The usually staid Wall Street Journal has an AP article about how the Philippine government is planning to regulate a growing black market in buying kidneys from poor people in Manila. The headline reads:

Philippine Health Chief Orders Eradication of Kidney Black Market

Ah so. It’s already against the law, since it was made illegal by a 2002 law, but how is he going to stop it? By a new law that allows kidney donations, but regulates it.

Health Secretary Francisco Duque said the order, which he signed Monday, called for the creation of a government board to oversee kidney donations and transplants, ensure proper care of donors and make more transparent and ethical a disturbing practice that has flourished in secrecy…The order seeks to provide a more benevolent image to kidney donations by prohibiting the payment of money as a precondition…

One contentious issue was whether to ban foreigners from securing kidneys from local donors — a move backed by private advocacy groups to prevent the exploitation of the poor in Third World countries, Mr. Padilla said.

Authorities eventually decided against such a ban but made it difficult under the new order for foreign patients to obtain kidneys, he said.

Let’s get real.

All this does is legalize what is already going on.

Medical tourism in various Asian countries is big business, and some here are having visions of dollar signs (or Peso signs) in their dreams.

So  all one has to do is be clintonesque and  change a few words around, and voila, things will be fine.

Hospitals won’t be allowed to recruit donors? No problem. A friendly local middle man will get an altruistic farmer to donate.

No payment of money as a “precondition”? No problem. The person receiving the kidney will be so happy to get a new lease on life, he will give a large gift to the middleman to thank him. The middleman, of course will take a cut of the “gift”, and give the rest to the man supplying the kidney.
Buying a kidney? No way. Bribery and kickbacks? No way. But if someone wants to be generous and give a gift, who is going to stop him?

Reality check, please. You can pass all the laws you want to, but can anyone really see a rich businessman or a rich surgeon being arrested because a tricycle driver or out of work farmer complains?

The reality of the terrible exploitation of poor people by this practice can be found in the fact that those actually caring for people with end stage kidney disease are against the new government policy to allow “living donors”.

The Philippine Society for Nephrology have a power point download HERE which explains the problem. The rest of this article is a summary of Benita Pedilla’s report which in on the ABS CBN news site.

Summary

Donating a kidney for altruistic reasons is fine, but ethically, donors should not be under duress to do so.

Donors should be medically and psychologically suitable.

Donors should be aware of the problems and complications, and should be able to understand the risks.

Financial stress is one contraindication to a free donation, since it is a form of coercion.

Those with limited education who might not understand the risk involved is another contraindication.

Finally, donors need to be screened to insure they can donate without harming their own health.

So what’s the problem, ask libertarians?

Well, the reality is the problem. Again, from that report.

The Philippine Society of Nephrology held a one day Kidney clinic on March 15, 2008 to examine those who had donated kidneys, including 107 who were not related to the person who got the kidney.

The donors were all men, average age 29, and averaged over a year since the donation.

Two thirds of them had not reached high school, and 16% were unemployed when they donated a kidney. The average monthly income for their families was 3600P (about $90 a month). The average payment for the kidney was 112,000P (slightly less than $3000).

However, like studies conducted elsewhere, the donors were left with health problems. 45% felt weaker after the surgery, 80% felt less able to do hard work, and one third were now unemployed. Indeed, 75% said that despite the payment they received, their financial situation didn’t get any better.

Significantly, 76% would not donate if they had realized the cost to their health, and 96% would not recommend others to donate an organ for money.

The Nephrologists then examined the donors, and found that their kidney function was low (Creatinine clearance of 66, serum creatinine 1.4). Normal creatinine clearance is over 90, and if it is below 20, you need dialysis. So you can live with this level of kidney function, but it’s a lot lower than you would like to see in such young men. Similarly, 16% had mild high blood pressure.

These numbers need to be compared to a similar donor base, such as this study of living kidney donors in India.

Conclusion? The donors weren’t properly screened.

The inability to protect the health of kidney donors even under the present law suggests that any future law weakening the prohibition will not be enforced either. That’s why the Nephrologists oppose the new version of the law implemented by the government.

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Nancy Reyes is a retired physician living in the rural Philippines. Her webpage is Finest Kind Clinic and Fishmarket, and she writes medical essays at heydoc Xanga Blog

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