Archbishop Cruz, the former head of the Philippine bishop’s conference, is always on a crusade. Last week he was in the news for preventing a flashy “priest healer” from performing miracles in his diocese. The week before, he was denouncing government corruption….well, actually, almost every week he is denouncing government corruption of one sort or another.

And just in case you don’ t read about it in the papers, he has a blog

But this week, he has a bee in his bonnet, and again, it has to do with government planning to legalizing profiteers who sell organs to rich people, mainly foreigners.

The problem is not that rich people jump to the head of the list to have an organ transplant, but that those making money bartering in kidneys are getting more and more active and open  in buying the organs from poor people in Manila Slums. And in the last few years, the numbers of such transplants have increased.

This has been going on for awhile in Asia, but as India and other countries face abuses and have started to make such profiteering illegal, the Philippines stands to gain a lot of money for doing kidney transplants under the disguise of “medical tourism”.

Some lawmakers are urging guidelines to protect Filipinos against the commercial export and sale of human kidneys. But others want the country to become an Asian hub for “medical tourism,” the practice of traveling to other nations for health care…

The NYPost story reports

As the industry grows and more foreigners – unable either to wait or afford their medical bills – increasingly rely on organ donors from elsewhere, the Philippines is one of the few places where paying a living kidney donor isn’t illegal as long as no third parties are involved.

According to the country’s National Kidney Transplant Institute, there are about 3,000 to 5,000 registered kidney transplants a year. Most of the recipients are Japanese, Chinese and Arab. There are a handful of European and American recipients.

Naive Americans, mainly of the libertarian persuasion, say, well, why not?

The rich guy gets a new lease on life with a new kidney, and the poor guy gets a bundle of money to help his family. End story.

But of course, that is not the end of the story.

From a WHO (World Health Organization) report:

Several social scientific studies described the perceived health and economic status effects of kidney donation on paid donors in certain countries. Three quantitative data sets are summarized in Table 4. This research shows that the underlying motivation of most paid kidney donors is poverty, and that lasting economic benefit after donation is limited or even negative because of the limited employability of such patients and the perceived deterioration of their health. Results from other more qualitative research are consistent with these quantitative surveys in other countries. Paid kidney donation is also associated with depression, regret and discrimination. Paid kidney donors do not receive follow-up care, due to financial and other reasons.43–48

In other words, most of them end up unhealthy, often unable to go back to work (most are poor people whose jobs involve heavy physical labor).

The WHO article has a summary of Egyptian, Indian and Iranian donors, which summarizes the findings.

Those receiving the organs don’t get off free either. They risk getting hepatitis B and C from the donors, and may not last as long as a kidney from a local source. LINK Some of the papers in this table show a suspiciously high survival rate, so it is significant that the Australian study shows a low 66% graft survival.

So who benefits? Follow the money.

The Philippines stands to benefit hugely from Medical tourism, and when confronted with the Univ Philippine survey, the government has piously announced that they are going to regulate the business of buying and selling organs.

MANILA (PNA) -– To combat unbridled human organ trafficking in the country, a new administrative order (AO) that will ensure the protection of organ donors against abuses is set to be released this month.

(Health Secretary Francisco Duque III) said said the order will now eliminate the direct or “one is to one” process that usually takes place in the commercialization of organ donation…

“… This will stop syndicates preying on unwitting indigent patients, get their kidneys, then they just pay. It’s really unethical,” Duque said.

Ah, yes: That’s the dirty little secret.It’s “unethical”.

Guess he didn’t notice that Buying and selling organs is also illegal under Republic Act 9208 law (AntiTrafficking of persons Act of 2003), and that the Manila Time reports that the local NBI (federal police) are busy investigating an organ buying scam at one of Manila’s most respected hospitals.

But this is the Philippines, where one local wag said: here the bribes are over the table, under the table, and with the table.

You don’t buy organs, you give a little gift in exchange for the donor’s generosity.

And doctors and hospitals don’t buy organs, a friendly person who feels sorry for the sick people finds generous young people who are willing to donate their organs to save a life.

In other words, the third party is involved to do the dirty work of recruiting people to donate, and they get a certain percentage of the fee (whoops I mean gift given to thank the donor).
And of course, there is the dirty little secret: that the middlemen are the ones who make the money, often luring poor people to donate and then not screening properly to ensure they won’t be harmed, and then never providing follow up care for their wounds and complications.
The Ottawa (Canada) Citizen expose describes buying a kidney on the internet:

The website asks me whether I want to add the kidney transplant package to my shopping cart, as if I were buying a book or DVD.

Organ brokers connect individuals wanting to buy kidneys to poor individuals desperate for cash. As organ sales — illegal in most countries — drop in India, China and Pakistan, brokers are shifting to the Philippines as their main source of kidneys.

The author then goes on to state that the total cost is 50-80thousand dollars US, of which $3000 goes as a donation to the donor. The NYPost article says that donors who they interviewed received much less, their top price being $2100 and ten percent of the fee went to the go between who recruited the poor person.

A recent survey by the University of the Philippines found 3000 people in one Manila slum who had sold organs for $1,440 to$2,469.

So there you have it. A new law to regulate an illegal practice making it legal. The Japanese and Arabs who come for transplant will benefit, the doctors and hospitals will benefit, and the government’s new “medical tourism” business will increase the economic growth of the Philippine economy.

The only ones who will suffer are the donors.

And the main protesters are the Catholic Bishop’s conference, who have released a letter condemning the legalizing of the organ buying from the poor. They remind the government that Catholics traditionally see organ donation as a good deed, and it is encouraged, but to exploit the voiceless poor to benefit the rich is a no no.

So Archbishop Cruz is angry:

This shameful phenomenon is not really new in the land. But it has become more common and open, more in frequency and number.

But the victims and beneficiaries are the same, viz., the poor Filipinos and the wealthy foreigners as well as influential citizens of this country….
The thriving business or organ sale in the Philippines comes complete with middlemen, i.e., go-betweens, the perceived seller and determined buyer, and making much money with the consummation of the deals….
Never mind the living reality of poverty and hunger in the ground which precisely serve as a root cause of organ sales by those Filipinos living in slum areas, under the bridges, in shanties that have recently become favorite targets of merciless demolitions….it is the poor that need more societal attention, that it is the already helpless that should not be made more miserable.

And I would add: the reality of many poor people dying of kidney failure due to simple high blood pressure because they can’t afford medicine.

So who will win? The bishop or the hucksters?

Personally, I suspect the money men will win in the short run, but that Bishop Cruz and the other bishops will continue to be an unwelcome thorn in the side of certain government officials, reminding them that in the long run, they can’t bribe their way into heaven.


Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at Hey Doc Xanga Blog.

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