How much Money can you place between your Misery and a Kidney?

Imagine

You live in a home of mud brick in the slums of the capital of Pernambuco, Brazil. You have accumulated insurmountable debt on your used car and have endured physical threat if you were to not pay it off. Poverty is nothing new here—but getting out of it and being able to cover your debt quickly? You may think that your options are tight, but there are people that will help you get out of this misery… in exchange for a kidney.

Wait what?

Yes, organized kidney sales, along with a variety of other organs, are available on international markets. The aforementioned scenario is a specific case out of Brazil, and is just one of numerous organ sale stories that circulate the globe (Scheper-Hughes, 2015). The commodification of your own organ is a delicate topic, and for many there is no right or wrong answer (Andoro, 2016). But what if you would have to do so for your own survival?

Well, while this concept of survival through selling your own kidney is intriguing and disturbing at the same time, we focused more on another perplexing concept: the difference in cross-border prices of kidneys.  

Why Cross-Border Price Differences?

As we all know, a market which has a seller must have also a buyer. For the man who sold his kidney there is also a receiver that has to buy the kidney. In the case of Mr. da Silva, it was an elderly woman from Brooklyn (NY) who suffered for a long time from kidney failure, battling daily with death. To get out of her misery, she was willing to pay the offered kidney at $60000—ten times the amount offered to the man selling his kidney. Ten times (Rohter, 2004). Maybe this story has now triggered something in your mind. This article provoked a wild argument within ourselves. It seemed so unfair und unjust.

Screen Shot 2017-06-14 at 18.00.46
Figure 1:  The path of the organ transplant of Mr. da Silva (Own illustration).

How can a factor of ten differentiate the amount received for an individual relinquishing part of his body to the amount offered to purchase the same life-saving organ. What factors cause this disparity? Race? Socioeconomic status? Changes in life quality?

Of course, the difference between a buying and selling price may be determined by considering different factors. Nevertheless, the question about why there is such a vast difference never left our mind. So we rolled up our sleeves and dug a little bit deeper.

 

Shedding Light on a Black Market

To reinforce our first instinct, we reviewed various articles about the international black market of kidney transplantation, discovering that there are indeed strong discrepancies between prices of kidney in various countries (Havocscope, 2017).

In the following blogpost, we would like research the reasons for international price differences from buyers to traffickers to sellers on the black market. In short:

How is the value of a kidney determined along the trade route?

A comparison between recipient and donor countries

Screen Shot 2017-06-14 at 18.00.57
Figure 2: A price comparison of recipient (blue) and donor (red) countries (Own illustration).

Let’s start slow: Kidney Transplant?

First of all, one must understand the concept of a kidney transplant and the influential factors leading to a transplant in order to understand anything about the illicit trade of kidneys on the black market… let alone price differentiation. Kidneys are vital life organs of which every human is typically born with two. The kidney filters toxins out of the blood in order to keep it clean. Contrary to most vital organs in the human body, a person can survive with a single kidney. This allows for the concept of live kidney donations: if someone suffers from a kidney failure, then she can receive a transplant from a healthy individual, leaving the donor with only one remaining kidney to function. Of course, this leaves the donor with a lesser quality of life due to decreased physical capacity, but life can still be sustained.

With this in mind, we can lead you into the illicit market for organ trafficking worldwide.

A Question of Supply and Demand

One of the main causes for the rise of the illegal organ market remains the concept of supply and demand. Basic economics. According to Stefania Negri, only 10% of the global demand for organs is met, leading to drastic and illegal actions of involved parties. Put yourself into the shoes of someone at risk of impending death, and you will understand why these markets arise. Many international regulations and frameworks are trying to both control the market for organs and suppress transplant commercialism and transplant tourism. (Negri, 2016)

Considering transplant ethics and international biolaw, as Negri points out, a transplant can only be carried out if four key values are met: respect for individuals, autonomy, consent, and altruism. This should reinforce the prohibition of financial gain and commodification of organs. But when a supply gap is evident, there are always some individuals willing to fill it as well as their pockets. Organ trafficking is highly lucrative.

Screen Shot 2017-06-14 at 18.01.29
Figure 3: The 4 key values of organ transplantation (Own illustration).

