Summary:
I read this book before watching Yennai Arindhal. While the movie portrays a specific character involved in human organ trade and does a pretty good job of explaining the mechanics of illegal human organ trade, this book takes a broad view of a select number of trades in human organs. As the author confesses, writing a book about every type trade in human organs was not his intention. So, the traveling museum exhibitions using bodies of executed prisoners, US funeral parlors selling bodies from graves to tissue supply companies, Human Growth Hormone producers using stolen pituitary glands from England, Israeli military harvesting corneas of killed Palestinian militants and Bolivian serial murderers selling fat from their murder victims to European beauty supply companies for upmarket facial cream do not make the cut. Maybe, because the author married into a tamil family, he showers his attention on Chennai and the city does not come out looking good.
In his view, whether it is the supply of blood, kidney, hair, human eggs or children, the sourcing is usually done out of altruism or through coercion. The actors upstream (doctors, nurses, hospitals, hair companies, medical schools) make quite a lot of money peddling their services based on those products but the inherent contradiction of treating humans (and their body parts) as mere commodities that are considered to be offerings from altruistic humans runs throughout the book. Reading the chapter on child adoptions using abducted kids is enough to scare any parent straight. In the human organ trade, countries in the developed world are usually on the demand side and countries in the third world are usually on the supply side. Because of the obsession with privacy in developed world (which has seeped into third world laws as well), the brokers and middlemen in these organ trades make out like bandits. Same can be said of the companies and the medical establishment in both developed world and third world countries. It is the donors (willing and unwilling), the children and their parents from third world who bear the brunt of the downsides in this trade.
The author is clear eyed on the scope of the problem, not so much about solutions. The technologies that save lives through transplants run smoothly for the most part and have extended lives of patients, even if they are condemned to live on a battery of medications to ensure acceptance of the transplanted organs. However, for the 10% of the organ transplants that are sourced in the black (red) market, the lives of the people who parted with their organs becomes a nightmare. The author posits transparency at all stages of the red market as a solution but he admits that wont make the market go away. It can only cut down on egregious violators who kill or kidnap people for their kidneys which is still a start.
Analysis:
The depiction of postapocalyptic Australia in the new Mad Max Fury Road movie has shades of similarity in the human organ trade in present day India, especially in the blood and kidney trades.India's population is now considered to be its asset. The vast population allowed Indian professionals to improve their lot in life by using brainpower for the commercial benefit of the developed world, either through outsourcing or immigrating to those developed countries. Because it is a monetary exchange that is strictly defined and enforced through contracts, those professionals have been able to benefit from the immense power of the human brain and re-use it repeatedly (at least till they become senile) to improve their lot in life. Indian governments historically have neglected education and healthcare and as a result, India is saddled with an illiterate and barely literate population that cannot get monetary compensation for their brain power. Because of wretched poverty (whether life long or caused by natural disasters like tsunamis), they are forced to peel off their body parts for much needed cash. Because it is a physical body part, it does not regenerate and as a result, the ability of organ donors to build a sustainable future based on that one time cash infusion is bleak. Academic literature has shown that the quality of life for paid organ donors is usually not high even though some economists still argue for loosely regulated organ markets. The lack of enforcement of contracts in India means that poor people donate their body parts with the expectation of a cash payment that sometimes does not come through when the broker breaks the contract. Because of lax regulations, they do not have a recourse, ending in a far worse position from where they started. The only exception to this rule, occurs when a whole child is abducted and placed into the global adoption supply chain thereby elevating it to a privileged life status (kids who are abducted for the purposes of adoption come from third world countries and are placed for adoption in developed countries).
