Black market kidney sales in the Phillipines

Last Friday I was part of a panel at Harvard at the National Undergraduate Bioethics Conference , at which a panel consisting of me, Frank Delmonico, and Nir Eyal, and moderated by Dan Brock, was asked to consider the question "Should willing sellers be permitted to sell body parts to willing buyers?".

Among other things, I defended the point that the performance of a potentially regulated legal market can’t be well predicted from the performance of unregulated, illegal markets. Frank largely disagrees with that, and expects that any regulation short of attempting to ban organ markets outright will inevitably deteriorate into the kinds of illegal markets we see in some parts of the developing world. Regardless, it's good to pay attention to the black and grey markets around the world. Here's an account of such a market in the Phillipines: No Turning Back. Some aspects of this market are quite black (the subject of the story is threatened with retribution if he changes his mind once medical tests have been paid for), and some are grey (quite a few medical tests are done, although perhaps not to the standard we would like), and some are not even so grey (the subject of the story is paid, and gets a motor vehicle and a house out of it, and would do it again).

"Lito, 23, a resident of Gumaca, Quezon, who sold one of his kidneys, knew the stakes just got higher when he was told before the transplant procedure that he could not back out anymore. A friend of his decided to pull-out. “They are hunting him down. They want to have him killed." ... "On February 14, 2007, the friend accompanied Lito to a house in Barangay Tikalan, a village in San Juan, Batangas where a man named “Junior” who was referred to by his men as the “manager,” housed other would-be donors.“Junior” is also an organ donor. The following day, Lito and nine others were brought to a private hospital laboratory in front of the National Kidney and Transplant Institute (NKTI) where many people were having their blood samples taken. They also underwent a number of tests. X-rays were also taken. Junior paid for the procedures. " ... "For over a month after the first tests, Lito shuttled back and forth from Batangas to Metro Manila in order to undergo various tests in different hospitals. In each of the trips, he was accompanied by either “Junior” or one of his men. The purpose, he was told, was to look for a match. ... "Back home in Gumaca, Lito found that money has a way of slipping easily between one’s fingers. In his case, it lasted only for six months. Almost half of the amount he got from selling his kidney—about P40,000—went to the payment of debts. With the rest of the money he was able to buy a tricycle and a small dwelling. Months later, however, he had to pawn the tricycle to pay for his daughter’s hospitalization. Lito does not regret going through the operation. “I was in dire straits,” he explained. If he did not go through it, he said, he would not have been able to pay his debts. Besides, he said, he did it for his family’s sake. “I am ready to give up my life, for the sake of my family.” "