Body Parts Trade (BODY Case)

          CASE NUMBER:        323
          CASE NAME:             BODY
          CASE IDENTIFIER:    HUMAN BODY PARTS TRADE

A.   IDENTIFICATION

1.   The Issue

     Despite the great inroads medical science has made since the
Renaissance, we have not yet succeeded in reproducing human body
parts.  While the search for compatible artificial organs and other
human parts goes on, the medical art of transplant surgery has
become the most popular alternative choice.  Although transplant
surgery is saving lives, at the same time, it has created a trade
in human body parts.  Such a dubious trade stems from our innate
desire for longevity and a great pool of supply-and-demand reality
of organs.  The inevitable result is a booming international black
market of body parts that caters to rich recipients and destitute
(and sometimes helpless) donors.  More surprisingly, the biggest
participant in the trade are unscrupulous Western pharmaceutical
companies seeking to profit from marketing their latest products
that have derived from the procurement of human body parts.  The
problem raises complex ethical questions as to how far is enough in
human's efforts to strive toward longevity and whether selling
one's organ a justifiable means to fight poverty.  Lastly, equally
valid on a less philosophical level, the body parts trade
unequivocally borders on violating one of universal human rights,
i.e., the right to decide what to do with one's corpse.

2.   Description

     In advanced industrialized countries, more often than not,
transplant surgery for those who are waiting to receive an organ
can be a difficult process because there are not enough organs (or
corpses) to go around, let alone persuading willing donors.  Aside
from the fact that people in these countries lead healthy and
longer lives compared to those in poorer countries, improvements in
safety of cars and enforcement of seat-belt laws have certainly
contributed to fewer sources of organs.  Coupled with the shortage
of organs in places where the demand is high, destitute, coercion,
and greed in developing countries have created the supply base of
much needed organs; ready to be serviced for those willing to pay. 
     India probably ranks in the top among countries that are
becoming great organ bazaars of the world.  With the average
monthly income of $11 a month for an Indian worker, especially in
a background of vast destitute underclass, trade in kidneys has
boomed so rapidly that in each of the last five years 2,000 or more
kidney's have changed bodies. Moreover, of the total kidney
transplants, almost 10% are estimated to have commercial
considerations involved in "donation."  In some cities it is as
high as 95%.
     
     The players in the above kidney trade are the doctors who
usually charge $1,660 for the surgery, agents who seek out
potential donors, and the paid donors who are mostly poor watchmen,
laborers, or mechanics, and for whom the price paid for an organ
could be more than they could save in a lifetime.

     The price quoted on the open market for organs taken from live
patients is $4,425 for a cornea, $55 for a patch of skin, and
$1,000 to $2,000 for a kidney.  This figure is of course subject to
change depending on the circumstances of either the donor or the
patient.  For instance, if a donor is in an immediate need of cash,
he can be sure that he will not receive the market rate.  But if he
is in no hurry and the need is urgent, he could profit more than
$5,530.  To expand the business, these transplant surgeons are
believed to be using powerful immuno-suppressant drugs that
anesthetizes the pain.  As a result, patients, who otherwise think
twice, readily choose the transplant option.
     
     The paid donors of India might fare better when compared to
the Chinese prisoners who have their organs removed upon death. 
According to Human Rights Watch/Asia, about 2,000-3,000 organs a
year are cut from the bodies of executed (as well as not-quite-
dead) prisoners.  The transplant service is readily available to
high ranking Party officials and cash-paying foreigners.  In Hong
Kong, for instance, only 50-60 kidneys are replaced each year,
while the waiting list for transplant is around 500.  Because of
close proximity to Guangzhou and Shenzen, two of the richest cities
in China, Hong Kong residents put aside scruples for longevity.

     Organs and other body parts do not necessarily have be donated
or coerced from some unfortunate souls.  They can be stolen.  In a
German controversy involving autopsy, human body parts are smuggled
out of hospital basements by shady hospital workers and sold to
local drug companies for the extraction of growth hormones.  The
list of items on drug companies's plan does not stop there.  In an
investigative report by Der Spiegel, a liberal German newsmagazine,
drug companies also buy meninges --the membranes that surround the
brain and spinal cord -- by tens of thousands.  They are used to
make a valuable medication used in skin transplants.  Recently,
pathologists in one city began extracting muscle membranes from
corpses thighs, which is then sold to firms that market
reconstructive surgery.  Lastly, brains and other organs are
shipped to medical schools to be used by students in anatomy
classes.  The loser in all this, human market, is undoubtedly the
dead people and their loved ones who do not realize that with or
without the permission for autopsy, the parts of the deceased are
being plundered.