The Players in the Web

Many have their hands in the game on this organ trade route: the recipient, the seller, and the organ brokers. As seen in the figure below, numerous industries fall into these three blanket categories of players. Hospitals, insurance companies, surgeons, travel agents, organ hunters (former sellers), and others want their fair share of the money pie. (Negri, 2016)

Screen Shot 2017-06-14 at 18.01.38
Figure 4: The participants of the organ trafficking market (Own illustration).

So how is this bag of money split in theory? In the cases examined, kidneys were sold for $2,500 to $8,000 while recipients paid around $100,000 to $200,000. Transplant surgeons were paid more than $10,000. The price difference between the amount recipients pay and donors pay reflects what flows through the deep web of organ brokers. (OSCE, 2013)

Screen Shot 2017-06-14 at 18.01.57
Figure 5: How the money is split amongst the participants (Own illustration).

The Aspects to Consider

Now you have a quick overview and the basics of the illegal market of kidneys and the parties involved. Moving on, to answer our research question more specifically, we looked at three main areas: global differences in prices, the arrival at a price, and the willingness to pay. So let’s start with those.

Global Differences

Organ trafficking is a global web that affects many countries such as China, India, South Africa, Israel, the United Kingdom and the United States. The distinction between countries of origin and destination should be made. The journey of da Silva’s kidney had its origin in Recife, Brazil and ended up in the US with a stop in South Africa for the surgery. This international link illustrates where the money streams go. It is not uncommon that wealthy parts of the world hold an advantage in obtaining organs, as they have the means to afford the pricey commodity (Bakdash et Scheper-Hughes, 2006). Predominantly, but not exclusively, the supply of organs comes from poor and underdeveloped countries. This is raising the question of whether education, minimum wage and other social and economic factors feed into the pricing of a kidney (OSCE, 2013).

Arriving at a Price

Question: How can you place a value on a life?

E. J. Mishan approached this topic in the 70s. Despite him stating that “no sum of money is large enough to compensate a man for the loss of his life,” he ironically provides methods to value a person’s life: (Mishan, 1971)

  • Gross output method: Future earnings deduced to the present
  • Net output method: Investigation of social implications of the loss of life
  • Insurance principle: The premium a person is willing to pay, and the probability of being killed as a result of engaging in some specific activity.

We won’t delve into these concepts any further, but it does raise an important question: If we can put a price on our body, then why not on our kidneys?

First things first: the literature has much to say about how prices are made and the influencing factors.

Education. Let’s look at eggs. No, not the byproducts chickens. Human eggs. In India, the value of eggs varies on the basis of “how well educated the donor is”. One may expect to find eggs for sale between £500 and £7,000 (Hickman, 2009). Could this apply to a kidney as well?

Health Care. For kidneys in particular, organ pricing may be influenced on the costs associated with alternative means for treatment (dialysis). This is due to the fact that transplantation would circumvent the hard costs and time lost as a result of years of dialysis treatment (Postrel, 2012). To reinforce this point across any type of organ transplant, demand for organs outside of national boundaries increases with heightened “costs of health care, level of technical capacity, and the availability of organs” (Shimazono, 2007).

Income. You may be wondering, “Shouldn’t the rich be willing to pay heaps of money for a kidney simply because they can?” If so, you are right. One may reasonably assume that kidneys would be valued higher for those with great wealth than those on the brink of poverty. For this reason, a seller may settle for less than an amount desired by someone of higher socioeconomic class (e.g. a white citizen in the USA). Wages are crucial in determining the price of a kidney, as referenced by an economic paper delving into additional pricing factors such as “cost of the chance of death during surgery, lost earnings while recovering from surgery, and compensation for the possibility of reduced quality of life for kidney donors”. (Lowery, 2010)

In the United States, one may find the price of a kidney to hover around $45,000—assuming an American earns an average wage of $40,000 annually and that she has a life valued at “$3 million” while considering the costs associated with recovery, risk of death, and overall decrease in quality of life. (Friedman, 2006)

Our First Discovery: This Research is Sketchy

We then tried to enrich this theoretical approach with some personal research.

