First I would like to say thank you to the Federation for giving me the opportunity to share with you my views on the buying and selling of kidneys. Now I don’t claim to be expert on the subject, I’m just a patient and I just came to tell you the way I see it.

The buying and selling of kidneys is a highly complex and emotive topic. Now when I speak to people about it, their views is often a reaction of revulsion and there is no professional association that is in support of it. There still remains a lot of hypocrisy surrounding it. Currently the surgeon, the medical team and nurses are paid. The transplant coordinators do not go without remuneration and the recipient receives an important benefit in kind. The only person who doesn’t receive a reward is the donor. They are ones who have to undergo the operation. In light of the increasing disparity between the numbers of people awaiting kidney transplants and the number of kidneys available, I feel it is time to re-open the discussions surrounding the buying and selling of kidneys. If we are to deny treatment to the suffering and dying it needs to have better reasons than our own feelings of natural disgust.

So let's look at the current situation. Although illegal, the practice of buying and selling of kidneys is rife, we only have to look on the Internet to see that. The voluntary health association of India estimates that more than 2000 people sell their organs each year. People openly advertise their organs for sale in Brazilian newspapers and a recent European report found that the trafficking of organs in the Eastern Block was well organised. Other countries that have been associated with the buying and selling of organs include Moldova, Turkey, Israel, the Philippines, and China, South Africa, Palestine and Peru. Despite being illegal there have been no successful prosecutions for the buying and selling of organs.

So it appears to me there are many problems associated with the current situation; donors who sell their kidneys tend to be among the poorest in the world. Often they receive as little as one tenth of what the recipient actually pays. They often lie about their previous medical history and once donated receive little in the way of follow up medically. Then there are the brokers; there is a direct link between transplant tourism and organised crime. With the middle men pocketing large sums of money and finally under the current system if something goes wrong during surgery or with the financial transaction turns out to be a scam, neither the donor nor the recipient has any legal recourse.

Now it has been well documented today that the chronic shortage of organs is increasing the length of wait for a transplant; we reckon it is about three years at the moment and experts tipping it has increased to 10 years by 2010, hence the situation for me and a lot of you out there will only get worse not better and I can just see more and more people being forced to opt for illegal transplants.

So what should we do about it? I see we have three choices. Firstly we do nothing. Well this isn’t really an option is it? It continues to allow the poor to be exploited for their organs and the sick to be exploited, as they are in desperate need of a transplant. We ban it completely! We are doing that now and isn’t really working is it? It’s a little naïve to think that we can start enforcing it now that the trade is well established and it can also be argued that the banning of organ sales robs the sellers who are often the poor of a rare opportunity to escape poverty and makes the range of options open to them even less. Trying to end exploitation by prohibition will be like trying to end slum dwelling by bulldozing the slums. It only makes it worse for the victims.

Now I’m not really sure that I want to ban the selling of organs. Early this year my Mum donated one of her kidneys to me and I was really grateful for that, it actually gives me opportunities and a decent quality of life. Now I don’t know if I would have been any more grateful for that gift if she had actually been paid for it or if I had actually given her some money for it. Surely it is the same risk for paid vendors as it is for unpaid donors? The exchange of money cannot in itself turn an acceptable risk into an unacceptable one. It is also been quite acceptable by my Mum to donate me a kidney to improve my quality of life, but somehow doesn’t seem quite acceptable for her to donate a kidney to be paid for me to be paid to have a life-saving operation if I needed it. If the rich are doing endangered sports for pleasure or dangerous jobs for higher pay, I find it difficult to see why the poor who take the lesser risk of selling kidneys for the greater rewards for getting paid to save them from poverty and debt should be thought of as misguided. The only way I see to improve matters is to lessen poverty and until organ selling no longer seems to be the best option. If that could be achieved then prohibition would no longer be relevant. No one would want to sell his or her organs.

Finally. I see a third option - a Government regulated programme. This would enable vendors to sell and deposit a kidney into a virtual organ bank. Efforts could be made to ensure that informed consent was given and sellers would be reasonably compensated for their time and risk. There would be regulated testing of donor kidneys and the provenance would be known. Counselling and financial advice could also be given. This would prevent exploitation of the poor and prevent the brokers and organised crime from profiting. Such a system would have to have built into it safeguards against the wrong exploitation and show concern for the vulnerable and also taking into account consideration of justice and equity. There could be a way of separating the treatment and payment and not necessarily making it payment from the recipient. What about the money that is being freed up from getting people off dialysis? We have seen this costing £30,000 a year so could we not use some of that money to be re-directed? It could be even a way of making it funded for the people. Kidneys could be distributed according to some fair conception of medical priority and there would be no direct sales or purchases and no exploitation of low-income countries and their populations. A regulatory system would allow vendors to receive adequate after care and allow things like malpractice suits which would help safeguard the process.

Now I don’t claim to have all the answers. All I know is that the wait for kidney transplant is going to get longer and not shorter and the current situation we see ourselves in is unacceptable for both vendor and recipient. Therefore I think it is time that we re-opened the discussion on the buying and selling of kidneys. Thank you.

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