Exploring the Gray Area in Organ Trafficking

Kimberly Leonard
November 11, 2013

Raul Fain was dying of kidney failure, and doctors told him he would have to wait 12 years to receive a transplant in his home country of Canada. Desperate, he turned to an international organ trafficking ring. He traveled to Kosovo, where he paid $105,000 to receive a kidney transplant from a Turkish surgeon. The kidney came from a Russian donor who volunteered to sell her organ.

"To sell an organ, it's a terrible thing," Fain says. "But on the other hand, maybe it saves a life - like it saved my life."

"Tales from the Organ Trade," an HBO documentary released this month by Emmy award-winning filmmaker Ric Esther Bienstock, shows Fain's story and that of many others who face a dilemma of how to get an operation they need to stay alive given a global shortage of kidney donations. The film reveals the morally gray areas of black market organ trafficking and explores the perspectives of patients, doctors, prosecutors, organ donors and brokers who arrange the business end of the exchange, including finding donors, travel and selecting a surgeon. At the center is a world in which patients desperate for a kidney trade with those desperate for money.

Every month, more than 2,000 new names are added to the national waiting list for organ transplants, which had 120,675 patients as of publication, according to the Department of Health and Human Services. About 18 people die every day while waiting for an organ transplant in the United States.

"It's not living, it's existing," says Walter Rassbach, a patient with kidney failure from Denver, in the film. He admitted he was facing the ethical dilemma of whether to buy a kidney illegally. Doing so on the international black market could cost $100,000 and involves traveling to developing countries like Kosovo or the Philippines. People who sell their kidneys receive only a small amount of what the patient pays because a significant sum goes to the broker, medical team performing the operation and travel for all those involved. In the Philippines, for example, sellers receive $1,600 to $2,500 for their kidneys. In exchange, they save a life.

Bienstock, 54, shared with U.S. News what she learned as a result of making the film, saying that she wanted people to go through the same ethically nuanced journey she did when it came to understanding how people could bring themselves to buy or sell a piece of the human body. Her responses have been edited:

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Why did you decide to make a documentary about this topic?

I was making another film about sex trafficking, in which I followed a man whose wife was trafficked to Turkey. At one point he said: "I would sell my kidney to get her back!" I wondered how prevalent it was.

At the same time, my co-producer had a friend who needed a kidney. He found an altruistic donor, and the hospital was suspicious that the donor was getting paid. The issues started brewing. I thought it would be a meaty story. Unlike other illegal trades - like sex trafficking, human trafficking and drug trafficking - many people involved in this elicit operation are law-abiding citizens. The people selling their kidneys live in poverty, but they're not criminals.

There is a co-dependency that occurs in the exchange of a kidney for money: People depend on the organ to survive, but those selling their kidney are often desperate for money to survive. Can you elaborate on the exchange?

When I began work on this film I thought I was doing a story about exploitation. It was only when I started meeting the people involved that the arena became much more morally ambiguous. I don't think the people who buy a kidney on the black market do so in a cold-hearted way. They are characterized as wealthy Westerners harvesting the organs of the poor, but the reality is that they are patients with kidney failure who are going to die.

On the other side is people who are living in abject poverty - people who will never get their hands on a large sum of money. When I spoke to those people and said, "We think this is bad. We don't want to use people in poverty as body parts." Their reaction was: "Who are you to judge? Walk a mile in my shoes. You don't know what it's like to live in poverty." These men weren't bothered by their choice. Some of them changed their lives, others squandered the money. All of them say, "I made money, but I also saved a life."

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Were any of the patients concerned the film could be used as evidence to prosecute them for doing something illegal?

There haven't been many prosecutions for organ trafficking. There is no appetite to prosecute recipients or the sellers, even though they did something illegal. The rhetoric around this issue is that people selling their kidneys are coerced to do so. That implies force. The truth is, those I interviewed are coerced by their poverty. They are so poor, this is their only chance at money, and that offer is coercive.

One-by-one I approached them and told them I wanted to hear their story. It is hard convincing people to talk.

One woman in the film was a match for her father but decided not to donate a kidney. Why do some people choose not to be organ donors?

I don't judge her. It was brave of her to talk about that. Choosing not to be an organ donor is more common than we think. I know from talking to surgeons that there can be pressure to give. Doctors take the person who agreed to be a donor into a private room. They will tell them, "If you really don't want to do this, I'll give you a medical out so it's not your fault." Sometimes people are scared or are worried about the surgery.

Some people don't register to be organ donors because of procrastination, some might have religious reasons, others are afraid that if they are an organ donor then maybe they won't get treatment at a hospital and their organs will be harvested. The medical establishment has accepted that we can live well with one kidney. Many people are born with one kidney and never know it. Even if everyone registered to be an organ donor, however, there wouldn't be enough kidneys to go around.

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What role does money play in the film? Why is donating a kidney heroic, while receiving money for a kidney is controversial?

You're considered a hero if you donate a kidney, but the minute money enters the transaction it becomes something else. I do believe money changes the transaction. As there have been advances in medicine, our ethics evolve. I intuitively think it's repulsive to think about selling a body part, but then I step back and look at some of the people who did it and benefited from it. Maybe selling your kidney isn't the worst thing in the world.

Your film shows proponents for a government-regulated organ trade that would compensate donors financially. What is your position?

The film is not an advocacy film, but I mentioned it because I wanted audiences to know there are people arguing for it. I don't think we should simply dismiss the issue as exploitative, and only crack down on the black market. That is not a solution. Why not try a trial project? The current system is not working, and there are needless deaths.

Have you heard of anyone giving away a kidney because of your documentary?

We surveyed people at film festivals to ask whether they would consider buying a kidney. We also asked after the film whether they were moved to register as organ donors. Sixty percent of the audience said yes. I saw people on our Facebook page write that they saw the film, registered to be an organ donor and encouraged others to follow. I have received emails and phone calls from people thanking me for the story. Some have chosen to be altruistic donors. I think we have to do everything we can to move people to donate, and I hope the film continues to do that.

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