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Selling a kidney does little to ease the seller's poverty, study finds

Wednesday, October 02, 2002

By Christopher Snowbeck, Post-Gazette Staff Writer

Selling a kidney for transplant isn't a deal you want to make, according to a survey of more than 300 Indians who agreed to the now-illegal surgeries.

The results, being published today in the Journal of the American Medical Association, found that while patients received an average payment of $1,070 for their kidneys, the immediate economic benefit enabled few to escape poverty in the long run. What's more, kidney sellers suffered physically from the transaction.

Taken together, the findings serve as a stinging rebuke of any initiative to provide financial incentives to donors, said Dr. Madhav Goyal, an internist at Geisinger Health System in State College.

"There's been this idea that people are selling of their own free will, so it's OK. But it's not that simple," said Goyal, lead author of the study. "These people are selling because they are heavily in debt."

Even though India outlawed the sale of kidneys in 1994, the practice continues, said Goyal, who traveled in February 2001 to Chennai (formerly called Madras). On average, sellers were 35 years old and had sold their kidneys six years earlier. At least one had had surgery within one month of the survey.

More than 70 percent of the sellers were women. The same percentage of sellers were living in poverty.

The researchers asked why people sold their kidneys and what impact the decision had on their lives. Among their findings:

About 86 percent reported a deterioration in their health;

Seventy-nine percent would not recommend that others sell a kidney;

Two women in the survey stated that they had been forced by their husbands to sell a kidney.

Goyal said some have argued that paying for kidneys is an acceptable practice because it helps people out of poverty, but there was little evidence of that in the survey. On the contrary, average family income declined by one third after the surgery and the number of participants living below the poverty line increased.

Ninety-six percent said they sold a kidney to pay off debts, yet three-fourths of participants were still in debt at the time of the survey.

"It's pretty obvious that this is unmitigated exploitation and there is, in fact, no benefit to the donor," said Dr. Ron Shapiro, director of the kidney transplant program at the University of Pittsburgh Medical Center. "So, this study sort of confirms our worst fears."

The idea of selling organs in the United States is debated by transplant experts because of the country's chronic shortage of organs.

This summer, writers from the conservative American Enterprise Institute were the latest to argue that a free market in body parts could solve the problem. There have been less formal endorsements: Bidding for a human kidney offered on the Internet auction site eBay hit $5.7 million in September 1999 before the company put a stop to it.

A more moderate proposal for introducing financial incentives came from the state of Pennsylvania in 1999.

An advisory committee to the state Department of Health voted to create a pilot program through which $300 in funeral expenses would be covered by a state-run organ donation trust fund. The "funeral benefit" would have been directed to the funeral home responsible for burying the donor, not to the donor's family.

But fearing the program ran afoul of a federal law that prohibits the buying and selling of organs, the state Department of Health in January started an alternative program that covers food and lodging costs incurred by a donor or the donor's family. A total of 37 donor or donor families have taken advantage of the benefit so far.

Goyal, the State College researcher, said he doesn't like funeral benefit programs -- which have been proposed outside Pennsylvania, as well -- because even $300 could be a significant incentive for poor families.

"They're more likely to be swayed by that. Would the public then perceive that we're really out to exploit the poor?" he asked.

But Shapiro, the Pitt transplant surgeon, said he thought there were some important differences between funeral benefit programs and India's organ trade.

The funeral benefit programs, for instance, aid families who have agreed to donate organs from a loved one who has died and are not an inducement for a healthy person to sell an organ.

"I think it's a far cry from paying people to donate organs," he said.

Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412-263-2625.

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