3.   Related Cases

     KIDNEY case
     CIGAR case
     MADCOW case

     Keyword Clusters         

     (1): Trade Product            = BODY parts
     (2): Bio-geography            = TROPical
     (3): Environmental Problem    = MORAL

4.   Draft Author:  Glenn Baek

B.   LEGAL FILTERS

5.   Discourse and Status:  AGReement and INPROGress

     In most countries there are clearly written laws prohibiting
the sale of organs.  But there are some who believe that corpse,
once in the hands of pathologists, should be used without further
discussion.  Such an issue involving a battle between ethics verses
advancement of science needs to be discussed further by
governments, medical establishments, and donors (paid or unpaid).

6.   Forum and Scope:  INDIA and UNILATeral

7.   Decision Breadth:  1

8.   Legal Standing:  LAW

     Aside from remotely related United Nations Declaration of
Human Rights, there is no legal agreements among countries that
focus on illegal flow of human body parts.  There are individual
national laws that ban the trade, but they are not vigorously
enforced, and sometimes it takes a national scandal to pass any
legislation banning the trade.  

     The Indian parliament, after procrastinating on addressing the
issue, finally cleared the Transplantation of Human Organs Bill
1993.  The bill prohibits any commercial trading in human organs
and allows the removal only for therapeutic purposes.  Anyone
convicted of supplying human organs for payment shall be imprisoned
from two to seven years.  However, in the backdrop of vast indigent
population and increasing number of organ patients, as one
prominent Indian surgeon put it, the bill would not stop the organ
trade completely.

     In Britain, it was only after the kidney-for-cash scandal in
1990 that the Parliament passed the Human Tissue Act which
prohibits the practice of purchasing kidneys or any human organ.  

     On the international level, The World Health Organization is
deeply concerned with the trade, and has urged member countries to
ban it.  But such a request by an international organization
without legal binding powers will not carry much weight.  The
United States has accused China for forcing its prisoners to donate
their organs for transplants, and has threatened economic
sanctions.  However, the decision to decouple human rights and
trade regarding China certainly sends the message that body parts
trade is not on the priority list among countries.

C.   GEOGRAPHIC FILTERS

9.   Geographic Locations

10.  Sub-National Factors:  NO

11.  Type of Habitat:  TROPical

D.   TRADE FILTERS

12.  Type of Measure:  LAW

13.  Direct vs.Indirect Impacts:   DIRect

14.  Relation of Trade Measure

15.  Trade Product Identification:  Human Organs

16.  Economic Data

17.  Impact of Trade Restriction:  Regulatory Stadnard [REGSTD]

18.  Industry Sector:  MEDICine

19.  Exporters and Importers:  INDIA and MANY

E.   ENVIRONMENT FILTERS

20.  Environmental Problem Type:  MORAL

21.  Species

     Name:          Homo Sapien
     Type:          Mammal/Primate
     Diversity:     NA

22.  Impact and Effect:  LOW and PRODuct

24.  Urgency and Lifetime: LOW and 62 years

25.  Substitute:  SYNTHetic Organs

F.   OTHER FACTORS

26.  Culture:  NO

     The ethical questions and apprehension regarding human body
trade run across the world.  In the case of India, despite being
relegated as the organ bazaar for living donors and patients, the
Indians are quite reluctant when it comes to consenting to the
removal of organs upon the death of their relatives.  In their
religious beliefs, such an act is often viewed as body mutilation,
and thus a taboo.

     In South Korea, the last bastion of Confucian traditions, it
is culturally forbidden even to cremate the body of the deceased. 
According to Confucian doctrine, one's body is considered as a
precious gift from his parents.  Alteration or removal of one's
body parts (including the topknot in the old days) was considered
unfilial.  Steeped in such a cultural heritage, the Koreans clearly
have aversion to autopsy, let alone removal of organs of the dead. 

     Confucian teachings, on the other hand, can have positive
influence on organ donations.  As one story goes in China, sixty
students in People's University of China volunteered for the bone
marrow donation upon learning that one of their respected teachers,
who has become inflicted with leukemia, faced probable death
because no one with the same tissue type could be found among her
relatives.  In traditional deference to teachers, these students
remarked, "To save our teachers life, we will willingly donate our
own bone marrow for her."

