Authors: Scott Carney
It also meant that collection centers grew into big businesses. By 1956 clinics in the United States were paying for more than five million pints annually. Ten years later reserves tipped six million pints. Blood-collection shops sprang up in skid-row shantytowns of every major city. They became as commonplace as check-cashing stores and pawnshops are today in the same areas. In India, national unions negotiated blood rates with the government, and soon professional donors plied their trade in every major city on the Indian subcontinent.
The blood business was saving lives, and few people troubled with the ethics of the supply chain. It took until 1970 for a British social anthropologist named Richard Titmuss to express his concern that body markets were creating unequal access to medical advancement. Titmuss was influenced by his own country’s ethical stance on the issue. England invented blood drives during World War II and millions of people donated to help the war effort without expecting to be paid. Even after the war, hospitals almost never paid for blood; rather, British people saw it as their patriotic duty to give. In his book
The Gift Relationship,
Titmuss compared the commercial system in the United States to the altruistic one in England and made two main arguments.
First he showed that buying blood increased incidents of hepatitis in the blood supply and drove hospitals and blood banks to rely on increasingly coercive measures to increase stocks in human blood. Bought blood was dangerous. It was also exploitative. Commercial collection led the state to seek the cheapest possible sources. They started turning to prisoners to donate blood: a situation that he likened to a modern-era version of slavery. The same sort of exploitation, he said, had the potential to spring up in any other market in human tissue.
Second, Titmuss argued that the only way to solve the problem would be to create a system based exclusively on altruistic donation. He believed that blood-donation systems could do more than save lives and create profits for hospitals. He thought they could build communities, too. He wrote: “those who give as members of society to strangers will themselves (or their families) eventually benefit as members of society.”
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For Titmuss, bodies and body parts should only be exchanged as gifts. Think of it as blood socialism.
Remarkably, and despite massive opposition by the commercial blood lobby, people listened. The United States passed laws that made voluntary donation the norm. Paying for blood of any kind was now considered coercion and brought stiff penalties. (Though it should be noted that not all blood was created equal. They made an exception for blood plasma, which is easier for the body to regenerate; it continues to be a frequent source of side income for many people across the United States.) And the trend spread across all other markets in human tissue.
In 1984 on the floor of the US Senate, Al Gore famously proclaimed that “the body should not be a mere assemblage of spare parts” when he helped pass a national law that forbade payments for any type of human flesh. After invoking Titmuss in the halls of government, the Senate voted in favor of the National Organ Transplant Act and explicitly banned the sale of human organs and tissue. The world followed suit. Today, with just a few notable exceptions, it is illegal in every country to sell blood, buy a kidney, buy a child for adoption, or sell your skeleton in advance of death. Instead we have complex systems set up to give consent for voluntary harvesting. We donate our blood at blood banks, sign organ donation cards, and will our bodies to scientific institutions after we die. All for free. In theory, anyone who takes money in exchange for a body part could wind up in jail. The law is unambiguous: Buying bodies is bad.
Unfortunately the laws fell short of leeching profits from the body business. The system that Titmuss outlined and the rest of the world adopted has two fatal flaws. First, while individuals can’t directly buy and sell bodies, doctors, nurses, ambulance drivers, lawyers, and administrators all can bill market rates for their services. You may not pay for a heart, but you definitely pay for a heart transplant. In effect, the cost of a heart migrates into the costs of services to acquire one. Hospitals and medical institutions increasingly turn profits on organ transplants; some even return revenues to shareholders. Everyone in the supply chain makes money except the actual donor. The ban on buying human body parts has allowed hospitals to acquire them essentially for free.
From a customer’s perspective, the organ transplant business in the United States resembles Gillette’s famous business model. Gillette charges next to nothing for the actual shaving handle, but charges an arm and a leg for the blades. Kidneys are no different. Sure you can’t buy one, but installation costs for a certified used kidney can run close to half a million dollars.
As with any economic system, a free supply of raw materials is only an invitation to find new ways to utilize them. In the United States we generally do not question that demand for transplantable flesh is a fixed thing—something tied to an absolute number of emergency situations, like kidney failure. The existence of a five-year waiting list seems to be proof positive that the demand for organs far outstrips supply. But that may not be the case.
For forty years the United Network for Organ Sharing has consistently expanded the available pool of cadaver donors and yet has never caught up with demand for new organs. Instead the waiting list has only grown longer. As more organs become available, doctors add new, previously considered unqualified patients to the transplant list. Transplant techniques and patient outcomes are always improving as surgeons discover that an even wider number of people can be helped with donor material. The transplant list disguises the reality that there isn’t a fixed demand for organs. The length of the list is a function of the overall supply of available organs. Demand is a function of supply. The good news is that many people’s lives are being extended this way. However, the limitless potential for expansion means that instead of only looking at the potential beneficial use of organs, we also need to be critically aware of how large and coercive the system of collecting organs can become.
To use an analogy, there seems to be an almost limitless demand for oil products in the world. Innovations with petroleum energy have led to unheralded economic, technological, and social gains. Distances have shrunk with the use of cars, there is light at night and heat in the winter. However, this does not mean that drilling and burning those products into extinction is necessarily the best thing for humankind.
The second flaw in Titmuss’s model is that he failed to account for basic standards of medical privacy. While authorities might be able to track down an individual donor in their records, they are sealed from any sort of public scrutiny. It is simply not possible for anyone outside the hospital to discover the identity of the blood donor whose sacrifice has saved a life in surgery. The blood is depersonalized, marked with a bar code and poured into hermetically sealed plastic bags. We buy units of blood, not parts of people. The prevailing medical logic is that to connect the dots between donor and receiver could compromise the entire system, maybe even stop people from donating their tissue in the first place.
