Legal crackdown fails to stem sale of illegal organs

“I want to sell my kidney for money. Blood group B+. I am from Dhaka. I am in good condition,” says a classified advertisement.

Appearing on a leading online news portal in Bangladesh, it is one of many notices that find their way into the country’s media outlets. Not only are the advertisements sordid, but they are also highly illegal.

Bangladesh’s Organ Transplant Act-1999 prohibits organ transplants unless the donor is a patient’s parents, spouse, children, siblings or other blood relatives such as aunts and uncles.

But the law is routinely ignored and advertisements offering organs for sale are openly displayed. One reason is that there are always potential buyers who are willing to exploit the poor to ensure there is a steady supply of organs in the market.

Another reason is that there are never enough organs available through legitimate avenues: almost 80% of those on waiting lists end up looking in the back market.

About 20 million Bangladeshis suffer from kidney disease, an unusually high ratio of the country’s 160 million people, and about 20,000 need transplants annually, according to data from the National Institute of Kidney Diseases and Urology.

A 2017 report by Global Financial Integrity revealed that 12,000 of nearly 120,000 organ transplants conducted in Bangladesh in 2014 were illegal. Two-thirds of the illegal transplants involved kidneys, and the rest livers, hearts, lungs and pancreases.

A 2017 report revealed that 12,000 of nearly 120,000 organ transplants conducted in 2014 were illegal.

The report said an illegal kidney could be purchased for Tk 160,000 (about US $2000), well below the cost of a legal organ, even if one were available.

After being under the radar for years, the illegal organ trade in Bangladesh was exposed in 2011 when the police announced they had cracked down on a network of organ brokers in Kalai, a small town in Joypurhat district on Bangladesh’s northeastern border with India.

Police arrested a few local brokers, who told them that more than 50 people in Kalai had sold kidneys or parts of their livers. But although the police started an investigation to expose the network, they didn’t make any headway.

Most of the arrested brokers were released on parole. Abdul Latif Khan, officer-in-charge of Kalai police station, told Asia Times that his squad has a list of persons involved in the organ trade and he hopes to take action against them.

But Inspector Suman Kumar Roy, who leads investigations at the same police station, insisted the situation was far more complex.

“After the crackdown in 2011, most of the illegal surgeries moved to India. We need cooperation from the Indian police to stop this,” he said.

The detained organ traders revealed the identities of doctors who ran the illegal transplant business with them, but none was arrested.

Traders slip through legal gaps

Under pressure to stamp out the trade, the Bangladesh Parliament replaced the 1999 law with a new Transplantation of Human Organs Act on January 9 that expands the list of potential donors to include grandparents, grandchildren, and first cousins.

A fine of Tk 1 million (US $12,000) now applies, up from Tk 300,000 (US$ 3,618) in the 1999 act, but the jail term is fixed at a maximum of three years instead of three to seven years. Otherwise the revamped law is more or less the same as the old version.

As in the earlier act, body parts cannot be removed for transplant in any hospital without the government’s consent. These include kidneys, livers, bones, eyes, hearts, lungs and tissues; they can only be taken from bodies with a beating heart. Donors must be blood relatives except for eye and bone marrow transplants.

The 1999 law failed miserably to curb the illegal organ trade, and there is little optimism that its replacement will have any better impact.

Dr Monir Moniruzzaman, professor of Anthropology at Michigan State University in the US, said “the new act will not curb illegal organ trading in Bangladesh.” The trade can only be halted through “honest and hard decisions from Bangladeshi authorities”, he added.

Dr Moniruzzaman spent more than 15 years researching the exploitation of poor Bangladeshis through illegal organ trades. He is skeptical that the expanded donor list will help curtail it.

“For example, how will you verify the relationships between recipients and donors, if they claim they are ‘cousins’?” he asked.

Organ brokers use forged documents to establish that the person donating an organ is a relative of the patient, and thus bypass the law.

Research by Dr Moniruzzaman revealed that organ traders often go to great lengths to ensure a transplant goes ahead.

“I found Hiru, a 38-year-old Hindu seller, who underwent circumcision because his recipient was Muslim,” he said.

A 38-year-old Hindu seller underwent circumcision because his recipient was Muslim

Extreme poverty encourages many Bangladeshis to sell their organs, the researcher said, relating the story of Mofiz, a 43-year-old tea stall owner  on a low income, who saw an advertisement for kidney purchases several years ago. Mofiz asked a friend what a kidney was and how much money he could get from selling one.

It was an example of how some doctors skirted the law to make profits, thus helping the trade to flourish, Dr Moniruzzaman said.

Like the old act, the new law stipulates that any doctors convicted of involvement in the trade will have their registrations cancelled by the Bangladesh Medical and Dental Council.

If a hospital or clinic is found to have violated the law, its organ transplant permits are supposed to be revoked and personnel fined. Worryingly, there is no record of such penalties ever being imposed.

Dr Mostafa Jalal Mohiuddin, a lawmaker from the ruling Awami League and the President of Bangladesh Medical Association, believes the new act is a “refined version of the previous one.”

Referring to the expanded donor list, he told Asia Times: “As cases show, organs are matched with family members in only 50% of cases; it was difficult to find and match organs.”

Poverty feeds supply of organs

Dr Mohiuddin admitted that the black market trade in organs was due to an acute shortage of legal donors. “It is expected that the crisis of organs may decline as the number of donors is increased,” he said.

He said both versions of the Organ Transplant Act had empowered the authorities to take strict action, but this hadn’t happened. “(The) implementation of the act, however, is a different thing.”

While the law’s intention has been to prevent the poor from being exploited, it seems to have ended up encouraging this.