failure has created a market for kidneys for sale.

Philippines: a hotbed?

Given the current economic situation of the average Filipino and the aging populations in first-world countries, it comes as no surprise that many foreigners come to the Philippines to take advantage of the hapless Filipino who will do just about anything to make a few bucks. This sort of setup has inspired many documentaries and other exposes to show the real magnitude of the problem. It is said that there is usually a middleman involved in the entire scenario who matches the donor and the person who needs to kidney. The middleman would then get a significant part of the price paid by the patient and only a fraction would remain with the actual person who sold his kidney.

During the turn of the century, the government tried to curb the number of foreigners who get kidney transplants in the country to ensure that no gross abuse happens and no Filipino is forced to do something that would be potentially disadvantageous to him or her in the long run. The Department of Health is currently in the process of drafting a memorandum that would effectively ban the performing of kidney transplant procedures on foreigner patients in the country.

The registry

Former Department of Health Secretary Esperanza Cabral was able to institute a body that would be responsible for matters regarding the transplants that happen in the country. In the last week of June this year, Cabral started the Philippine Network for Organ Sharing or PHILNOS which is meant to ensure that the transplant procedures in the country would be feasible, equitable and ethical.

The new body is expected to make the transplant protocol more streamlined. It is also expected that the new setup would weaken the very corrupt and entrenched black market culture for kidneys. According to some reports, kidneys now fetch to as much as half a million pesos. This price is doubled when the patient is a foreigner.

The ethics

Bodily autonomy has always been something that has been valued by most medical circles. Before something is done to a patient, he or she has to be thoroughly briefed on what is going to happen. Patients are given choices on which steps to take and the doctor is expected to respect the choice and decision of the patient.

Technically, a certain degree of autonomy is being exercised as well when a poor person decides for himself to sell his kidney at a premium price. The two hundred thousand-peso price tag of a kidney is easily equivalent to over two year’s worth of income for most of these people, so the trade-off may seem pretty equitable at first. Besides, there are various jobs that require a high degree of risk and these types of occupations are not banned under the law.

The only thing that makes the peddling of kidneys in this scenario very unfair is the implied absence of informed consent. The donor is thought of as someone who is never really fully aware of the consequences of losing one kidney and having to live the rest of his life with just a single kidney. The doctors may try to explain this to him but in the end, the money could be just way too hard to pass up.

It would be interesting to see if a well-educated man who has fully understood the risks of kidney transplant would still choose to donate his kidney. Interestingly, this is being done – in cases of people donating their kidneys to their loved ones and sometimes, even their friends. There are rewards that are considered greater than the financial benefits of being paid for selling a kidney. Interestingly, the ethics behind this wanton disregard for personal bodily integrity is never questioned at the ethical level.

The wait

What happens then is that patients who need kidneys tend to wait longer in the transplant list. They would have to wait for their turn and it’s clear that the demand for kidneys outweighs the amount of kidneys that are legally available for transplant and the actual number of transplants that are done in the country. This makes it really difficult for families. You can’t really blame them if they choose to take matter into their own hands when they see their relative or other loved ones suffering through the symptoms of end-stage renal disease.

In an even more disturbing turn of events, it seems like the adapting of registries all over the world has made other people more aggressive in terms of pushing their illegal activities. In one article, it is being asserted that some people actually sell the organs from the bodies of the executed prisoners in China. China executes the most number of people every year and the chance of greedy people to profit off the corpses of those who have been sentenced to die for their crimes is certainly hard to ignore.

The problem is not simply limited to the Philippines and China. Another country with a big impoverished population is India and the situation is even grimmer. There are people who scout the city slums for volunteers who would want to go on “kidney tours”. The volunteers would be whisked away abroad for some vacationing but when they go back to their homes, they would be lacking one kidney already.  Many local and international organizations have tried to stop this unfair trade of kidneys but due to the big populations involved and the logistical challenges of the locations, it seems like it’s a hard war to win.

The new leadership

In a controversial statement, new Department of Health secretary Enrique Ona said that he was leaning towards lifting the ban on the donation of organs towards foreigners. This is a hot issue since a lot of people in the private sector think that the practice of sourcing kidneys from impoverished communities and a donation system created by middlemen is very likely to cause corruption, deception and, of course, exploitation of those who are economically-challenged in life.

A losing Liberal Party senatorial candidate also supported this very polarizing notion. Physician Martin Bautista said in a statement that the existing ban on donations violates the right of the foreigners to extend their life and improve their quality of life. At the same time, it is also something that violates the right of any person to do whatever he or she wants to do with his body and his organs. According to him, this right extends even up to his or her prerogative to sell his organs. This is a rather hot rod of a statement since a lot of Filipinos think that those who donate their organs eventually are people who have been tricked, deceived or blinded by money.

As the new secretary of the DOH, Ona says that he will try to expand the coverage of the socialized health care insurance system Philhealth along with trying to fight the forces that drive the very exploitative black market for organ donations. He says that there has to be transparency in order to curb the black market that takes advantage of the poor who are talked into selling their organs without being told the repercussions of losing a kidney. Ona believes that the commercialization of these practices would have to be stopped by being more transparent about who’s giving away the organs and who’s taking them instead of simply relying on a black market-driven system where unknown entities pull the strings from the background.

The bottom line

At the end of the day, you can’t really blame the foreigners for going to foreign country to get a kidney. It’s a matter of survival; those who have the means to stay alive and get a better quality of life would surely try everything to keep themselves from dying. With the new DOH leadership in place and the seeming shift in opinions happening at present, it would be very interesting how the new policies and proposed routes of actions are actually executed for this very controversial issue.

Photos: “Scar” by Alan Turkus, c/o Flickr. Some Rights Reserved / “Unclaimed Organs” by Brady Wahl, c/o Flickr. Some Rights Reserved.