91´«Ã½

Artist Credit: Paula Yaniz Macia ’28, 91´«Ã½

In 2013, 121,272 Americans were on the waitlist for an organ transplant, yet only 14,257 people donated their organs (Wright 2015). This massive gap between organs needed and organs donated leads to the economic exploitation of those in poverty around the globe. In the village of Jamdi, located in Nepal’s Kidney Valley, 13-year-old Shuddhata begged her dad not to sell his kidney as her uncle had done a few years ago. She knows “it is because of poverty. No one does such a thing if not in dire need” (Warsi 2023). In this same village, “every other home has at least one person who has sold their kidney in the past due to financial need” (Warsi 2023). Organ trafficking is a dire issue that occurs mainly amongst the global poor due to desperation, exploitation, lack of education, lack of protection, and the large demand for organs worldwide. As the organ business grows, questions on its ethicality increase, along with calls for protecting those most affected. Understanding and addressing this underground issue and its ethicality is important because its impact is widespread and variable—affecting people physically, mentally, and financially. 

Organ trafficking is a lucrative, illegal business. With such high organ demand worldwide, especially for the kidney and liver, it is speculated to be worth over $1.7 billion (Nebe and Shemang 2024). When compared to the drug and human trafficking businesses, which are worth between $426 billion to $652 billion and $150.2 billion respectively, the organ trafficking business might seem miniscule; however, the illegal organ trade is direr (Transnational Crime 2025). About 12,000 transplants are illegal, accounting for 10% of all transplants yearly, but these crimes are hard to track because they happen “within a network of legitimate medical settings with legally certified medical professionals” (Maginn 2023). 

With such legitimate networks for the illegal organ trade, a key question arises: How does organ trafficking target low-income individuals? One video documenting an organ trafficker—often called a broker—follows his process and methods of manipulating financially challenged individuals. In the video, the broker approaches these individuals and offers them an “easy solution” to their money troubles by giving one kidney—which they do not need—for $5,000. Later, he tells the interviewer that “he’s not a demon or anything” but truly believes he is helping people by convincing them to sell their organs. However, in most cases, poverty-stricken individuals selling their organs end up suffering from debilitating health issues (Organ Trafficker 2023). The illegal surgeries leave them with large, unnecessary, and painful 15-to-20-inch scars that would not be there if the brokers or recipients paid $200 more for a less invasive surgery (Wynne 2012). undergraduate 91´«Ã½ who both contribute to the journal and help produce it are dedicated to fostering exciting intellectual exchange, creative engagement, and critical thinking outside the classroom. We invite you to pore through the images and words of this new edition. We hope they inspire you to consider new possibilities and solutions within these ethical debates.

Exploiting Poverty

Every individual has capabilities—things they can do or be — and functionings —beings and doings that have been realized. The capability approach stems from the claim that people’s well-being should be understood regarding their capabilities and functionings. Furthermore, a person’s ability to convert their capabilities into functionings. (Robeyns and Byskov 2023; Narayan 2024). With choices like that, it is no wonder that those living in poverty fall prey to the deceptive lull of brokers: It appears to be their only way out of a dire situation. 

According to Nussbaum, tragic choice implies sacrificing one of the ten capabilities every person is entitled to: life, bodily health and integrity, senses, imagination and thought, emotions, practical reason, affiliation, other species, play, and control over one’s environment. Nussbaum believes that having all ten central capabilities is essential for all humans to live a dignified life. The Kenyatta National Hospital, located in Nairobi, Kenya, had to put out a notice on Facebook that read “We Don’t Buy Kidneys!” because they had received multiple queries of “How much for my kidney?” (Nebe and Shemang 2024). Individuals who participate in organ trafficking must make a tragic choice—a choice often driven by desperation. This desperation is what organ brokers exploit.

When 23-year-old rickshaw puller Mehedi Hasan sold part of his liver to a wealthy recipient, he did not even know what a liver was; he just needed the money (Growing Market n.d.) Many of the poverty-stricken people who have sold their organs, especially in Third World countries, are being exploited in this same manner. They willingly sell their organs to brokers in exchange for promised financial gain they usually do not receive. Most organ donors receive less than 10% of the value they were promised due to exploitation by brokers (Leonard 2021). This situation is terribly unjust because kidney recipients can pay over $150,000, while donors are offered no more than $6,000 in every case, with the remaining money going to the broker and other parties involved (Nebe and Shemang 2024). In fact, in a study by Moniruzzaman, an assistant professor in anthropology at Michigan State University, 81% of sellers did not receive the money they were promised (Wynne 2012). Mehedi Hasan, like many others, received only part of the money he was promised and is now too sick to work, walk, or breathe properly (Growing Market n.d.).