Our initial thought was to get more insight with interviews of people involved. Even though this approach did not seem like a hassle, asking doctors about the pricing of a kidney was an utter failure. We are not pointing fingers, but the topic was so incredibly taboo to many medical professionals that they outright denied the fact that there even existed illegal kidney transplantation.

Reaching further with the aim of arriving at a cost structure of kidney transplants, we went ahead and contacted medical tourism companies offering the all-inclusive package of getting a kidney in your prefered destination country. Yes, just like booking your next vacation trip to Thailand to see temples or to Ibiza to get your suntan on. (UNOS Transplant Living)

Because we knew that this path could get dirty quickly, we used a disposable phone number and a fake email account. We went organ shopping as Anna Elisa Brunner, a 52-year-old in need of a kidney.

What we got was far from our expectation when we asked for a price and cost structure. Companies focused more on asking personal questions back, such as questions about our character Anna’s height, weight, and allergies. It seemed more like an eccentric inquiry prior to a date rather than an economic conversation as we had hoped for.

Screen Shot 2017-06-14 at 18.02.11
Figure 6: Quotes by medical tourism companies (Own illustration).

Clearly, that was a dead end for us—Anna does not exist and definitely has no medical records to send. Thus, we had to find some other way that would not take us too deep into the web.

Your Own Opinion and Reasons

So let’s get personal for a second: What price would you be willing to pay for a kidney? And if you had to, how much would you charge someone to buy your kidney? Those questions might be considered highly sensitive and even unethical. But there are many people who had to answer these questions given their individual circumstances and even had to act on it.

So we went ahead and asked 55 people within our networks these questions along with their reasoning for their responses. Due to our group’s diversity, we collected answers from two recipient (UK and USA) and two donor (Brazil and India) countries, spanning four different continents—talk about a global operation!

And don’t worry, we are very aware that this study is not representative at all, so don’t get too hung up on the numbers: the gist counts!

The findings did not surprise us much to a certain extent. We already expected that there would be strong international differences and that donor countries would hold lower selling and buying prices. But most noticeable of all was that the prices are far of from reality.  

Screen Shot 2017-06-14 at 18.08.33
Figure 7: Results of the survey – comparing buying (red) and selling (blue) prices (Own illustration).

Because all of the people questioned were not personally affected by receiving or giving a kidney, they had no point of reference and had to rely on other factors, which we identified in the follow up question. If we would ask you to put a price tag on one your most personally valuable possessions—let’s say that it is your phone—you would argue with the buying price, acknowledge the wear and tear, and you might increase the worth as it has all your secret contact and family pictures from last Christmas on it. This last emotional connection was the key argument for many of our friends and family: their “personal feelings” and factors related to life quality.

“Truly, I don’t know what influences my decision. Every country has its own economy and values for concepts such as life, health, love and human rights. When it would come to my own life, I’m driven by my emotions. The rational side is lost.”

– Anonymous, 2017

Unlike a random object in your pocket, one may struggle to put a number on a feeling and her own life. What are we willing to pay? Let’s get into that a little bit more.

Willingness to Pay

A study in the US about the willingness to pay for a kidney transplants sheds light on other factors influencing the price. There were significant correlations between gender, health status and household income, and origin/age of the organ donor. The study illustrates that higher income and poorer health conditions increase the willingness to pay. Furthermore, the opinion of the doctor involved has a strong influence on the price: the higher the price, the more the specialist matters. (Herold, 2010)

To further accentuate our case for factors influencing prices, we analyzed multiple cases.

In many cases, the organ broker did not sufficiently educate the organ donor about the complication and the cost, financial or non-financial, involved with the loss of a kidney. Thus the aspect of education might be a crucial influence on the price for which people are willing to sell. After all, who spends their time day in, day out researching international kidney market prices? Well, besides us.

Furthermore, the main cause to sell is the lack of money, as we all know by now. If those people had better access to financial aid to cover their debt and expenses, wouldn’t that decrease the amount of people being stuck in this dilemma of selling their own organs, thus decreasing the supply of kidneys and pushing up the price? It is worth looking into it.

Screen Shot 2017-06-14 at 18.30.54
Figure 8: Results of the willingness to pay study (Herold, 2010; Own illustration).