The brokers and traders in body parts and skeletons are capitalistic just like the rest of the world. They happen to deal in commodities that are human body parts. They aim to buy low and sell high. As a result, if they have to break the law, cheat the donor or fake documents, they have no compunction doing it, especially when countries like India do not strictly enforce their own laws. Breaking the law is also made easier when the buyer of the harvested body part is in developed world. The brokers take advantage of differing legal systems and standards of enforcement across developed and third world. It also allows the beneficiary of the harvested body part to rationalize their culpability by taking refuge in the legal standards of the developed world. The wealth differentials between the developed and third world provides a ready made situation for the broker to offer a discounted price for the buyer in the developed world and still book a substantial profit. According to the author, there are 3 types of markets that are generally recognized:
White markets - Products being traded are legal and aboveboard. Example - Cars, Houses
Black markets - Products being traded are illegaol or fall under a legal gray area. Example - Bootleg DVDs, Drugs
Red markets - Products from human bodies that are caught between the altruistic nature of the sourcing ("donated" or "abducted") and commoditized nature downstream (which ensures humongous profits for the middlemen (who legalize the source material by a sleight of hand and pocket the premium from assuming the risk), corporations and medical establishments (who make a killing on providing services (transplants) to utilize the sourcing material for the beneficiary). Trade in the following products are described in this book:
Bones:
For the longest time, India remained the pre-eminent source for bones and skeletons that were used to teach future doctors across the world. Doctors in 19th century England and America were notorious for paying grave robbers to get their hands on dead bodies (the rise of medical profession to respectability is fascinating when compared to the profession it used to share a murky reputation with, barbers). Governments looked the other way, thinking of grave robbing for medical skeletons as a necessary evil. After a particularly grisly series of murders done to supply skeletons to University of Edinburgh, England passed the Anatomy Act in 1832. Other Western countries followed with their legislation outlawing grave robberies in their countries, causing a serious shortage of skeletons in medical schools. As has happened before in other commodities, the measures by English government pushed the trade to its colonies, specifically India, with British encouraging it. Bone and skeleton traders in India openly dug up graves and stole bodies from funeral pyre after the families left and shipped it abroad. The local villagers were aware of the trade. The book describes the step by step process by which a dead body becomes a completed product for prestigious medical schools across the world. By 1984, India was exporting 60,000 skulls and skeletons every year to medical schools across the world. In 1985, a bone trader was caught exporting 1,500 children's skulls in West Bengal. In the panic that followed, Indian government passed a law outlawing export of bones and skeletons even though it made an exception for the domestic trade. Brokers have taken advantage of that loophole to supply medical schools and hospitals abroad even though the law has succeeded in curbing egregious violators.
Kidneys:
Kidney transplants prey exclusively on the poor. With the progress in life saving technologies, people across the world have come to expect a long life. On the demand side, the medical establishment in the developed world (doctors, nurses, hospitals) know that the kidney supply is extensive (even if some of it can only be obtained through illegal means) and they have lowered the threshold for patients who need a kidney transplant. This has increased the demand for kidneys in the western world. The medical establishment in the western world also maintains an iron grip on the organ donor waiting list that manages the flow of kidneys from donors who are willing to donate one to patients who need one. By leveraging privacy concerns, the medical establishment in the western world keeps the ratio of recipients to donors the same even when the donor pool for kidneys grows larger. This scarcity approach also ensures a premium for the ancillary services that have to be performed by the doctors and nurses and hospitals (which are not outlawed even though sale of kidneys is). As a result, patients perceive a shortage of kidneys that can be had and rush headlong into the arms of third world organizations that offer kidney transplant services at a much discounted price. Insurance companies have further added fuel to the fire by covering patients (and reducing their own costs) in western world who opt for kidney transplants in third world countries. It also helps bring in much needed cash in the form of medical tourism for the governments of the third world countries. The only people who are left in the lurch are the poor donors in third world who lose their kidneys and depending upon the broker, their payment as well.
When a donor wants to donate their kidney in India, they have to go through an ethics review by Transplant Authorization Committee. Because of the demand and lax regulations, the committee looks the other way as unscrupulous brokers coerce poor people to sign contracts that take away their kidneys but stiff them when it comes to payment. The book describes a case by a social activist who convinced some kidney donors to petition the court, that ended in defeat because the brokers had already gamed the system to their advantage. While the brokers might come across villains, the doctors and the medical establishment play the part of enablers of this exploitation as they hide behind the convenient language of patients rights. Different third world countries use different approaches to kidney trade - India pays lip service to a legal framework that is then easily manipulated by the medical establishment and the brokers leaving desperately poor people without kidneys and payments, Iran has legalized kidney transplants but the coercion continues with homeless and the poor feeling the brunt of it, China forcibly removes kidneys from political prisoners which then are used to generate revenues for the Communist party. Making the kidney trade transparent would expose China for its crimes against humanity, force the medical establishment in the West to account for the source of the kidneys and (maybe) shame Indians into paying fair price to kidney donors.
