Brisk Organ Trade Imperils Lives

by Gemma Bagayaua, abs-cbnNEWS.com/Newsbreak

Posted at Mar 05 2009 11:37 PM | Updated as of Mar 06 2009 07:58 AM

Brisk Organ Trade Imperils Lives 1first of two parts

Slightly after midnight on March 27, 2008 in Kasiglahan Village, a subdivision in San Jose, Rodriguez, Rizal, 27-year old Elmie Anchiola was trying to sleep on the floor of his tiny, mosquito-infested home when a figure approached him without warning and started stabbing him and his wife.

His wife Elna survived. Anchiola died of his injuries.

Their assailant, Jayson Araiz, who recently arrived from Samar and who had been living with the couple for three weeks, was in town for one reason: to sell one of his kidneys.

Anchiola, an agent who facilitates organ donation in Kasiglahan, was supposed to have helped him. After a failed interview, Araiz was declared unqualified to donate a kidney. Araiz, blinded with rage and desperation, turned on the Anchiolas.

The talk of the town for many months, the Anchiola murder highlighted a trade that has been going on in Kasiglahan and its neighboring villages for years.

Since the resettlement site was set up almost a decade ago, over a hundred residents here—women included—have had their kidneys extracted for quick bucks.

With the influx of many rich transplant patients from abroad who are willing to pay for new body spare parts, a brisk local trade in human organs has evolved that has not only led to one or possibly more heinous crimes, it is also putting the health and lives of many poor Filipinos at risk.

In most cases, the donors were assisted by entrepreneurs like Anchiola, who received commissions for referring them to the hospitals where very sick but well to do patients waited for new organs and a fresh lease in life.

Safe Procedure
Three decades ago, back in 1976, Teresita Marasigan Baesa donated one of her kidneys to her sister. The transplant operation was a success. Both Teresita, now 73, and her sister, now 65, are still alive.

Cases like that of the Marasigan are among the reasons why----whenever donors are available---doctors advice patients suffering from end-stage renal disease to resort to transplant operations.

Recipients in transplant operations---who otherwise would have to undergo regular and costly dialysis procedures---often enjoy a better quality of life after getting a new kidney.

It is generally safe for a living person to donate a kidney, says Benita Padilla, recently elected president of the Philippine Society of Nephrology. “There are many long term studies where donors did well.”

But unlike in Western settings where most living donors agree to give a part of their body to friends and relatives for altruistic reasons, material gratuity----not filial or emotional attachment to the recipient has become the primary reason motivating living individuals to donate organs.

Viral Marketing
Newsbreak talked to over a dozen individuals who “donated” their kidneys in exchange for cash in the towns of Calauag and Gumaca in Quezon Province as well as in Rodriguez (formerly known as Montalban), Rizal. We also talked to health officials and experts who are either involved in organ transplantation processes or have been observing and investigating this trade for years.

Our sources tell of cases of organ trade in different parts of the country----from Pangasinan and Northern Luzon to Davao City in Mindanao.

By various accounts, a vendor stands to earn from P110, 000 to P225, 000 from selling a kidney. What is worrisome is that the practice of selling organs is spreading like wildfire in the country. Like multi-level marketers, former donors often end up recruiting other donors for extra cash.

One can earn P2, 500 for every new donor one recruits, according to “Lito” (name changed upon request, a 23-year old donor from Gumaca, Quezon. A friend who is also an organ donor recruited Lito.

The huge amounts at stake---from P110, 000 to P225, 000 for a kidney is motivating prospective donors to lie about their health records, making the screening of organ donors more difficult and the nephrectomy operation (procedure done to extract a kidney) itself very dangerous for Filipino donors.

Earlier, Newsbreak reported on the case of 50-year old Dominador “Doming” Umandap, a resident of Calauag, Quezon, who died of heart attack months after donating.

Due to lack of access to Umandap's records, specialists are unable to determine with certainty if it was the kidney donation which triggered his heart failure. But what is clear is that, had all the medical requisites been followed, he should never have been allowed to donate at all.

The same Newsbreak report cited findings from a medical mission conducted by the Philippine Society of Nephrologists in Lopez, Quezon, where donors were found to have kidney abnormalities and hypertension.

These were early studies, according to Padilla, but the findings were not promising. It might very well mean that, years after donating, the donors themselves may eventually develop kidney disease.

Stricter Process?
Mike, a 40-year old barangay tanod was with 50 others in the room at the National Kidney and Transplant Insitute (NKTI) when he volunteered to undergo a screening process that will determine if he was qualified to donate a kidney. Most of them were not related to any potential organ beneficiary. Nor were they motivated by altruistic reasons.

Many secretly regarded the exercise as a mere transaction from which they expected to earn thousands of pesos in quick cash.

Mike, a resident of Rodriguez was earning only P1, 500 a month, barely enough to rent a room, let alone pay for food and daily expenses. With little prospects owing to lack of education and his girlfriend two months pregnant at that time with their first child, Mike mustered the courage to ask a neighbor who recently donated his kidneys for tips.

The going rate for selling a kidney, he was told, was P175, 000---enough to buy the rights to a small dwelling which at that time was around P50, 000. To donate, one can go directly to the NKTI, which holds regular seminars for would-be donors After the seminar, one fills out a form and is interviewed. Afterwards, a series of medical tests follow.

Mike attended the seminar back in April 2008. Later, during the interview, he was asked if there is a history of diabetes in his family. He told the interviewer that his grandmother had the disease when she was still alive.

This prompted the interviewer to have his blood sugar tested. “It came out high,” Mike recalled. He was rejected at that point. “Mahigpit sila,”he said, clearly very disappointed.