One of the things the brokers exploit is the lack of education prevalent among individuals experiencing poverty. Brokers tell vulnerable and uneducated communities the story of the sleeping kidney: “One kidney sleeps, the other kidney works, so people do not need two kidneys. Doctors turn on the sleeping kidneys and extract the old kidney and give it to the recipient” (Wynne 2012). Others say they were told that their organ would regrow, and they do not need it at all (At the Nexus n.d.). Additionally, brokers take advantage of donors’ lack of knowledge by recruiting them through deceptive advertisements. One researcher collected over 1,200 newspaper ads with false promises to potential organ sellers such as visas, vacations, jobs, and citizenship in North America or Europe (Growing Market n.d.).

The question then is, how does this deceptive information spread to the point where a whole region of Nepal is referred to as the Kidney Valley? Through survival networks: “Any time an individual interacts with an acquaintance in an organization, that acquaintance may introduce the individual to others” (Small and Gose n.d.). Although most low-income people are ashamed to have resorted to selling an organ to pay their debts or buy food, word gets around about this method of financial gain, resulting in more people becoming connected to the brokers. Furthermore, most donors in Kenya eventually become recruiters, trying to encourage other young men to sell their kidneys for the lucrative organ trafficking business (Nebe and Shemang 2024). The situation is even worse for those experiencing poverty: “poorer people living in high-poverty neighborhoods have smaller nonkin networks and are more likely to be isolated” (Small and Gose n.d.). Because their network is so limited, they are unable to find out other less invasive and life-changing methods for financial assistance. This lack of networks occurs not only in the Kidney Valley but in developed regions as well. Some people who found their way to the US for the American Dream also find themselves in the hands of an untrustworthy broker who offers them an “easy solution” to their life issues (Organ Trafficker 2023).

Addressing the Problem

One way to reduce the number of poverty-stricken individuals falling prey to the illegal organ trade is to give them the asset of “organizational ability”: the ability to get their voices heard and interests represented through strong networks and organizations (Narayan 2024). Another important thing to do is to increase their knowledge through education. Education is important to ensure that fewer people believe in the deception of organ brokers. Shuddhata firmly believes education is the key to transforming the Kidney Valley: She said, “I think what we need is education. Please help us with education, build schools for us, create jobs for us. So, no one has to be so helpless that they sell their kidney” (Warsi 2023).

An ethically questionable yet simple solution to the illegal organ trade is to legalize it. Often, low-income individuals selling their organs have no idea about the implications or are sometimes coerced into selling. These situations are in direct violation of the principles of Biomedical Ethics–especially the principle of autonomy (Page 2012). For individuals to make medical decisions autonomously, they must be fully informed, comprehend what will happen to them, and participate voluntarily (Page 2012). Proponents of organ trade legalization claim that it would benefit the vulnerable communities that are being harmed by the illegal trade (Ambagtsheer 2017). Among those who sell their kidneys, their stories are generally the same: they do not know the risks involved, they do not get screened, they do not receive proper medical aftercare, they receive much less than the agreed price or nothing at all, and because they are ashamed and fear being convicted of having done something illegal, they do not seek help. Not only do the donors suffer, but the patients are victims too: they often return home with grave medical complications (Ambagtsheer 2017). Mehedi Hasan’s recipient died soon after receiving part of Hasan’s liver (Growing Market n.d.).

Opponents of legalization include the World Health Organization, which banned organ trafficking in 1987 (Leonard 2021). WHO stated, “Payment for cells, tissues, and organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation, and leads to profiteering and human trafficking. Such payment conveys the idea that some persons lack dignity, that they are mere objects to be used by others” (Leonard 2021). Both sides bring up extremely valid points. By legalizing the organ trade, those who choose to sell their organs will most likely do it out of financial need. However, the advantages are they would receive proper medical care and aftercare, full compensation for their organ, and be thoroughly informed about the risks of the procedure they would be undergoing. As a society, ignoring the organ trade business and pretending it does not exist harms impoverished and vulnerable communities around the globe. Legalizing the trade would allow for monitoring and protecting those communities in a way that does not. After all, poverty-stricken individuals will continue to be prey for brokers as there is a large demand for organs worldwide.

Ethical Considerations

This then raises the ethical question of whether organs should be bought and sold. In a heated conversation among experts (Abdul, Matthew, Ryan, Nicole, Ellie, Ericka, Alex, Emily), both sides of the argument were debated. Some asked, how free and dignified is the choice a person makes to sell their organs when made from a point of desperate poverty (The Body Market 2018). When a person is forced to make a tragic choice that involves giving up one of their organs, they are sacrificing multiple capabilities, including but not limited to bodily health and bodily integrity. As mentioned earlier, some people who sell their organs on the market are coerced into doing so without knowing the full truth behind the trade. Therefore, in many of these cases, bodily health and integrity are sacrificed because they receive harmful, underhanded surgeries.