Adoptions:
Global adoption supply chain that enables families in the West to adopt children run on the backs of kids kidnapped from their families in third world countries (India, China, Chad, Malawi, Haiti). Because there is potential for significant profit to be made by an orphanage (US adoption agencies charge clients $14,000 for a child and orphanages spend $3,500 on the child which amounts to a tidy profit), it has led to some orphanages in India to place kidnapped kids in the global adoption supply chain. The demand from Western world is for younger kids who have just been admitted to the orphanage so the orphanages usually try to place a kidnapped child as quickly as possible. The book details the case of a kid in Chennai called Subhash who was kidnapped by his gardener when he was playing outside and sold to Malaysian Social Services (MSS), an orphanage in the city. Following the paperwork and court documents, the author is able to trace the person from MSS, Raghupati who sold Subhash (and has since been arrested) to an adoption agent in Wisconsin, Ramani Jayakumar who then passed the child to Paquette Adoption Services. Paquette Adoption Services placed the child with a Christian couple in Mid West and Subhash is growing up with them. When the author confronts the couple with the evidence of Subhash's kidnapping and his birth parents' (Nageswara Rao and Sivagami) frustration at not being able to keep in touch, they refuse to entertain even keeping in contact with the birth parents. The adoptee couple and Paquette Adoption Services throw doubt on the legality of Indian documents and consider them fake. It is not an isolated incident. An orphanage called Preet Mandir was caught in a sting by CNN-IBN in 2006 (where the reporters posed as adoptive parents and Preet Mandir's director offered to provide 2 children for $24,000). Some of the famous adoption agencies in US including Children's Home Society and Adoption Services worked with Preet Mandir till the expose. When questioned on the legality of its adoption practices, Children's Home Society and Adoption Services hid behind legalese arguing that the papers looked in order. Reading this section should scare parents of Indian children. Even celebrities are not exempt from the red market. Madonna was feted by the world in 2006 for adopting a child from a Malawi orphanage who was not an orphan.
Egg Harvesting:
The desire to have families is an universal one and with wealth comes a bevy of options for those parents who cannot make eggs on their own (infertile couples, gay couples). Because the demand comes from western world and a premium is placed on lighter skin color, egg harvesting primarily exploits Eastern European women who are poor. Egg donors require a minimum of 2 weeks of hormone stimulation followed by surgical removal. It requires surgery and general anesthesia with its attendant complications. So, it takes commitment to put themselves through the process. Because eggs are perceived to be life affirming, recipients and medical establishment in developed world look upon it as an altruistic act even though the risks incurred by the donors are significant. Because of the ethical complications, US and Britain have banned egg havesting within their borders which has allowed Cyprus to attract medical facilities that fly in Eastern European women on the promise of quick cash, harvest the eggs and put them back on the return flight. When the recipients want to purchase eggs, they fly to Cyprus and get it implanted and fly back home. Because the recipients perceive it to be an altruistic act, fertility clinics are able to get away with paying lower compensation to the egg donors. Treating it as a commodity would allow higher payments and a measure of protection for the Eastern European women but would result in higher costs for the recipients and unwelcome attention for Cyprus.
Surrogacy:
The stark difference between monetizing brain power and physical body shows up in surrogacy. The long gestation period required for delivery means the surrogate's body cannot be used to earn cash repeatedly (which is the prime reason that motivates women in third world to carry another family's child even though the family paying for the surrogate perceives surrogacy to be an altruistic act). Western women who hire surrogacy services in India do it with the explicit understanding that the fertility clinic keeps the surrogate mother under strict watch in their facility (where she is not allowed to go outside even for a walk). India legalized surrogacy in 2002 and the lax nature of the regulations means the fertility clinics can focus on surrogate women as efficient child bearing machines. American Society of Reproductive Medicine recommends implanting one embryo in a woman's uterus per attempt. Indian government guidelines allow implantation up to 3 embryos in a woman's uterus per attempt. Indian fertility clinics stretch it even further and implant 5 embryos in a woman's uterus per attempt. The cash benefits are significant for an impoverished family in India (and because the surrogate women are housed in the clinic, it also protects them from innuendo about their pregnancy in their village). A successful delivery provides $5,000 - $6,000 for the surrogate woman. If the woman miscarries, she gets to keep what has been paid up to that point. If she chooses to abort, the woman must reimburse the clinic and client for all expenses incurred.
