Human Nature: Science, Technology, and Life.

Selling Organs in the Recession

Will the global recession push more people to sell their organs? Apparently, the answer is yes.

Here's the question as I posed it two months ago:

You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings. ... The next question is whether money can persuade you to donate not just a body product, but a body part.

And here's an initial answer, courtesy of Agence France Presse:

The economic crisis has forced dozens of "desperate" people in Spain to put their organs up for sale on the Internet, a consumers association said Tuesday. The association, FACUA, told Spanish authorities it has detected "31 announcements of organ sales" on 13 Internet sites by Spaniards and Latin American immigrants. "These are offers of kidneys, lungs and bone marrow, by persons who say they are going through economic difficulties and asking for sums ranging from 15,000 to one million euros (19,000 to 1.3 million dollars)," FACUA said.

The trend is all too logical: As the recession takes away the external assets of more and more people, they'll be forced to sell what's left.

Surrogacy and the State

Is the global market in womb rentals out of control? Does it need regulation?

I wondered about that three weeks ago when I saw this Reuters story: "Poverty Makes Surrogates of Indian Women in Gujarat." The $4,000 to $8,000 paid to successful surrogates in India is "a huge sum of money in a country where many live on less than $2 a day," Rina Chandran reported. But compared with U.S. rates, it's cheap. That's why foreigners have begun

to flock to [Nayna] Patel's clinic, drawn by the lower costs, relaxed attitude toward surrogates and lack of legislation. A draft bill on surrogacy is pending before parliament, and meanwhile, hundreds of clinics have mushroomed across the country, with critics saying touts promoting this "reproductive tourism" care little for the health or rights of the surrogates. ... Patel has a list of nearly 200 [would-be surrogates] and is seeing more women walk in everyday because they are feeling the pinch of the slowdown.

And yet, Chandran noted, Patel "draws the line at gay couples."

Cheap reproductive labor for wealthy foreigners, but no gay parents allowed? For the usual incoherent combination of lefty reasons—not enough private discrimination in working conditions, too much private discrimination in family values—I felt the urge to support regulation of the industry.

Then, yesterday, Reuters published another investigation of overseas surrogacy conditions, this time in China. "With China's rising affluence, increasing numbers of infertile couples have been seeking surrogate mothers," James Pomfret reported. "Surrogacy agencies have been recruiting girls, often from poor villages, to have babies on behalf of prospective parents."

Should the government do something about this? Actually, authorities are already on the case:

In the southern Chinese city of Guangzhou, three young surrogate first-time mothers were discovered by authorities hiding in a communal flat. Soon afterwards, district family planning and security officers broke into the flat, bundled them into a van and drove them to a district hospital where they were manhandled into a maternity ward, the mothers recounted to Reuters. "I was crying 'I don't want to do this'," said a young woman called Xiao Hong, who was pregnant with four-month-old twins. "But they still dragged me in and injected my belly with a needle," the 20-year-old told Reuters. ... Another of the surrogates, who said she'd come from a village in Sichuan province, recounted how officers made her take pills then surgically removed her three-month-old fetus while she was unconscious.

This isn't the kind of policing liberals have in mind when they call for tighter regulation of the fertility industry. But the tricky thing about official intervention is that once the state gets its foot in the door, you don't necessarily get to dictate what it can and can't do.

Every time the global market in human body parts and rentals looks ugly enough to regulate, I'm reminded how much uglier things can get when the government steps in.

Organ Rewards

If financial incentives for donating a kidney are wrong, what about financial rewards?

Frances Kissling offers that idea in a beautiful piece at Salon. She writes:

Appropriate concern for the international organ trafficking problem ... has so distorted the concept of altruism and eroded the principle of mutual respect that potential kidney donors are denied the basic safety net that a just and giving society should provide people who offer to risk their own lives to save the lives of others. ... [W]e financially abandon the donor almost immediately after we take their kidney. There is no provision for comprehensive long-term health insurance for donors, or for life and disability insurance. Opponents of any form of compensation or benefit to donors beyond costs directly attributable to the transplant itself fight efforts to provide these benefits.

What worries compensation opponents is that such benefits, framed as incentives to increase the organ supply, will economically coerce poor people to surrender body parts. But what if we don't frame the benefits as incentives? What if we present them, in Kissling's words, as what "a just and giving society should provide [to] people who offer to risk their own lives to save the lives of others"? And could we make this difference real, not just a matter of spin, by designing the reward system without regard to its effect on the organ supply?

Kissling argues that we should

treat potential donors with the same generous spirit with which they have offered their kidneys. No donor should spend a single dollar in the process of giving an organ. And donors should have the safety net they need to stay healthy, to support their family if they cannot work and life insurance should they die. ... One member of Congress who gets it is Arlen Specter, who is circulating the Organ Trafficking Prohibition Act of 2009. The bill increases the penalties for really buying and selling organs, but makes clear that state and federal government can provide the kind of benefits donors deserve without going to jail. Anyone disagree?

Well? Do you?

Creativity and Body Parts

Drawn by payments of up to $10,000, an increasing number of women are offering to sell their eggs at U.S. fertility clinics as a way to make money amid the financial crisis. ... The Center for Egg Options in Illinois has seen a 40 percent increase in egg donor inquiries since the start of 2008. New York City's Northeast Assisted Fertility Group said interest had doubled and the Colorado Center for Reproductive Medicine said it had received 10 percent more inquiries.