In reply, those in favor of legalization argue that people have control over their bodies, and it respects people’s dignity by giving them the choice to make their own decisions (The Body Market 2018). It is on this level of examination where the balance between well-being and free will in the ethical debate comes into play. Caring for human beings’ health and well-being by banning the organ business is reasonable considering the risks, though extremely low, that comes with being a living donor: the possibility of hypertension, diabetes, and the less than 1% chance of having the remaining kidney fail (Long-Term Risks n.d.). However, well-being must be balanced with free will. If someone chooses to sell their organ for money, as people do with blood or tissues, why limit their freedom and personal agency? Unfortunately, if the organ trade business is made legal, there would be a largely disproportionate number of impoverished people donating their organs for the monetary benefits, leading to whole populations with overall decreased health. However, since illegal organ brokers already target impoverished individuals, proponents believe the legal organ business would better protect vulnerable communities (The Body Market 2018).  Legalization would involve proper medical screening, knowledge of the procedure, proper aftercare, and other resources for both the donor and recipient. As it currently lies, communities hurt by the illegal organ business receive low payment for their organs and leave the surgery table with more problems than they arrived with.

Opponents of legalization argued that the sale of organs would undermine altruistic donations, while proponents of legalization countered that such donations do not currently meet the organ demand, and—from a utilitarian point of view—legalization would benefit most people. Yet, we are unsure as to whether legalizing the organ trade would increase or decrease the supply of organs; for example, Swiss residents were asked if they would agree to a nuclear reactor being placed near their homes. “Consent to this nuclear reactor was greater before a monetary reward was offered than afterwards” (Nass n.d.).

Opponents of legalization also say that once legalized, there would not be a fair distribution of organs because it would depend on the ability to pay (The Body Market 2018). However, questions arise on the fairness of the current system of sharing organs for those on the transplant list: because of the large gap between demand and supply, people face difficulty getting a transplant, if they are even able to get access to a transplant center. Additionally, a lot of people are rejected from the list based on their lifestyle or personal characteristics like age, criminal history, health history, history of substance abuse, and others (Caplan 2014). Because of this, public confidence in the equity of the system is down as they believe “the allocation of organs is based on bias, prejudice, favoritism, greed, geography, or ability to command publicity” (Caplan 2014).

To resolve this in a situation where the organ business is legal, a third party, whether a government agency or another, should be involved in the distribution of organs (The Body Market 2018). A third party would be responsible for matching up patients and being a moderator for organ negotiation. This third party can be an insurance company, as “insurance typically covers all medical services related to your organ donation” (Living-Donor Transplant n.d.). Having the insurance company act as the middlemen in the organ transplant process would be the easiest implementation as insurance companies are already involved in the health system and processes. However, a less involved party could be a non-profit organization that is responsible for matching up donors and recipients based on a multitude of factors to aid negotiation.

Iran

Currently, only one country has legalized the organ trade: Iran. Iran has eliminated their kidney transplant waitlist since it implemented a government-regulated system in 1988, where living donors receive financial compensation for donating a kidney. Iran legalized the sale of organs mainly due to the increasing number of people in end-stage kidney failure and the strain this put on the country’s dialysis resources (Major 2008). In Iran, 76% of kidneys come from living donors (strangers) compared to the US, where 65% of transplanted kidneys are from deceased donors. In a study done on Iran’s transplant system, it was found that “84% of donors were poor, 79% of donors were uninsured, only 30% were employed full time, and only 6% were either at university or had a degree” (Griffin 2007). In addition to this, 95% of donors expressed satisfaction with their donation at the time of discharge. However, a follow-up study, 6 - 132 months after donation, found that 76% of donors thought kidney sales should be banned (Griffin 2007). Opinions are mixed on Iran’s organized transplantation system, but one thing is sure: “the poor remain poor but with one less kidney”; however, they are healthy because Iran offers one free year of healthcare following the transplant (Griffin 2007).

Alternative Solutions

Other solutions are to increase economic assistance for people experiencing poverty so they might not have to sell their organs. Perhaps to curb the organ trafficking business, the government could offer a benefit (cash, free healthcare, food assistance) if they sign an agreement not to sell their organs. Additionally, countries should also implement a country-wide cadaveric donation option. Bangladesh currently does not have a system where, if a person dies, they can donate their organs. Meanwhile, in Spain, every person is entered into the system to donate their organs upon death, and people can opt-out if they wish (Growing Market n.d.). Systems like this can increase the number of organs that can be used from dead donors. Awareness for altruistic donations can also be increased: if people know how much they can impact someone’s life with one kidney, they can be encouraged but not forced.

Conclusion

There is a strong correlation between people who sell their organs and their socioeconomic status. By investigating the ethicality of the current organ transplant system, and the ethicality of an organ trade business, we look out for the wellbeing, autonomy, and dignity of the globally impoverished and vulnerable communities, so that they do not have to resort to illegal and harmful methods. Rather, they can control how they live and die by making their own decisions.