Blood donation:
Voluntary blood donation in Chennai and US are not all that different in terms of how the donors are treated. While the number of questions asked by Indian medical facilities might be lesser in scope in terms of the diseases, the staff make it a point to provide an excellent experience. Because medical technologies that require blood transfusions matured earlier in US than India, US was able to take into account perils of paid blood donation (susceptibility to contamination and race to bottom in terms of quality), as outlined by Richard Titmuss in his book, The Gift Relationship. In the 1940's and 1950's, US used paid blood donation. However, the hospitals and patients were not happy. After the publication of Gift Relationship, hospitals started using volunteer blood but faced significant push back from Federal Trade Commission which sued them to use paid blood instead of volunteer blood. With heavy lifting from American Medical Association, voluntary blood donation became the norm. Congress followed suit and banned paid blood donation. Arkansas became the last state in US to ban paid blood donation in 1994 and held onto deteriorating quality of paid blood the longest. However, Congress punted on capping the amount that the medical establishment can charge for services using the volunteer blood. As anyone who has donated blood knows, US is always in a state of chronic blood shortage. The effort by American Medical Association to encourage volunteer blood donation also allowed hospitals to reduce the cost of paying for blood, boosting their bottom line as well.
In India, a patient who needs blood has to find a matching donor who will provide the hospital or the blood bank with the equivalent amount of blood that the patient uses. This approach shifts the responsibility of finding blood for surgeries onto the patients themselves. While it works out for patients who are able to use their social networks to find matching donors, it is a recipe for disaster for people who are migrants or medical tourists who visit cities like Chennai for its excellent medical facilities. Because Indians are not open to donating blood and consider it as a literal drain on their energy (similar to what Donald Trump thinks of energy levels in human body), the medical establishment and the government have had to rely on professional blood donors to fill the gap. As with kidney harvesting, Indian doctors and nurses hide behind patients privacy rights when pressed about moving away from using professional blood donors. The ambiguity in the stance of medical profession when it comes to blood donation is a godsend for criminal gangs that kidnap people and use them as a reservoir for blood (as happened in Gorakhpur recently).
Drug testing:
Pharmaceutical companies need their drugs to pass through different phases of testing by FDA for it to be a moneymaker. In 1950's and 1960's, pharmaceutical companies used prison inmate population to conduct their drug testing. Because of the captive nature of the population, they were able to gather pretty accurate data on the efficacy of their drugs and made impressive advances. After prisoners were excluded from participation in drug testing, pharmaceutical companies have had to come up with a new approach. They settled on using third party Contract Research Organizations (CROs) to conduct drug testing trials. This led to a proliferation of professional drug testers who hoodwinked CROs and made handsome amount of money jumping from one protocol to another.
With the saturation of drug usage across US, CROs have hit upon Chinese and Indian population as the next frontier for their drug testing. Because Indian government has historically neglected investment in healthcare for its citizens, the amount of drugs coursing through the population is much lesser than their counterparts in the US. The Indian government also stands to rake in significant revenues from pharmaceutical companies who conduct their drug tests in India. As a result, the lack of rights for the participants in the drug testing protocol and even their deaths has not prodded Drug Control General of India too rein the practices of CROs.
Hair:
The closest human organ trade comes to being a commodity is in the hair trade. Tirupati is well known in India for its devotees offering their hair to Lord Vishnu. In the 1960's, TTD burnt all the hair it got from devotees. However, Indian government banned that practice citing pollution concerns. As a result, TTD got into the business of supplying human hair for wig makers in India and overseas, pulling in $10 million - $15 million per year(maybe that revenue will make a dent in Lord Vishnu's debt to Kuberan). Hair of a devotee regenerates (most of the time) and as such, this trade comes pretty close to being a commodity even though the devotee does not see any payment for it.
With all the technological advances, people have started expecting longer life spans due to miracle cures. The human body has a finite life span. To give people what they desire (and make a tidy profit out of it), the medical establishment has has made impressive leaps in surgical technology. The other components of the miracle cures, pharmaceutical innovations and regenerative therapies have proceeded at a much slower pace. This has led people to opt for surgical solutions when their body breaks down with advancing age. As much advances as there have been in surgical technology, the source material still requires human organs. Countries can entirely ban payment for human organs and ancillary services in which case the trade will go underground. At the other extreme, treating human organs as a commodity and assigning payments to each, will end up in a race to the bottom. Transparency in the source of human organs will at least force the medical establishment across the world to acknowledge and give credit to the people who do the donating (willingly or through coercion) which currently is not the case.