Down to business: Running the variables

As per our findings in literature, the following aspects were considered in the correlation analysis: health, education, employment, wage, financial access, and the overall economy.

Surprisingly and disappointingly, no significant correlation was found between the selling or buying price when compared to the variables above. What does that mean?

Facing the Facts: Limitations

First off, we have to talk about the limitations of this research topic. The black market is not transparent, and prices are mostly accessible to individuals if historically involved parties come forward and share their experience and injustice. Organ brokers are interested in keeping a veil on top of street kidney prices so that people do not have a clear idea of the street price of a kidney. This makes sense, because if they were to disclose their prices, they would lose some of their bargaining power. Thus, we lack proof due to a lack of numbers.

Moreover, too many variable are drivers in this bargain, and they are very local. The black market is very global and reaches into a slum in Recife and into the suburbs of New York. But neither the donor nor the buy have the means to go so far as to investigate where where the prices are more favorable and how they are made. The network is so tangled and far spread that you could not possibly consider all variables causing price divergences.

Finally, one cannot put a price on the willingness to pay, as emotions are not quantifiable for many people and are very unique to each person. Subjects’ most frequent response, when inquired about why they would set the price as XYZ amount, was personal feelings. How much money can you place between your misery and your kidney? Unable to answer that? Same for us.

Screen Shot 2017-06-14 at 18.02.51
Figure 9: Conclusion (Own illustration).

So, what did we find out?

The black market of kidney trafficking is truly a black market. All the work we conducted did not provide the answer we wanted! You wander around aimlessly in the dark trying grasp how everything works and is justified. The irony of the word “justified” brings us to our second point: nothing is just. Justice is inexistent for the people selling or buying organs because brokers are playing with their weak spot and know how to manipulate them, yielding the bargaining power needed to stuff brokers’ pockets.

Overall take-away: Illegal markets make a profit out of despair and leverage ignorance and emotions against you. But to beat the organ brokers at their own game and uncover the truth, it takes more than a blog post’s research to take this web down. If we could look right through the whole system and if an easy fix to the problem of the illegal market of kidneys existed, there would be no issue in the first place.

Are you now curious to learn more? Start with this video:

 

References

Andorno, R. (2016). Buying and selling organs: issues of commodification, exploitation and human dignity.Journal of trafficking and human exploitation. Retrieved from https://transculturalbodies.files.wordpress.com/2017/03/andorno2017_buying-and-selling-organs_new.pdf

Bakdash, T., & Scheper-Hughes, N. (2006). Is It Ethical for Patients with Renal Disease to Purchase Kidneys from the World’s Poor?

Friedman, EA, and AL Friedman. „Payment for Donor Kidneys: Pros and Cons.“ Kidney International 69.6 (2006): 960-62. Web.

Herold, D. K. (2010). Patient Willingness to Pay for a Kidney for Transplantation. American Journal Of Transplantation, 10(6), 1394-1400. doi:10.1111/j.1600-6143.2010.03113.

Hickman, Leo. „The Cost of Body Parts around the World.“ The Guardian. Guardian News and Media, 27 July 2009. Web. 18 Apr. 2017. <https://www.theguardian.com/lifeandstyle/2009/jul/28/sperm-egg-donors&gt;.

Lowrey, Annie. „Can Economists Make the System for Organ Transplants More Humane and Efficient?“ Slate Magazine. N.p., 15 Dec. 2010. Web. 18 Apr. 2017. <http://www.slate.com/articles/business/moneybox/2010/12/the_kidney_trade.html&gt;.

Negri, S. (2016). Transplant Ethics and the International Crime of Organ Trafficking. International Criminal Law Review, 16(2), 287-303. doi:10.1163/15718123-01602001

Organ Trafficking and Kidney Prices. (n.d.). Retrieved March 22, 2017, from http://www.havocscope.com/black-market-prices/organs-kidneys/

Roscoe, P.  (2013). On the Possibility of Organ Markets and the Performativity of Economics, Journal of Cultural Economy, 6:4, 386-401

Picture Based on Integration of Available Information.“ WHO. World Health Organization, 2007. Web. 18 Apr. 2017. <http://www.who.int/bulletin/volumes/85/12/06-039370/en/&gt;.

