At Large
Preying on the poor
By Rina Jimenez-David
Philippine Daily Inquirer
First Posted 00:11:00 04/13/2008
MANILA, Philippines—Since 2002, the sale of kidneys by living non-related organ providers (LNROPs) has been prohibited by law, with the issuance of Administrative Order 124 by the Department of Health. The next year, 2003, the Anti-Trafficking in Persons Act was signed into law, and this new law specifically prohibits the removal of organs in exchange for monetary considerations.
And yet, despite this “double-barrelled” prohibition on kidney sales, the practice continued and even flourished, such that by 2005, the Philippines has been listed by the World Health Organization as one of the “top five organ trafficking hotspots” in the world.
Last year, the DOH commissioned a study to look into the implementation of the “Philippine Organ Donation Program.” The study found that the DOH, through the Bureau of Health Facilities and Services, had not and could not enforce the rules, mainly because it lacked the personnel and means to “enforce ethical guidelines on accredited facilities.”
This year, AO 124 was revised and yet, contrary to expectations that it would tighten the rules against the sale of kidneys, the new order instead states that “foreign patients may receive organs from local donors subject to the guidelines and limitations formulated for this purpose by the Philippine Network for Organ Donation and Transplantation as approved by the Board.”
The Philippine Society of Nephrology, under its president Dr. Lynn Almazan-Gomez, in a statement, warns that such a wording “will open the floodgates for more exploitation of poor Filipino donors by foreign recipients.” The PSN cites the fact that, from 2002-2005, despite a 10-percent cap for transplants to foreigners, more than 400 kidney transplants (or more than half) from local donors to foreigners were performed.
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IT seems to me that the continued and growing sale of kidneys to foreigners in need of transplants may be only partially due to the DOH’s lack of personnel and means to enforce the law. A more likely cause is the lack of will and motivation on the part of enforcers—within the DOH, and in the medical community—to curb the practice because too many people are profiting from it, and these profiteers are extremely influential.
Of course, the “donors” or “vendors” are complicit in the sale. It is they, after all, who agree to give up one kidney in exchange for cash. But since the vast majority of LNROPs in this country are poor, and say that it was only extreme need that drove them to sell their kidneys, then the matter of their “consent,” informed or not, is brought into question. It’s like saying a woman who is trafficked for purposes of prostitution is to be blamed for her victimization.
In fact, under the AO which prohibits kidney sales, only the kidney provider (not even the procurer, the middle-man or the transplant institution or surgeon) would be committing a crime. Even if, as the PSN states: “the most common scenario is that the kidney provider is an impoverished Filipino who is a victim of human trafficking under RA 9208 who needs to be helped, rather than prosecuted.”
The Transplantation Society, the international body overseeing the implementation of ethical and legal guidelines on transplant procedures, has this to say on organ sales: “The rich of the world have become predators for the poor of the Philippines, using them as a targeted source of kidneys.”
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DR. Albert Chua, former president of the PSN, makes clear that the sale of kidneys for transplantation to foreigners “is happening in other countries of the world.” But in most of the countries in the WHO roster (China and India where it is banned, Pakistan, Colombia, Egypt and the Philippines) the trade in kidneys is done on the sly, clandestinely, under substandard conditions.
“I don’t know if it is a matter of pride or shame for the country,” says Dr. Chua ruefully. “But in the Philippines, because transplantations from Filipino donors to foreigners are done in the open and perhaps even with official assent, patients are at least assured of high-quality of services.”
But at what cost? First, to the living donor. The PSN notes with concern that “there are no specific or concrete policies with regard to the welfare of the donors.” Despite a requirement in the old AO that follow-up treatments of the donors be conducted, only 53 percent compliance was recorded.
True, donating a kidney is not and should not be a life-threatening procedure. Former President Fidel V. Ramos, a kidney donor, is a prime example. “He shows that with a good diet and an exercise regimen, a donor can live a long and healthy life,” says Chua. But most donors here are poor and in fact are driven by desperation to sell a kidney. Though a donor is supposed to undergo a check-up before being approved, there are talks that some potential donors with hypertension problems are told to take medication first and go for a check-up once their blood pressure has normalized. And do they realize that, aside from the money, they have also signed up for a lifetime of careful monitoring of their vital signs, a low-salt diet and exercise?
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IT is also true that foreigners who otherwise find it difficult, if not financially challenging, to undergo a life-saving procedure in their country do deserve a shot at a second chance, even if it takes place in the Philippines.
But should it be at the expense of Filipinos? Should the poor pay the price for the survival of wealthier foreigners? In the end, if the sale of kidneys is unabated, then we will all end up paying the price, in terms of the added burden on the health system of thousands of “single kidney” survivors who may be in need of a kidney transplant themselves down the road, but who will find that it is even farther beyond their reach.
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