From the exclusively market-oriented 'supply and demand' perspective that is gaining ground among transplant specialists and bioethicists today, the buying and selling of kidneys is viewed as a potential solution to the global scarcity in organs and as a 'win-win' situation that benefits both parties.
The Secretary of Health of the Philippines, Dr Manuel Dayrit, had two proposals on his desk at the time of my interview with him in February 2002. The first would create a government-regulated kidney bank (to be called KIDNET) that would allow poor people to sell and deposit a kidney into a virtual 'organs bank' that would presumably make them available to all Philippine citizens who needed them. Dr Dayrit was, however, reluctant to discuss just how the Ministry of Health might set a 'fair price' for a poor person's kidney, preferring to leave this task to the free market. Dr Clemente, the director of Capitol Hospital in Manila, agreed: 'Some of our "donors" are so poor that a sack of rice is sufficient. Others want medical care for their children, and we are quite prepared to provide that for them.'
The second proposal is a government-sponsored programme to grant Death Row prisoners (most of them killers) a reprieve in exchange for donating a kidney. Their death sentence would then be replaced by life imprisonment. Supporters of this programme believe that the donor incentives programme could end up convincing society that the death penalty is a terrible waste of a healthy body.
In fact a government-regulated programme is already in place in Iran where for the past five years kidney sellers have been recruited directly from the slums and from among the homeless by a non-governmental medical self-help organization, Beniad Amuz-e Bimarihay-e Khas. Under the Iranian programme, kidney sellers are paid an officially designated pittance (about $280 each) in addition to whatever can be arranged between the donor and the recipient. The only follow-up study, conducted by an Iranian urologist, found kidney sellers reporting considerable pain, shame, anger, resentment and hatred for both the surgeons who removed their body part and the patients who received their organ.
In Moldova, where kidney selling is seen not only as a crime but as a personal affront to national pride, local police, collaborating with INTERPOL, have cracked down on some of the more notorious local kidney brokers, like Nina (see story above), who is today in hiding outside the country. Despite these positive moves, as recently as February 2002, responding to a tip from Organs Watch, Turkish health officials raided a small private hospital in a suburb of Istanbul where they found foreign patients recovering from kidney transplants with organs procured from four young men from rural Moldova, who were themselves recovering in a separate ward. The Turkish surgeon was arrested but later released when his lawyer produced signed consent forms, although none of the rural sellers could speak, understand or read a word of Turkish.
To date, the buying and selling of kidneys is yet to be recognized as a growing medical human-rights abuse. The time has come for the World Medical Association, the World Health Organization, the Council of Europe, and the governments of those countries now producing the majority of organ buyers and sellers to take concerted action.
Report from Moldova
Though Vladimir, a skinny lad with a rakish metal stud in his lip, had never been further from his village than to Moldova's small capital city of Chisinau until a few years ago, he was easily lured away with the promise of a good job at a Turkish dry cleaner's factory. Nina, a local kidney hunter, arranged his passport, visa and bus ticket to Istanbul, a bumpy 18-hour overnight ride.
Once in Istanbul, Vladimir was housed in the basement of a run-down hotel in the immigrant neighbourhood of Askary. He shared the space with several other Moldovan villagers, including a few frightened village girls barely out of high school. Nina arrived to break the news to one of the girls that her 'waitressing' job would be in a bar where 'exotic' dancing was required. Then Vladimir was told that he was wanted for more than pressing pants. He would start by selling a few pints of his blood and once a 'match' was found, he would be taken to a private hospital where he would give up his 'best' kidney for $3,000, less the cost of his travel, room and board and the fees for his 'handlers'. A few days later Vlad was told that an elderly transplant patient from Israel, who had travelled to Istanbul with his private surgeon, was matched and ready to go. When Vlad demurred, Nina arrived with her pockmarked, pistol-carrying Turkish boyfriend who said that he was quickly losing patience. 'Actually,' Vlad says ruefully, 'if I had refused to go along with them, my body minus both kidneys and who knows what else, could be floating somewhere in the Bosphorus Strait.'
Report from the Philippines
Bangon Lupa is a garbage-strewn slum built on stilt shacks over a polluted and faeces-infested stretch of the Pasig River that runs through the shantytown on its way to Manila Bay. In Bangon Lupa 'coming of age' now means that one is legally old enough to sell a kidney. But as with other coming-of-age rituals, many young men lie about their age and boast of having sold a kidney when they were as young as 16 years old. 'No-one at the hospital asks us for any documents,' they assured me. The kidney donors lied about other things as well - their names, addresses and medical histories, including their daily exposure to TB, AIDS, dengue and hepatitis, not to mention chronic skin infections and malnutrition.
So while donors are not scarce, foreign transplant patients willing to risk the operation in a Third World country are. This, despite the fact that a kidney transplant in a private hospital in Manila costs foreign patients (mostly from Japan, the Gulf States and North America) only $30,000 compared to the $200,000 charged at private clinics in Turkey, Europe and the US.