Other Books of Reference:
Body Brokers: Inside America's Underground Trade in Human Remains - Anne Cheney
Stiff: The Curious Lives of Human Cadavers - Mary Roach
The Gift Relationship - Richard Titmuss
Strange Harvest - Leslie Sharp
I read this book before watching Yennai Arindhal. While the movie portrays a specific character involved in human organ trade and does a pretty good job of explaining the mechanics of illegal human organ trade, this book takes a broad view of a select number of trades in human organs. As the author confesses, writing a book about every type trade in human organs was not his intention. So, the traveling museum exhibitions using bodies of executed prisoners, US funeral parlors selling bodies from graves to tissue supply companies, Human Growth Hormone producers using stolen pituitary glands from England, Israeli military harvesting corneas of killed Palestinian militants and Bolivian serial murderers selling fat from their murder victims to European beauty supply companies for upmarket facial cream do not make the cut. Maybe, because the author married into a tamil family, he showers his attention on Chennai and the city does not come out looking good.
In his view, whether it is the supply of blood, kidney, hair, human eggs or children, the sourcing is usually done out of altruism or through coercion. The actors upstream (doctors, nurses, hospitals, hair companies, medical schools) make quite a lot of money peddling their services based on those products but the inherent contradiction of treating humans (and their body parts) as mere commodities that are considered to be offerings from altruistic humans runs throughout the book. Reading the chapter on child adoptions using abducted kids is enough to scare any parent straight. In the human organ trade, countries in the developed world are usually on the demand side and countries in the third world are usually on the supply side. Because of the obsession with privacy in developed world (which has seeped into third world laws as well), the brokers and middlemen in these organ trades make out like bandits. Same can be said of the companies and the medical establishment in both developed world and third world countries. It is the donors (willing and unwilling), the children and their parents from third world who bear the brunt of the downsides in this trade.
The author is clear eyed on the scope of the problem, not so much about solutions. The technologies that save lives through transplants run smoothly for the most part and have extended lives of patients, even if they are condemned to live on a battery of medications to ensure acceptance of the transplanted organs. However, for the 10% of the organ transplants that are sourced in the black (red) market, the lives of the people who parted with their organs becomes a nightmare. The author posits transparency at all stages of the red market as a solution but he admits that wont make the market go away. It can only cut down on egregious violators who kill or kidnap people for their kidneys which is still a start.
Analysis:
The depiction of postapocalyptic Australia in the new Mad Max Fury Road movie has shades of similarity in the human organ trade in present day India, especially in the blood and kidney trades.India's population is now considered to be its asset. The vast population allowed Indian professionals to improve their lot in life by using brainpower for the commercial benefit of the developed world, either through outsourcing or immigrating to those developed countries. Because it is a monetary exchange that is strictly defined and enforced through contracts, those professionals have been able to benefit from the immense power of the human brain and re-use it repeatedly (at least till they become senile) to improve their lot in life. Indian governments historically have neglected education and healthcare and as a result, India is saddled with an illiterate and barely literate population that cannot get monetary compensation for their brain power. Because of wretched poverty (whether life long or caused by natural disasters like tsunamis), they are forced to peel off their body parts for much needed cash. Because it is a physical body part, it does not regenerate and as a result, the ability of organ donors to build a sustainable future based on that one time cash infusion is bleak. Academic literature has shown that the quality of life for paid organ donors is usually not high even though some economists still argue for loosely regulated organ markets. The lack of enforcement of contracts in India means that poor people donate their body parts with the expectation of a cash payment that sometimes does not come through when the broker breaks the contract. Because of lax regulations, they do not have a recourse, ending in a far worse position from where they started. The only exception to this rule, occurs when a whole child is abducted and placed into the global adoption supply chain thereby elevating it to a privileged life status (kids who are abducted for the purposes of adoption come from third world countries and are placed for adoption in developed countries).
