A human kidney is said to go for as low as US$1,800 and the transplant procedure is sometimes done in Manila hospitals by U.S.-trained doctors.

For Sale: Third World Kidneys

By Antonio D. Sison

NIJMEGEN, The Netherlands -- The pipes of a clogged hotel toilet yields the macabre. It is a human heart. How the heart got there reveals a bigger nightmare. The hotel is a front for a lucrative black market trade in human organs.

But this is London, England, not Manila, Philippines. There is no abject poverty to push human beings to sell their own organs for survival. Where does the "supply" come from? London, like a number of great First World cities, is a melting pot. When it gets to a boil, the "scum" rises to the surface. Unscrupulous traders capitalize on the misery of globalization's non-persons- illegal aliens- and offer forged passports in exchange for their kidneys and other organs. The traders then receive US$10,000 from organ traffickers, who, in turn, sell the organs to waiting patients in affluent countries.

Senay, a Turkish woman, considers literally selling a pound of flesh to survive the harsh conditions illegal immigrants have to face in a foreign country. She contemplates selling one of her kidneys in exchange for a legal identity. She believes the new identity is the last ticket to salvation available in her struggle to escape poverty and oppression.

The film is Stephen Frears' Dirty Pretty Things (Miramax Films, 2003). Revealing and unsentimental, it problematizes the ethical controversy that is the illegal trade in human organs. It has the tension-filled atmosphere of a Hollywood thriller but, it is much closer to life than that. In the case of Dirty Pretty Things, art indeed imitates life.

I find this to be true especially because I come from a country that has gained a reputation for being a clandestine source of human organs.

The Philippines, together with India, Colombia, Brazil, to name a few, is one of the known suppliers of human kidneys to First World countries like the U.S., Canada, and Great Britain. In this lopsided socioeconomic equation, the bodily integrity of the poor in the Third World is sacrificed for those with resources in the First.

The cardboard and tin-roof landscape of the slum communities of Manila sets up the subhuman conditions that push the indigent into biting the bait offered by organ traffickers. A human kidney is said to go for as low as US$1,800, and the transplant procedure is sometimes done in Manila hospitals by U.S.-trained doctors.

Nongovernmental organizations such as the PREDA (People's Recovery, Empowerment and Development Assistance) Foundation report the horrific reality that at times, poor children become defenseless victims of the illegal organ trade. Like hungry rabbits going crazy over a dangled carrot, criminals resort to kidnapping children and extracting their kidneys, eyes, and other organs for a couple of thousand dollars. That is, if the impoverished parents themselves, have not been persuaded to beat them to it.

A year ago in May 2003, Manila's legislature tightened laws governing organ donation. But precisely at the time of heightened awareness and legislative action against the illegal trade in human organs, fuel has been added to the flame, ironically, by an influential leader of the Catholic Church.

Jaime Cardinal Sin expressed his support for Kidneys for Life, a proposal by renal patients that Filipino prison inmates be allowed the option to trade their kidneys for pardons or a commuted sentence. The recently retired Archbishop of Manila, one of the key players of the 1986 "People Power" movement that disposed the dictator Ferdinand Marcos, found nothing morally objectionable about the idea of organ donation as a form of reparation for crime. While a different set of motivations factor into Kidneys for Life, it nonetheless raises contentious moral and ethical issues that have to do with human agency.

Christoph Hübenthal, professor of social ethics at the Katholieke Universiteit Nijmegen, clarifies the key question in both cases: "Can it be proved that the decision (to sell or give away organs) is made in freedom?" He adds, "It is not too difficult to see that the social situation infringes on human freedom; it is forcing them to resort to selling their own organs." The Kidneys for Life proposal never advanced because no legislator would sponsor such a bill, but the questions it raised remain.

If a survey by the research firm Pulse Asia is a reliable index of the social situation in the Philippines, it becomes easier to imagine how poverty and desperation play a big role in determining people's choices. Twenty-six percent of Manila residents thought that the country was hopeless. Thirty-one percent of the country's population wanted to migrate out of despair.

There is also a more fundamental anthropological question: What does it mean to reduce human beings to sources for harvesting body parts? Whether it be the case of the black market trade in organs or organ donation as reparation for crime, there is, inarguably, something lost in the very idea of the dignity of the human person. Drawing from philosopher Immanuel Kant, Hübenthal asserts, "the 'ethical loss' in this whole issue is that human persons, who are ends in themselves, are used simply as means."

Steven Frears' Dirty Pretty Things, in fact, had presented an analogy of this argument in cinematic language: A human heart flushed down the toilet.