Philippines restricts foreign kidney trade
New law ensures outsiders do not outbid citizens for desperately needed organs
By MARINA JIMENEZ
Monday, June 23, 2003
MANILA -- The Philippines has introduced a new law to stop the controversial practice of foreigners buying kidneys from local peoples, as the government tries to control a thriving organ trade that cuts into the country's poorest slums and is threatening to become common practice in its prisons.
Embarrassed by the practice, the government has prohibited paying for kidneys and created a committee that will screen all living non-related donors.
"Unfortunately the Philippines has been pictured as a place where people could buy a kidney. There are some clandestine things still going on, but I hope the kidney trade will soon be closed down," Enrique Ona, executive director of the National Kidney and Transplant Institute, said in a recent interview in Manila.
The new law, signed last month, restricts the number of foreign patients who can obtain kidneys from living donors, thereby ensuring that foreigners do not outbid locals for desperately needed organs. In theory, donors are supposed to be motivated by altruism, not profit; however, the government has not outlawed cash gifts, common in this culture.
Several Canadians, a wealthy Vancouver man among them, have travelled to Manila in recent years and purchased kidneys from slum dwellers for $2,000 (U.S.) and then undergone successful transplants at state-of-the-art hospitals with U.S.-trained surgeons.
There are still a handful of surgeons who operate on foreigners at two private hospitals here, and at least four brokers working in the city. Rey Arcilla is one of them. Last July, he arranged for a Filipino-Canadian to buy a kidney from an indigent man and recently arranged for nine more people to sell their kidneys. In Bagong Lupa, an area near the city's pier where he lives, hundreds have sold their kidneys over the years for as little as $1,800. Nobody has heard about the new law.
"The rich should be thankful to us poor people," Mr. Arcilla said. "Without us they would have no kidneys. I'm not worried about the new law."
At the same time the government is attempting to clamp down on the organ trade, a kidney patients association has backed a proposal, called Kidneys for Life, that would allow inmates to donate their kidneys in exchange for a pardon or to save their lives.
While there is a history of transplant surgeons in China using the kidneys of executed prisoners, the proponents of Kidneys for Life argue that it is a wholly original and potentially beneficial concept because it would reward both the donors and the recipients.
Leonardo de Castro, a philosophy professor at the University of the Philippines, says it would give inmates who otherwise would be executed a chance to save their own lives and the lives of others. He recently published an article in the Journal of Medical Ethics endorsing the plan.
"It is a way to atone for past sins, although it has the additional feature of being beneficial to another," he said. "The archbishop of Manila has found nothing morally objectionable with a creative idea by which a person makes a donation in reparation for a crime committed by an antilife by giving life."
Acts of penitence, such as walking barefoot on hot concrete, are popular among Filipino inmates during Holy Week, and organ donation can be seen as a form of medical penitence, he adds.
So far, however, Kidneys for Life has not been endorsed by legislators. The world's foremost scholar on the organ trade points out potential pitfalls. Dr. Nancy Scheper-Hughes, a medical anthropologist at the University of California at Berkeley, worries that prisoners could be manipulated by prison doctors and guards into thinking they could get special treatment in exchange for their organs.
"Captive populations, whether in prisons, concentration camps or refugee camps, are vulnerable to being used for egregious ends, for blood and tissue harvesting," said Dr. Scheper-Hughes, who will publish a book on the organ trade next year. "Do we want to reduce humans, even bad ones, to being used as living cadavers?"
She travelled to the Philippines in May with David Paperny, an Academy-Award-winning filmmaker who is making a documentary for CBC on Canada's role in the international organ trade. "What shocks me is how desperate and poverty-stricken many Filipinos are," Mr. Paperny said. "No wonder so many people, including inmates, are willing to sell off their kidneys for a pittance to North American buyers."
Transplant surgeons in Manila oppose the idea of allowing inmates to donate organs in exchange for freedom, although the practice has a long and controversial history here.
In the 1980s, about 50 maximum-sentence prisoners at Manila's New Bilibid Prison gave kidneys to patients in need. Most received a cash reward and expected that the Board of Pardons and Parole would reduce their sentences, said Zoraida Ocampo, medical co-ordinator for the Philippines Bureau of Corrections. But, she said, some were also motivated by repentance.
Only one got a reduced sentence, Dr. Ocampo said, and the government outlawed the prison program in 1990. Some recipients complained that their donors tracked them down after their release and threatened their families, demanding more money. In 1999, the former director of the National Kidney Institute was attacked on the way from his office and his daughter shot more than a dozen times. The crime was never solved, but police believe it was linked to the kidney trade.
While ethicists debate the appropriateness of inmates selling their organs in the Philippines, in Oregon, a very different problem has started an equally heated exchange: whether death-row prisoners deserve to receive kidney transplants to keep them alive long enough to be executed.