By the time they are found - if they are found at all - the bodies have been partly mummified by the sun and dry wind that sweeps across the sparse Chihuahuan desert. They have usually been dumped on the outskirts of Ciudad Juárez: a migrant-filled, industrializing border city of 1.2 million residents in Mexico just across the Rio Grande from El Paso in Texas. Scores of young women - most of them between the ages of 12 and 20 - have been raped and murdered in and around Juárez since 1993. The exact number is unknown. State investigators said in December 2002 that there had been 'only' 47, then 67 later that month. Activists and researchers put the figure between 80 and 90. Practically the only thing that state criminal investigators and women's advocates agree upon is that the rape-murders are the work of two or more serial rape-murderers that often bite off the nipples of the victims or cut away pieces of flesh in ritualistic patterns.
Claudia Ivette González Banda, aged 20, who disappeared on 10 October 2001, was one of their victims. 'When she was half-an-hour late, I knew that she was dead,' says Claudia's mother, Josefina González. 'Claudia never went out, she didn't have a boyfriend, she was quiet.' On 6 and 7 November 2001, the decomposed bodies of eight young women were found in a cotton field in Juárez. Within days, Josefina González was told by police that Claudia was among those found. However when the DNA test results came back - 10 months after they were promised - the federal government's lab tests were only able to make one positive identification. It was not of Claudia. Now, the Government has requested further 'data' from the González family. What is meant by 'data' has not been made clear.
Josefina González is a member of Nuestras Hijas de Regreso a Casa (May Our Daughters Return Home) - a group, like a growing number in Juárez, that criticizes law-enforcement authorities for their sloppy investigations and insensitivity to families wanting a resolution of the murders. Indeed, in 10 years only one person has been convicted for one of the rape-murders - and that conviction was overturned. Activist groups allege that investigators have pinned the rape-murders on nearly a dozen men as scapegoats, effectively protecting the real offenders. Because the killers still walk free, these groups believe that the perpetrators are either from the drug cartels that pay protection money to the police, from the ranks of the police, or are adult children of high-ranking politicians or the rich. Some also worry that the young women are either being mutilated by Satanists, exploited in snuff movies or used as organ donors.
The protests about this official inaction are growing. In Mexico City on 25 November last year, family members of the Juárez serial-killing victims led more than 6,000 protestors dressed in mourning through the city streets. In Juárez, a new group of victims' family members is being formed by other mothers - including Benita Monárrez, the mother of Laura Berenice Ramos Monárrez, who disappeared in September 2001. State authorities told Benita that her daughter's body had been found in the same cotton field as Claudia González Banda. However, the DNA test results have come back negative in Benita's case. Although troubled by the fact that she has buried a body she thought was her daughter's, Benita finds a positive side to what she sees as investigative incompetence. 'I now have hope that my daughter may be alive,' she says.
A grassroots peace movement in West Papua - supported by the Governor, the regional provincial assembly, the police, NGOs and religious institutions - is rapidly gaining momentum. It is a movement that is of increasing concern to the Indonesian military, whose commander for West Papua, Major-General Mahidin Simbolon, commented recently that the term 'zone of peace' is only used by separatists. Military leaders, who control the Indonesian civil administration, depend on continued conflict to maintain their positions of power.
Untold thousands1 have been jailed, tortured and summarily executed by the Indonesian military since 1963 when the Republic of Indonesia replaced the Netherlands as the colonial power in West Papua. To date, the killing has been one-sided. To name just a few incidents that have taken place in the last five years, at least 60 West Papuans were executed in Biak in July 1998, over 100 Papuan students were detained and beaten in Abepura prison in December 2000, and in the last year more than a dozen corpses have mysteriously appeared.
Given this recent state of violence and a long history of similar human-rights violations, some Papuans are understandably reluctant to accept calls for peace. On 23 December 2002 WPNews - an internet news source run by Papuan students - challenged calls for peace: 'Hey, don't you know that West Papua is a War Zone, not a Peace Zone. Go back home, ask your parents. Count how many of your people are already dead.'
With its current capacity, the West Papuan independence movement is not a military threat to the Indonesian army. The TPN/OPM (the liberation 'army' of the Free Papua Movement) have only a handful of outdated guns. Civil-society groups in West Papua are incorporating the voices of TPN/OPM leaders into the political dialogue while simultaneously convincing them to accept strategies of non-violent resistance. As a result several prominent TPN/OPM figures, such as Melkianus Awom, have made promises to lay down their weapons and continue their political struggle peacefully.
The cultural movement for peace in West Papua is more effective than other officially sanctioned peace deals. In Aceh, also home to a strong independence movement, a high-profile peace accord was signed on 9 December 2002. According to a 16 January statement by the Henry Dunant Centre, 12 civilians, three rebels and five security-force members have been killed in Aceh since then. West Papua has been comparatively calm during the same period: a series of shootouts near the border with Papua New Guinea provided the only major incidents.
Peaceful democratic process would ultimately lead to independence for West Papua, says Octovianus Mote, a Visiting Fellow at the Genocide Studies Program of Yale University. This may explain why Major-General Simbolon rejected an invitation to the Peace Conference for West Papua that took place last October. If the military loosens its stranglehold on West Papua, Indonesian civil administrators will need to make major concessions to win back the hearts of the Papuans. Peace - freedom from fear of death and intimidation - would allow Papuans to voice their political aspirations at long last. Peace is in fact a metaphor for self-determination: it will only come when West Papuans are free of Indonesian rule.
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