The brokers and traders in body parts and skeletons are capitalistic just like the rest of the world. They happen to deal in commodities that are human body parts. They aim to buy low and sell high. As a result, if they have to break the law, cheat the donor or fake documents, they have no compunction doing it, especially when countries like India do not strictly enforce their own laws. Breaking the law is also made easier when the buyer of the harvested body part is in developed world. The brokers take advantage of differing legal systems and standards of enforcement across developed and third world. It also allows the beneficiary of the harvested body part to rationalize their culpability by taking refuge in the legal standards of the developed world. The wealth differentials between the developed and third world provides a ready made situation for the broker to offer a discounted price for the buyer in the developed world and still book a substantial profit. According to the author, there are 3 types of markets that are generally recognized:
White markets - Products being traded are legal and aboveboard. Example - Cars, Houses
Black markets - Products being traded are illegaol or fall under a legal gray area. Example - Bootleg DVDs, Drugs
Red markets - Products from human bodies that are caught between the altruistic nature of the sourcing ("donated" or "abducted") and commoditized nature downstream (which ensures humongous profits for the middlemen (who legalize the source material by a sleight of hand and pocket the premium from assuming the risk), corporations and medical establishments (who make a killing on providing services (transplants) to utilize the sourcing material for the beneficiary). Trade in the following products are described in this book:
Bones:
For the longest time, India remained the pre-eminent source for bones and skeletons that were used to teach future doctors across the world. Doctors in 19th century England and America were notorious for paying grave robbers to get their hands on dead bodies (the rise of medical profession to respectability is fascinating when compared to the profession it used to share a murky reputation with, barbers). Governments looked the other way, thinking of grave robbing for medical skeletons as a necessary evil. After a particularly grisly series of murders done to supply skeletons to University of Edinburgh, England passed the Anatomy Act in 1832. Other Western countries followed with their legislation outlawing grave robberies in their countries, causing a serious shortage of skeletons in medical schools. As has happened before in other commodities, the measures by English government pushed the trade to its colonies, specifically India, with British encouraging it. Bone and skeleton traders in India openly dug up graves and stole bodies from funeral pyre after the families left and shipped it abroad. The local villagers were aware of the trade. The book describes the step by step process by which a dead body becomes a completed product for prestigious medical schools across the world. By 1984, India was exporting 60,000 skulls and skeletons every year to medical schools across the world. In 1985, a bone trader was caught exporting 1,500 children's skulls in West Bengal. In the panic that followed, Indian government passed a law outlawing export of bones and skeletons even though it made an exception for the domestic trade. Brokers have taken advantage of that loophole to supply medical schools and hospitals abroad even though the law has succeeded in curbing egregious violators.
Kidneys:
Kidney transplants prey exclusively on the poor. With the progress in life saving technologies, people across the world have come to expect a long life. On the demand side, the medical establishment in the developed world (doctors, nurses, hospitals) know that the kidney supply is extensive (even if some of it can only be obtained through illegal means) and they have lowered the threshold for patients who need a kidney transplant. This has increased the demand for kidneys in the western world. The medical establishment in the western world also maintains an iron grip on the organ donor waiting list that manages the flow of kidneys from donors who are willing to donate one to patients who need one. By leveraging privacy concerns, the medical establishment in the western world keeps the ratio of recipients to donors the same even when the donor pool for kidneys grows larger. This scarcity approach also ensures a premium for the ancillary services that have to be performed by the doctors and nurses and hospitals (which are not outlawed even though sale of kidneys is). As a result, patients perceive a shortage of kidneys that can be had and rush headlong into the arms of third world organizations that offer kidney transplant services at a much discounted price. Insurance companies have further added fuel to the fire by covering patients (and reducing their own costs) in western world who opt for kidney transplants in third world countries. It also helps bring in much needed cash in the form of medical tourism for the governments of the third world countries. The only people who are left in the lurch are the poor donors in third world who lose their kidneys and depending upon the broker, their payment as well.
When a donor wants to donate their kidney in India, they have to go through an ethics review by Transplant Authorization Committee. Because of the demand and lax regulations, the committee looks the other way as unscrupulous brokers coerce poor people to sign contracts that take away their kidneys but stiff them when it comes to payment. The book describes a case by a social activist who convinced some kidney donors to petition the court, that ended in defeat because the brokers had already gamed the system to their advantage. While the brokers might come across villains, the doctors and the medical establishment play the part of enablers of this exploitation as they hide behind the convenient language of patients rights. Different third world countries use different approaches to kidney trade - India pays lip service to a legal framework that is then easily manipulated by the medical establishment and the brokers leaving desperately poor people without kidneys and payments, Iran has legalized kidney transplants but the coercion continues with homeless and the poor feeling the brunt of it, China forcibly removes kidneys from political prisoners which then are used to generate revenues for the Communist party. Making the kidney trade transparent would expose China for its crimes against humanity, force the medical establishment in the West to account for the source of the kidneys and (maybe) shame Indians into paying fair price to kidney donors.