     There is one extreme example in Africa that is antithesis of
cultural examples given above.  In some parts of Nigeria human
parts are used for magical rites and other rituals.  These parts,
too, are stolen by debauched, profit-seeking individuals, and later
sold to witchdoctors or pastors who perform various kinds of
rites.

27.  Human Rights:  YES

     If this issue does not directly relate to trade and
environment, it certainly has explicit relations to human rights. 
Paid donors, surgeons who perform illegal transplant surgery,    
pathologists in hospital's basements, and profit seeking drug
companies might be left to answer ethical questions.  Yet, directly
or morally challenging them is a difficult matter.  Undoubtedly,
those willing donors fighting to climb out of poverty feel
justified in selling their own body parts.  By the same token,
although doctors of body parts trade generally agree that the fate
of the deceased is in the hands of relatives, they believe that
they should be allowed to use any body given them for autopsy
without further discussion.  Simply, they remove tissues without
reservation for the good of scientific innovations.  A board member
of Germany's professional association for pathologists summed the
profession's attitude best by saying that there "is no insult to
human worth as long as the shell of the body remains intact."

      For those Chinese prisoners, whether common criminals or
prisoners of conscience, their humans rights are unquestionably
violated.  It is reported that they are shot specifically in the
head so that their organs will remain undamaged.  Here, for those
who sell and receive organs through unscrupulous means, there is no
acceptable justification.  It is simply an inhumane act of greed. 
Any plausible explanation of such an act might be found in Chinese
cultural attitude toward human life, i.e., 'there is plenty of us
to go around.'

     There are many areas to be addressed in our effort to stem the
trade of body parts.  First, in the field of medicine, what is
needed are clear ethical guidelines that would define who has
rights to the organs after a person dies.  Second, on a domestic
level, tougher laws within the confines of national boundaries 
explicitly forbidding the transactions of body parts must be
implemented.  Lastly, on an international level, world bodies, such
as the United Nations and the World Health Organizations, should
aggressively broach the issue, ultimately merging it as part of the 
universal human rights.

27.  Trans-Boundary Issues:  NO

28.  Relevant Literature

Prakash Chandra, "Kidneys for Sale," World Press Review, Feb. 1991:
53.

Beijing Review, "Bone Marrow Donation in China,"  27 Apr.-3 May
1992:  46.
     
Der Spiegal in World Press Review, "The Body-Parts Trade,"  Apr.
1994:  38-39.

The Economist, "Of Car and Body Parts,"  3 Sept. 1994: 40.

Sanjay Kumar, "Curbing Trade in Human Organs in India," Lancet, vol
344, 2 Jul. 1994:  750.

National Public Radio, Morning Edition, "Executed Chinese Prisoners
Provide Transplant Organs," 29 Aug. 1994.

Alasdair Palmer, "Rigging the Human Market,"  The Spectator, 2 Jul.
1994: 11-13.

Paul Sieveking, "Forteana," New Statesman & Society, 4 Aug. 1994:
297.

The 1994 U.S. State Department's Annual Human Rights Report.

                           References

1.   Corpses are the only source for lungs, hearts and livers, and
for all but 8 percent of kidneys.

2.   Road traffic accidents are one of the principle sources of
corpses whose organs can be re-used:  the victims are normally
young and healthy, and die from head injuries which leave their
organs intact.  Alasdair Palmer, "Rigging the Human Market," The
Spectator, 2 July, 1994: 11-13.

3.   The actual data concerning kidney trade in India is not
readily available at the moment.  But according to the following
source, the number of kidney transplant surgery has more than
tripled since 1985.  In 1983, it was barely 50.  See Prakash
Chandra, "Kidneys for Sale,"  World Press Review, Feb. 1991: 53.

4.   Ibid.

5.   The Economist, "Of Car and Body Parts," 3 Sept. 1994: 34.

6.   World Press Review, "The Body-Parts Trade," Apr. 1994: 38-39,
originally published in Der Speigel.

7.   This story is from one of China's official magazines, Beijing
Review, "Bone Marrow Donation in China" 27 Apr.-3 May 1992: 46.

8.    To quote from Paul Sieveking, "Forteana," New Statesman &
Society, Apr. 1994: 47, "One man took a bath in the cemetery when
instructed by his pastor of his church to perform his ablutions on
a freshly dug grave to avert an impending tragedy."