About 10% of all kidney transplants are a product of transplant tourism, says the World Health Organisation. About 66,000 kidneys were transplanted in 2005, with about 6,000 of the recipients or donors travelling to a different country to evade the law. The trend is for people in developing countries to sell kidneys to richer countries, in what some bioethicists are calling "medical apartheid".

Speaking at a WHO conference last week, Dr Farhat Moazam, of Pakistan, claimed that there were villages in his country where 40 to 50% of residents have only one kidney. And the donors receive very little for their trouble. Brokers promise about US$2,500, but the donors end up with about half that amount. Recipients pay far more — between $12,000 and $20,000 for a kidney and a week in hospital. But this is still far cheaper than an operation in the US.

The background problem is the immense global shortage of organs as transplantation techniques improve. According to WHO, the 66,000 kidney transplants covered only about 10% of patients on waiting lists around the world. Dr Jeremy Chapman, of Australia, says that there is a "driving instinct for survival amongst people who face almost certain death. Their heart is failing, their kidney is failing, their liver is failing." But poor donors need cash. "The result is that in far too many communities of the world the rich prey on the poor."

For some observers, the solution is obvious: establish a market for organs: allow people to sell their organs to help others to live. This is fiercely opposed by others, who argue that body parts would turn into commercial commodities and altruistic donations would cease. The best-known critic is Nancy Scheper-Hughes, an American anthropologist who has written extensively about black markets in organs.

Coincidentally, this month the Journal of Medical Ethics featured a critique of her "mischaracterisation of the pro-market position" by a bioethicist from The College of New Jersey, James Stacey Taylor. He denies that buyers of organs think that they have a right to organs and want to preserve their lives at any cost, that transplant organs are luxury goods for the rich, and that markets are ghoulish. He contends that everyone is better off after the sale of an organ and that the transaction is not merely commercial, but virtuous. No doubt more ink will be spilled before this debate is shelved.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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