Adoptions:
Global adoption supply chain that enables families in the West to adopt children run on the backs of kids kidnapped from their families in third world countries (India, China, Chad, Malawi, Haiti). Because there is potential for significant profit to be made by an orphanage (US adoption agencies charge clients $14,000 for a child and orphanages spend $3,500 on the child which amounts to a tidy profit), it has led to some orphanages in India to place kidnapped kids in the global adoption supply chain. The demand from Western world is for younger kids who have just been admitted to the orphanage so the orphanages usually try to place a kidnapped child as quickly as possible. The book details the case of a kid in Chennai called Subhash who was kidnapped by his gardener when he was playing outside and sold to Malaysian Social Services (MSS), an orphanage in the city. Following the paperwork and court documents, the author is able to trace the person from MSS, Raghupati who sold Subhash (and has since been arrested) to an adoption agent in Wisconsin, Ramani Jayakumar who then passed the child to Paquette Adoption Services. Paquette Adoption Services placed the child with a Christian couple in Mid West and Subhash is growing up with them. When the author confronts the couple with the evidence of Subhash's kidnapping and his birth parents' (Nageswara Rao and Sivagami) frustration at not being able to keep in touch, they refuse to entertain even keeping in contact with the birth parents. The adoptee couple and Paquette Adoption Services throw doubt on the legality of Indian documents and consider them fake. It is not an isolated incident. An orphanage called Preet Mandir was caught in a sting by CNN-IBN in 2006 (where the reporters posed as adoptive parents and Preet Mandir's director offered to provide 2 children for $24,000). Some of the famous adoption agencies in US including Children's Home Society and Adoption Services worked with Preet Mandir till the expose. When questioned on the legality of its adoption practices, Children's Home Society and Adoption Services hid behind legalese arguing that the papers looked in order. Reading this section should scare parents of Indian children. Even celebrities are not exempt from the red market. Madonna was feted by the world in 2006 for adopting a child from a Malawi orphanage who was not an orphan.
Egg Harvesting:
The desire to have families is an universal one and with wealth comes a bevy of options for those parents who cannot make eggs on their own (infertile couples, gay couples). Because the demand comes from western world and a premium is placed on lighter skin color, egg harvesting primarily exploits Eastern European women who are poor. Egg donors require a minimum of 2 weeks of hormone stimulation followed by surgical removal. It requires surgery and general anesthesia with its attendant complications. So, it takes commitment to put themselves through the process. Because eggs are perceived to be life affirming, recipients and medical establishment in developed world look upon it as an altruistic act even though the risks incurred by the donors are significant. Because of the ethical complications, US and Britain have banned egg havesting within their borders which has allowed Cyprus to attract medical facilities that fly in Eastern European women on the promise of quick cash, harvest the eggs and put them back on the return flight. When the recipients want to purchase eggs, they fly to Cyprus and get it implanted and fly back home. Because the recipients perceive it to be an altruistic act, fertility clinics are able to get away with paying lower compensation to the egg donors. Treating it as a commodity would allow higher payments and a measure of protection for the Eastern European women but would result in higher costs for the recipients and unwelcome attention for Cyprus.
Surrogacy:
The stark difference between monetizing brain power and physical body shows up in surrogacy. The long gestation period required for delivery means the surrogate's body cannot be used to earn cash repeatedly (which is the prime reason that motivates women in third world to carry another family's child even though the family paying for the surrogate perceives surrogacy to be an altruistic act). Western women who hire surrogacy services in India do it with the explicit understanding that the fertility clinic keeps the surrogate mother under strict watch in their facility (where she is not allowed to go outside even for a walk). India legalized surrogacy in 2002 and the lax nature of the regulations means the fertility clinics can focus on surrogate women as efficient child bearing machines. American Society of Reproductive Medicine recommends implanting one embryo in a woman's uterus per attempt. Indian government guidelines allow implantation up to 3 embryos in a woman's uterus per attempt. Indian fertility clinics stretch it even further and implant 5 embryos in a woman's uterus per attempt. The cash benefits are significant for an impoverished family in India (and because the surrogate women are housed in the clinic, it also protects them from innuendo about their pregnancy in their village). A successful delivery provides $5,000 - $6,000 for the surrogate woman. If the woman miscarries, she gets to keep what has been paid up to that point. If she chooses to abort, the woman must reimburse the clinic and client for all expenses incurred.