Mike’s experience might be proof that kidney transplant facilities are tightening up the way they screen organ donors following media reports concerning the increasingly rampant trade in human kidneys all over the country.

But our investigation shows that with so many patients waiting in line, the process of screening donors remain haphazard and suspect. Even reputable establishments in the country willingly cut corners and respected surgeons connive with syndicates acting as middlemen.

Contrary to health department regulations that stipulate that “health and health-related facilities and professionals shall not allow the trade of kidney vendors,” our investigation shows that doctors knew that money was changing hands. In a number of cases, it was the doctor that paid the donor. Interviews with donors who went through brokers also established that the doctors clearly personally knew the brokers.

From interviews with the donors themselves or persons privy to the donations of over a dozen individuals, a pattern emerged.

Donors often learned about the process from neighbors or friends who previously donated. Many went through brokers who were also typically former donors.

The more recent donors, however, went directly to the hospital---some of them ironically encouraged by television reports about the rampant trafficking in human organs.

Coercion is seldom necessary, at least in the initial stage. Widespread poverty in the country has ensured that there is no shortage of people willing to sell a body part for the right price. Oftentimes, it is the donors themselves who approached known brokers after hearing of the amounts that may be earned from the transactions.

But those who went through the brokers told Newsbreak, that after undergoing initial tests, they were required to stay in the quarters provided by the middlemen until the time of the operation.

There is no turning back at this point, Lito a 23-year old organ vendor from Gumaca,Quezon was told. Nobody is allowed to “escape” or change his mind. The reason given was that the brokers had to shoulder the costs of the initial tests and would lose their investment if the donor backs out.

Lito donated his kidney to a Japanese patient at St. Luke’s hospital in 2007.

Since each hospital keeps its own registry of patients waiting for donors, an agent may have to take one donor to different hospitals to find a matching recipient.

A new set of check-ups is done at each of hospitals. If, at any of the check-ups, it is found that the potential donor has an existing ailment that can disqualify him from donating, the broker shoulders the cost of “nursing” the individual back to health so that he will qualify in the future. Those with high-blood pressure may be given the medicines for hypertension.

Lax Screening process
Health regulations also require each facility engaged in kidney transplants to have an ethics committee which shall be “primarily responsible for resolving ethical issues and concerns relating to the act or process of donation.”

But by some accounts, the ethics committees in hospitals often tend to be nothing more than rubber stamps in the screening process.

Oftentimes, they only get to interview the donor a couple of days before the operation, a doctor who sits in the ethics committee of one Mindanao-based transplant facility told Newsbreak.

The source even threatened not to approve the transplant operation if the committee is not given the two-week grace period. “But their alibi is that the patient already needs it (the operation).”

All the ethics committee can do, the source said, is ensure that the doctors understand the process and that they were not coerced and or motivated by a debt of gratitude to the patient.

Hospitals have also been remiss in verifying the validity of medical and personal data given to them by donors. There were no procedures in place to establish true names, ages and addresses of donors.

As a result, attempts to conduct research on the health and other situation of the donors failed because of incomplete donor registries. A study led by Benita Padilla of the Philippine Society for Nephrology, for instance, noted that in some cases, 10 donors would give the same address.

Ages were also not verified properly, according to a hospital source, thus, there is a strong possibility of underage donors slipping through the screening process, according to Amihan Abueva, Regional Coordinator of Asia ACTs, a non-government organization which is involved in fighting trafficking in children.

Inadequate Long-term Care
Many Filipinos forced by poverty to sell their body parts cannot afford the standard of living and medical care needed to maintain one kidney, Newsbreak learned.

Teresita Marasigan attributes having remained healthy and active decades after donating a kidney to the proper medical care she has received all these years. “If you only have one kidney left, you just can’t eat or take anything,”Teresita explained. Oil and salty foods are particularly forbidden. One also cannot simply take over-the-counter medications without consulting a doctor.

The Marasigans are fairly well off. Three years after she donated her kidney, Teresita was able to migrate to the United States where---thanks to her health insurance----she was able to get regular quarterly check-ups.

Aware that she was a kidney donor, Teresita’s doctor monitored all medicines she took to guard against any side effects on her remaining kidney. And now that she is older, Teresita takes maintenance medicine on a daily basis to prevent kidney infections.

As in Teresita’s case, doctors usually advice donors to undergo regular medical check-ups. This is because there is no telling who will develop hypertension or diabetes in the future, Padilla said.

With only one kidney remaining, a donor has to be doubly on guard against such diseases, Roland Tiong Eng, a doctor at the Health Center of Gumaca, Quezon said. “Once you are hypertensive, you have to take care of all your organs because if your organs fail, your hypertension can worsen.”

All of the donors interviewed by Newsbreak in Quezon Province reported that they did not go back to their doctors for follow-up check-ups.

In most cases, the check-ups are free. What the donors cannot afford is the fare to Metro Manila, where most of the transplant centers are. The typical fare by bus from Calauag, Quezon to Cubao, Quezon City is almost P200 for a one way trip that takes over five hours. One still needs additional pocket money for food and in-city transportation going to the hospitals.

Typical of most organ donors, Lito and his family managed to enjoy tasty food only until a few months after he donated his kidney in 2007. But the money is long-gone. Now, his family is back to their usual fare of salty dried fish. “The money only lasted six months.”

“The very reason, you donated is because you are poor. How can you be expected to lead healthy life? Naturally, you can’t afford to eat healthy food,” says Gloria Cabangon, municipal administrator of Gumaca, one of the towns in Quezon Province where Newsbreak found many organ donors. – with research assistance from Anna Bueno

To be continued on Friday, March 6:
Part II - Organ trade continues despite ban on transplantation to foreigners