Postrel, Virginia. „How Much Is Your Kidney Worth?“ Bloomberg.com. Bloomberg, 16 July 2012. Web. 18 Apr. 2017. <https://www.bloomberg.com/view/articles/2012-07-16/how-much-is-your-kidney-worth-&gt;.

Rohter, L. (2004, May 22). THE ORGAN TRADE: A Global Black Market; Tracking the Sale of a Kidney On a Path of Poverty and Hope. Retrieved March 10, 2017, from http://www.nytimes.com/2004/05/23/world/organ-trade-global-black-market-tracking-sale-kidney-path-poverty-hope.html

Scheper-Hughes, N. (2015). Scars – Ruined Lives and Deaths of Kidney Trafficking Victims. Retrieved from http://www.endslavery.va/content/endslavery/en/publications/acta_20/scheper_hughes.html

Shimazono, Yosuke. „The State of the International Organ Trade: A Provisional

Swingler, S. (2015, February 25). The dark world of internet kidney trafficking. Retrieved April 20, 2017, from http://www.health24.com/Medical/Kidney-and-bladder/News/The-dark-world-of-internet-kidney-trafficking-20150225

UNOS Transplant Living. (2017). Financing A Transplant | Costs. Retrieved April 10, 2017, from https://www.transplantliving.org/before-the-transplant/financing-a-transplant/the-costs/

Addley, E. (2003, December 04). A kidney costs $100,000. The donor gets $2,000. Retrieved April 20, 2017, from https://www.theguardian.com/society/2003/dec/04/health.medicineandhealth

Martinez, E. (2009, July 27). Black Market Kidneys, $160,000 a Pop. Retrieved April 20, 2017, from http://www.cbsnews.com/news/black-market-kidneys-160000-a-pop/

Putz, U. (2013, November 12). Lebanese Black Market: Syrian Refugees Sell Organs to Survive – SPIEGEL ONLINE – International. Retrieved April 20, 2017, from http://www.spiegel.de/international/world/organ-trade-thrives-among-desperate-syrian-refugees-in-lebanon-a-933228.html

Putz, U. (2013, November 12). Lebanese Black Market: Syrian Refugees Sell Organs to Survive – SPIEGEL ONLINE – International. Retrieved April 20, 2017, from http://www.spiegel.de/international/world/organ-trade-thrives-among-desperate-syrian-refugees-in-lebanon-a-933228.html

Tozer, J. (2009, September 28). Cash-strapped Britons are selling kidneys to pay mortgages and clear debts. Retrieved April 20, 2017, from http://www.dailymail.co.uk/news/article-1216465/Cash-strapped-Britons-selling-kidneys-pay-mortgages-clear-debts.html

Evans, S. (2017, January 25). Desperate Brits buying kidney transplants on Pakistan black market for £47,000. Retrieved April 20, 2017, from http://www.mirror.co.uk/news/uk-news/desperate-brits-travelling-pakistan-buy-9690665

Carey, B. (2013, August 29). Which Organs Can I Live Without, And How Much Cash Can I Get For Them? Retrieved April 20, 2017, from http://www.popsci.com/technology/article/2013-08/which-organs-can-i-live-without-and-how-much-cash-can-i-get-them

Naik, S. (2013, July 13). Crime & courts. Retrieved April 24, 2017, from http://www.iol.co.za/news/crime-courts/r2-million-for-a-kidney-1546299

Mishan, E. (1971). Evaluation of Life and Limb: A Theoretical Approach. Journal Of Political Economy, 79(4), 687-705.

Advertisements

Kommentar verfassen

Trage deine Daten unten ein oder klicke ein Icon um dich einzuloggen:

WordPress.com-Logo

Du kommentierst mit Deinem WordPress.com-Konto. Abmelden / Ändern )

Twitter-Bild

Du kommentierst mit Deinem Twitter-Konto. Abmelden / Ändern )

Facebook-Foto

Du kommentierst mit Deinem Facebook-Konto. Abmelden / Ändern )

Google+ Foto

Du kommentierst mit Deinem Google+-Konto. Abmelden / Ändern )

Verbinde mit %s