Blood donation:
Voluntary blood donation in Chennai and US are not all that different in terms of how the donors are treated. While the number of questions asked by Indian medical facilities might be lesser in scope in terms of the diseases, the staff make it a point to provide an excellent experience. Because medical technologies that require blood transfusions matured earlier in US than India, US was able to take into account perils of paid blood donation (susceptibility to contamination and race to bottom in terms of quality), as outlined by Richard Titmuss in his book, The Gift Relationship. In the 1940's and 1950's, US used paid blood donation. However, the hospitals and patients were not happy. After the publication of Gift Relationship, hospitals started using volunteer blood but faced significant push back from Federal Trade Commission which sued them to use paid blood instead of volunteer blood. With heavy lifting from American Medical Association, voluntary blood donation became the norm. Congress followed suit and banned paid blood donation. Arkansas became the last state in US to ban paid blood donation in 1994 and held onto deteriorating quality of paid blood the longest. However, Congress punted on capping the amount that the medical establishment can charge for services using the volunteer blood. As anyone who has donated blood knows, US is always in a state of chronic blood shortage. The effort by American Medical Association to encourage volunteer blood donation also allowed hospitals to reduce the cost of paying for blood, boosting their bottom line as well.
In India, a patient who needs blood has to find a matching donor who will provide the hospital or the blood bank with the equivalent amount of blood that the patient uses. This approach shifts the responsibility of finding blood for surgeries onto the patients themselves. While it works out for patients who are able to use their social networks to find matching donors, it is a recipe for disaster for people who are migrants or medical tourists who visit cities like Chennai for its excellent medical facilities. Because Indians are not open to donating blood and consider it as a literal drain on their energy (similar to what Donald Trump thinks of energy levels in human body), the medical establishment and the government have had to rely on professional blood donors to fill the gap. As with kidney harvesting, Indian doctors and nurses hide behind patients privacy rights when pressed about moving away from using professional blood donors. The ambiguity in the stance of medical profession when it comes to blood donation is a godsend for criminal gangs that kidnap people and use them as a reservoir for blood (as happened in Gorakhpur recently).
Drug testing:
Pharmaceutical companies need their drugs to pass through different phases of testing by FDA for it to be a moneymaker. In 1950's and 1960's, pharmaceutical companies used prison inmate population to conduct their drug testing. Because of the captive nature of the population, they were able to gather pretty accurate data on the efficacy of their drugs and made impressive advances. After prisoners were excluded from participation in drug testing, pharmaceutical companies have had to come up with a new approach. They settled on using third party Contract Research Organizations (CROs) to conduct drug testing trials. This led to a proliferation of professional drug testers who hoodwinked CROs and made handsome amount of money jumping from one protocol to another.
With the saturation of drug usage across US, CROs have hit upon Chinese and Indian population as the next frontier for their drug testing. Because Indian government has historically neglected investment in healthcare for its citizens, the amount of drugs coursing through the population is much lesser than their counterparts in the US. The Indian government also stands to rake in significant revenues from pharmaceutical companies who conduct their drug tests in India. As a result, the lack of rights for the participants in the drug testing protocol and even their deaths has not prodded Drug Control General of India too rein the practices of CROs.
Hair:
The closest human organ trade comes to being a commodity is in the hair trade. Tirupati is well known in India for its devotees offering their hair to Lord Vishnu. In the 1960's, TTD burnt all the hair it got from devotees. However, Indian government banned that practice citing pollution concerns. As a result, TTD got into the business of supplying human hair for wig makers in India and overseas, pulling in $10 million - $15 million per year(maybe that revenue will make a dent in Lord Vishnu's debt to Kuberan). Hair of a devotee regenerates (most of the time) and as such, this trade comes pretty close to being a commodity even though the devotee does not see any payment for it.
With all the technological advances, people have started expecting longer life spans due to miracle cures. The human body has a finite life span. To give people what they desire (and make a tidy profit out of it), the medical establishment has has made impressive leaps in surgical technology. The other components of the miracle cures, pharmaceutical innovations and regenerative therapies have proceeded at a much slower pace. This has led people to opt for surgical solutions when their body breaks down with advancing age. As much advances as there have been in surgical technology, the source material still requires human organs. Countries can entirely ban payment for human organs and ancillary services in which case the trade will go underground. At the other extreme, treating human organs as a commodity and assigning payments to each, will end up in a race to the bottom. Transparency in the source of human organs will at least force the medical establishment across the world to acknowledge and give credit to the people who do the donating (willingly or through coercion) which currently is not the case.
Other Books of Reference:
Body Brokers: Inside America's Underground Trade in Human Remains - Anne Cheney
Stiff: The Curious Lives of Human Cadavers - Mary Roach
The Gift Relationship - Richard Titmuss
Strange Harvest - Leslie Sharp
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