And what of the buyers? How can people justify buying a kidney? “I've spoken to far more sellers, because they're aggrieved and hurting, but of the buyers I have managed to speak to some have been remarkably forthcoming. What it boils down to, with them, is that you're not a patient. ‘You can't judge what I do. You're not sick so you can't judge my actions’”. This may have some validity, but from a legislative point of view questions must certainly be asked. Particularly when you realise that in many cases these transplants are not questions of immediate life or death for the buyer. “Many of these patients”, Professor Scheper-Hughes explains, ” are wealthy enough to wait on a waiting list, being taken care of on dialysis, which isn't aesthetic or pleasant, and it's not something anyone would want to do out of choice, but it is a bridge until an organ becomes available. Or they could ask a relative. What's happening now is that many people would rather buy from a stranger than ask someone close to them to harm themselves.” It poses many difficult questions: “I worry about the politics, the bio-politics in a global sense, of the people who are resisting the getting of an organ through a waiting list or through friends or family, and would rather get a poor and anonymous person. It's easier. You don't have to deal with them after the fact.” She doesn’t judge however, as one would expect both from an anthropological view, and also as she has met and talked to all the human elements in this illegal process. ”Patients will do almost anything they can to get the life that they think they deserve, and I can understand it, though I'm troubled by the ethics of it. There's a rejection amongst the buyers absolutely against the idea of having the cadaver organ, it's not healthy they say, I'd live better with a fresh organ from a living person”. There's often a web of deceit spun towards the buyer, as well as the seller: ”They're always told that the seller is in good health, that they're workers, that they're fine”, though many of the sellers would not pass qualification tests for organ donation in the legal system, and often end up suffering kidney problems themselves later as a result of the operation. Often the buyers are lied to in relation to the sums of money changing hands, believing that their kidney seller is receiving $10,000 when in actual fact it's closer to $2,000. There's an element of preying on the weak when brokers approach possible buyers: “The buyers are often approached while on dialysis, by the brokers. They're the other side of the kidney hunters, looking for patients to sign up. 'Don't be on dialysis, don't wait for a morgue organ, come with us and we'll get you a fresh organ.'”
Scheper-Hughes has addressed the US Congress, and the Council of Europe on the issue and works closely with the World Health Organisation, and a certain amount of progress has been made. A number of trafficking rings have been broken up. In Brazil a parliamentary commission was formed to examine the problem, and in South Africa a number of legal investigations have been instigated, raising the level of consciousness both within the Police force and with transplant professionals. On a wider level though, there is still much to be done, and little political will to do it. Why this reluctance to tackle the problem politically? According to Scheper-Hughes part of the problem relates to society's perception of transplant surgery itself: “Transplant surgeons are held in very high regard. For example, in the United States, where there's a very litigious culture that has reduced the status of doctors somewhat, transplant surgeons are really 'resurrection doctors' and they are the last vestige of the doctor as Priest, Shaman or the doctor as God, in a sense. Nobody wants to question what the transplant surgeons are doing”. At the same time, transplant surgery has always raised troubling ethical questions: “Transplant surgery, since the beginning, operated in a kind of special status a little bit above the law, because to develop transplant surgery they had to break the law. Chris Barnard had to take a heart from a brain dying patient – there was no such thing as 'Brain death' at the time, so he was effectively breaking the law, in order to do the transplant. The world responded by saying that if this is what transplant surgery needs, organs from brain dead as opposed to non-heart beating cadavers, we have to redefine death to serve the needs of transplant surgery.” She continues to explain ”the Harvard protocol is how it was done, where a bunch of bio-ethicists, surgeons, religious people got together and there was really no serious resistance to the idea of brain death”. She's quick to stress that “I'm not opposed to the definition, I'm just suggesting that there's a great deal of unanimous support for the work of transplant surgeons, and that is also the case here”.
Her work has gained recognition amongst the transplant profession itself, with numerous panel discussions on the issue of trafficking springing up at all major conferences. “They're starting to take notice of the problem. The doctors are frightened. What they want to know is, is there anyway this can be done legitimately. 'Can we change the laws, and control it?' Like the drug laws or prostitution. Is the way to go, to regulate it?”. There is one country that has introduced a legal buy and sell system of organ transplantation, Iran. The evidence is far from conclusive though that by regulating the system you remove the imbalances and ethical issues. “For ten years now they've allowed the buying and selling of kidneys”, she outlines, “The problem remains who are the people who are selling? They use the same methods though they don't call them 'kidney hunters' but rather 'social workers' who go to unemployment offices, jail and the margins of society, and try to convince people that this is the way out. The Iranian government promises about $1,000 to each person who gives a kidney, and they have erased their waiting list, that's for sure. Everyone who needs a kidney in Iran gets one, which is quite an accomplishment. However, they're doing it at the expense of the most marginal people in society.” As with the unregulated, illegal system that Scheper-Hughes deals with, the majority of follow up studies and care go to the buyers. The sellers, once they have sold their organ, lose their importance. “This portion of Society are being treated as living cadavers – they're not people, they don't need to be supported. If the Government decides to go the route of regulation, well then one of the regulations has to be that you have to ensure adequate medical insurance coverage for every person who has sold a kidney, and most countries will be unwilling to do that.”