The person who receives the blood doesn’t feel indebted to an individual donor, but to the system of blood donation in general, and specifically to the doctor who provides the service. Someone who receives a kidney, whether from a living donor or from a cadaver, rarely knows the person who gave up the organ. Though anonymity is meant to protect the interests of the donor, it also obscures the supply chain. Recipients buy tissue without ever having to worry about how it was procured in the first place. This sort of privacy is the last bit of alchemy that transforms human flesh into a commodity.
Obscuring the source of raw materials for any market is almost always a bad idea. We would never allow an oil company to hide the locations of its oil rigs, or not to disclose its environmental policies. And when an oil rig fails and leaks millions of barrels of petroleum into the ocean, we demand accountability. Transparency is capitalism’s most basic safety feature.
From the perspective of a criminal entrepreneur, the current system of tissue collection is a perfect storm for rampant and unmitigated exploitation. Donation-only policies make it illegal to pay for tissue, and while companies may invest heavily in transplant infrastructure in the same way an oil company invests in a rig, the actual price of the raw materials is often nearly zero. Meanwhile the rhetoric around privacy obscures the path that bodies and body parts take to the market. Anonymity means that organ buyers can purchase human flesh without worrying about where it comes from. Nobody is going to ask any questions. The structure of donations neatly takes care of any objections by masking the supply behind a curtain of ethics. The one-two punch of anonymity and donation means that profit-taking middlemen control the entire supply chain, and buying an organ is as easy as writing a check.
In part, this book is an investigation of what has gone wrong with the current system of tissue harvesting and body procuring. Red markets are now larger, more pervasive, and more profitable than at any other time in history. In the forty years since Titmuss published his book, globalization has made the speed and complexity of these markets bewildering. This is not a wholesale indictment or embrace of commercialization. We live within the red market. It is not something that will simply vanish if we reject the idea that there is an economy built around human tissue. Whether we like it or not, the human body will be bought and sold both covertly and openly in the world’s most respected institutions. The only question is how.
By and large, I have not focused on the millions of red market transactions that go right every day. There is no doubt that without transplant technology, blood collection, and adoption programs there would be terrible human fallout. We don’t need to follow the stories of people living happy lives because of something they bought on the red market. That is the story of tissue demand. It is far more important to understand how tissue makes it to the market than how it is used. This book is an exploration of the supply side of the economic equation. Without understanding supply we will never understand how quickly red markets can foster global criminal enterprises.
The collision of altruism and privacy undercuts the noble ideals that they were meant to protect. Every step along the red market supply chain helps transform humans into meat. The brokers who buy and sell bodies play the part of butchers who can see a living person as nothing more than the sum of their constituent parts.
HOW IT ALL STARTED
FROM 2006 TO 2009
I lived in Chennai, a booming coastal metropolis in southern India, just a few hundred miles north of Sri Lanka. Prior to that I had spent several years in India studying folklore and language at university programs in the desert state of Rajasthan and near Dharamsala, where the Dalai Lama lives in exile. I knew that I wanted to spend more time in South Asia, but at first I wasn’t sure that I was going to be a journalist. Fresh out of a graduate program in anthropology at the University of Wisconsin–Madison, I started my short-lived professional academic career teaching American students on a semester abroad in India.
I was in charge of twelve students as we traveled from Delhi to the holy city of Varanasi and the pilgrimage center of Bodh Gaya. At our last stop, one of my students died, leaving me and the other director in charge of returning her body to her family in the United States. I spent three days with her corpse staving off the inevitable process of decay. It was closer than I had ever been to a body before, and as she cooled and changed color, I confronted the physical nature of mortality.
More than anything else, her death taught me that every corpse has a stakeholder. As she made the transition from person to object, people seemed to come out of the woodwork to make demands on what was left of her material self. I spent much of that time negotiating with police, insurance companies, morticians, family members, and airlines to bring her home for burial.
Although I wasn’t aware of it at the time, this was the beginning of my own understanding of the international market for human bodies. In a way, I was thrust into this subject by events largely beyond my control. The first section of this book deals directly with that event. Some readers may find it disturbing.
After she died I felt that I couldn’t continue teaching. Eventually I started writing for
Wired
and
Mother Jones
magazines, as well as television channels and radio stations from my base in Chennai. My stories covered the business practices of kidney traders, skeleton thieves, blood pirates, and child kidnappers across South Asia. Later, I traveled through Europe and the United States cataloging the worst-case scenarios. In every case I was astonished to find that most people who buy a piece of a human have no idea what series of events had to happen to make that part available.
The idea of red markets being something special and apart from normal economic systems began with my investigations of bone traders and kidney thieves in India, but the concept encompasses more than just bodies that are being used for spare parts. The mix of misplaced altruism and privacy has serious implications for both the burial and adoption industries as well. When it comes to human bodies, the supply chain is always eerily the same.
As I began to contemplate putting all of my research into one book, I realized that there were more criminal red markets than I could ever hope to cover. I’ve left out landmark cases of morgue thefts across the United States, where funeral parlors sold the bodies they were entrusted to take care of to tissue-supply companies. The desecrated corpses were carved into surgical grafts and replacement tendons. I’ve ignored scandals around traveling museum exhibitions, where plastinated bodies of executed prisoners have been put on display. Likewise I’ve only briefly mentioned a report that more than one hundred thousand pituitary glands were stolen in England to produce human growth hormone. I make no mention of a recent report of Bolivian serial murderers who sold the fat of their victims to European beauty-supply companies that produce up-market facial creams. And every day the list grows. From the mid-1990s to 2000 the Israeli military harvested the corneas of Palestinian militants killed in combat. And deeper in history, at the turn of the nineteenth century a booming market for shrunken heads in Europe sparked tribal wars in South America. Providing an exhaustive account of every red market is beyond my abilities.