One clinic's egg donation manager explains that the bad economy "encourages women to find creative ways to make money." It's an interesting use of the word creative. In this case, two kinds of creativity seem to be involved. One is the invention of egg donation in the first place. Selling eggs was impossible until doctors learned how to extract, preserve, fertilize, and transfer them for successful implantation. These breakthroughs made eggs transferrable and commercially valuable.

The second kind of creativity goes hand in hand with the first. You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings.

Economics clearly drives the donation market. Two years ago, Reuters notes, a study found that the average payment to an egg donor in the United States was $4,216. But the average sperm donor in New York City gets only $60 per deposit. And sperm banks, unlike egg donation programs, are reporting no recent increase in donations. The money's not good enough.

The next question is whether money can persuade you to donate not just a body product, but a body part. In principle, half the world's kidneys are expendable. People are already buying and selling them on the global market, regardless of laws. Some reformers are proposing to replace this black market with a regulated system of incentives ranging from $15,000 to $40,000. If $5,000 is enough to make people think creatively about donating their eggs, $15,000 might well be enough to do the same for kidneys.

Seven Ways To Sell Your Body

As economies around the world continue to shrink, how many people will start thinking about selling their bodies?

Two years ago, the global market in human flesh looked like a humanitarian issue. It was a problem for those poor people in developing countries, not for us. But global capitalism doesn't care what color your skin is, as long as you've got some to sell and you need the cash. And, increasingly, people need the cash.

The idea starts with superficial rentals. Last month, according to the New York Times,

FeelUnique.com, an online beauty products store, paid 10 men and women to apply temporary tattoos with the company's Web address on their eyelids and then wink at strangers. Chosen randomly from more than 6,000 who applied online, participants were paid 100 pounds (about $149) to wink at people 1,000 times, or 10 pence a wink, an allusion to pay-per-view Web advertising.

Harmless, right? So let's move around to the back of the head. Thirty people have hired themselves out to Air New Zealand as "cranial billboards," the Times reports. "For shaving their noggins and displaying the ad copy for two weeks in November, they received either a round-trip ticket to New Zealand (worth about $1,200) or $777 in cash."

A bit tacky, but who are we to judge? They need the money. And if people are willing to wear temporary tattoos for pay, why not permanent ones?

Since 2005, Dunlop Tires has hired tattoo artists to work at its booth at the annual Specialty Equipment Market Association show in Las Vegas, geared to motorists who modify cars. Volunteers who agree to be permanently tattooed—either with Dunlop's logo or its trademarked tire tread—while onlookers gawk receive a set of tires worth $500 to $1,000, said Jim Davis, a Dunlop spokesman. About 200 people have been tattooed so far.

If it's OK to sell permanent advertising on your skin, it's hard to see why we outlaw temporary prostitution, especially in view of current financial pressures:

Signs of the economic free fall have cropped up in many of Nevada's 25 or so legal brothels. The Mustang Ranch, for example, has a steady stream of customers, but the number of women vying for work has soared.

Should women who resort to this line of work in other states continue to be arrested? Do you have some other employment opportunity to offer them?

And if extra cash to women who need it is a good thing, what about the increasing use of undeveloped countries as testing grounds for drugs not yet approved in the West? According to an article in the New England Journal Medicine, "Pharmaceutical and device companies can realize substantial cost savings by conducting trials in developing countries, so they are increasingly moving phase 2 and phase 3 trials to places such as India and South America." In these countries,

There may be a relative lack of understanding of both the investigational nature of therapeutic products and the use of placebo groups. In some places, financial compensation for research participation may exceed participants' annual wages, and participation in a clinical trial may provide the only access to care for persons with the condition under study. Standards of health care in developing countries may also allow ethically problematic study designs or trials that would not be allowed in wealthier countries. In one study, only 56% of the 670 researchers surveyed in developing countries reported that their research had been reviewed by a local institutional review board or health ministry. In another study, 90% of published clinical trials conducted in China in 2004 did not report ethical review of the protocol and only 18% adequately discussed informed consent.

So, the standards overseas are lower, and the people recruited to test the drugs have fewer choices. But isn't that how capitalism works? Aren't these people getting value in exchange for supplying their bodies at lower cost? As Ezekiel Emanuel, chairman of bioethics at the National Institutes of Health Clinical Center, puts it: "More places outside the United States are participating in research—is that a bad thing?"

And what about the sale of human eggs, sperm, and surrogacy? Driven by the recession, women are lining up to sell their eggs and rent out their wombs. It's fully legal. Do you want to stop them or their clients? Do you think you can?

If it's OK to sell your eggs and skin—and to rent out your body for pregnancy or drug testing—why not let people sell expendable organs? Thanks to the progress and spread of transplant technology, every healthy person with two good kidneys or a splittable liver now has a fungible asset. Earlier this month, for instance, the Asahi Shimbun reported:

Amid the serious shortage of available organs in Japan, a nonprofit organization admitted to helping 17 Japanese receive transplants in China even after Beijing banned such operations for foreigners in 2007. A deputy chief of the NPO [said] the group paid doctors in China, in addition to treatment costs, for the kidney and liver transplants there. ... Cases have already emerged of Japanese traveling to Southeast Asia for new organs.

I'm not saying all of these practices are acceptable or unacceptable. Some are more worrisome than others. But they're all happening, and they're all being driven by money. And as the recession takes away the external assets of more and more people, we're going to face increasingly difficult questions about letting them sell what's left.