In the course of studying this system, Organs Watch was born, a small human rights NGO dedicated to the task of promoting a human rights agenda for dealing with violations of the bodily integrity of vulnerable populations. Their findings to date have been astonishing, uncovering a worldwide system of organ and tissue trafficking. Some of it involves the removal of organs and tissue from cadavers, without consent. Scheper-Hughes uncovered a trading network for Achilles tendons, for example, originating from cadavers in South Africa, being sold to brokers in South Korea, and ending up in North America, taking advantage of ambiguities in legislation: “Most of the organ and tissue laws that exist in the world date back to the 80s and they all kind of look the same, and generally, in the morgues of State hospitals, prisons etc. there is a licence for the state pathologist to take excess tissue from unidentified cadavers, and to ship them for reasonable processing fees”. In this convoluted network, the excess tissue picks up value at each port of call, and finally ends up worth $2,500 apiece, so the profits are considerable”.
As troubling as the removal of organs and tissue, without consent, from cadavers is, Organs Watch has also uncovered the worldwide buying and selling of body parts from living sellers, ranging from kidneys, and half-livers to eyes: ”In Manila, I had men asking me if they could sell me an eye, a leg, anything of which they had two! One of my favourite ads”, she continues, in the matter of fact way of someone who has seen it all, ”which I saw in Recife, Brazil, was from a 37 year old unemployed man with a wife and two children. – ‘ I will sell any organ of which I have two and which the removal of will not cause my immediate death’”. Poverty has always provoked desperate measures, but the leaps in medical science are changing the possibilities, and the risks. ”There's that kind of the collapse of the sense of the body as indivisible, the living body, moving towards this sense of the body as eminently divisible, that you can cut off one piece after another. People have always been selling parts of themselves, hair, and teeth, so you can question whether there's anything new about this, but of course, now, the technology is different. It's inside the body as well as cutting off hair”. It's a terrifyingly widespread form of exploitation that can take hold of whole communities: ”In the Philippines there are whole slums where people have specialised in selling their body parts – she says, sadly – whole families will sell. You might start with the father, then his eldest son, then his younger son, then the wife, and before you know it the whole family have sold a kidney. What's really tragic is that, now, having sold the kidney, they want to sell something else because that money that they get -in Manila it's a couple of thousand tops – disappears quickly.”
Obviously the system involves more than just the buyer and seller. There has been the rise of the “broker”, international businessmen, often with links to organised crime, who work with local “kidney hunters”. These are, Scheper-Hughes explains, ”often very poor people who are the first people to sell a kidney. They can then lift up their shirt in the favela or the slum or inner city, wherever they're working, and they can say “look, I lived through it, and I made $10,000 and so can you”, and, of course, they lie to the patients and tell them they'll get more money than they'll receive, and they certainly don't inform them of the risk of the operation”. In many cases it's not just the temptation of money that convinces the seller to part with a part of themselves. Often there is deceit and violence. “In some cases, like those of certain Moldavian villages, they were simply lied to that there would be jobs for them as painters or drivers or construction workers in Turkey, and when they arrived they would be handed over from one broker to the next and told ‘no, no, no – you're job is to sell a kidney, and the only way to get back to your home in Moldova is if you do it’ and in these cases – she emphasises – there were real Mafia with guns and knives, forcing people on to the operating table. There's a range of behaviour, ranging from seduction to real trafficking of people.”
The reality is that, worldwide, there is a shortage of organs. This has lead to a murky world where the laws of supply and demand mix uneasily with notions of bodily integrity, with criminality and exploitation. It's far from simple, as Scheper-Hughes is quick to point out: “You can't, with a broad stroke, call all of it trafficking. Some of it is consensual, although it breaks the law of almost every country – living people are not supposed to be selling their kidneys or half their liver”. Ironically, though beauty is only skin deep, the laws of the market coupled with people's prejudices, mean that different kidneys cost more. Scheper Hughes tells the story of an Israeli broker, who offered both Brazilian and Israeli kidneys to her clients. The Brazilian kidney seller would receive $2,000, while the Israeli seller receives $20,000. You pays your money and takes your choice…