Organ failure

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Poverty and demand trump laws that ban trade in human body parts

Patients receive treatment for kidney failure at Ho Chi Minh City's An Sinh Hospital.

Two brothers, 20 and 17, who were distributing leaflets to the public around Hospital No. 108 in Hanoi's Hai Ba Trung District, drew a lot of public and media attention last week.

They were distributing leaflets offering to sell one of their kidneys to whoever wanted them. The boys had taken their offer to the streets after the hospitals had turned them down. They said they needed the money to "save" their parents who were being squeezed by creditors.

The brothers from the northern province of Hai Duong were certainly dramatic in their efforts to sell one of their vital organs, but there are in fact many who are making the same offers through several avenues, citing the need for money.

In fact, popular sell and buy websites carry many classified ads where people are selling their kidneys, and there are those advertising their need for the organs as well. Some of these ads are viewed more than a thousand times.

"I'm at the terminal stage of chronic nephritis [kidney inflammation] and looking for a kidney donor with O (type) blood. I'll offer a generous reward for the donation," reads a typical ad.

And like the brothers, direct offers are plentiful too.

Dr. Nguyen Cao Luan, head of Bach Mai Hospital's Artificial Kidneys Department in Hanoi, said every week they receive offers of kidneys from poor people, but they are turned down because it is illegal to accept them.

However, hospitals' rejection does not discourage sellers and buyers from striking deals, usually with dialysis clinics as brokers, Luan said.

The Tuoi Tre newspaper reported that the donor would typically sell a kidney for VND50-60 million (US$2,700-3,200). Usually, many brokers are involved in a trade and each of them is paid VND5-6 million. The main broker finally sells a kidney for VND300 million ($16,000).

The parties then go abroad for transplants, as Vietnamese hospitals only perform transplants on the condition that the donor and the recipient are blood relatives or pledge that the donation is absolutely voluntary, he added.

The regulations still fail to guarantee that kidney donations made by those not related by blood are all voluntary.

Dr. Ta Phuong Dung, head of the Kidney Department at Ho Chi Minh City's People Hospital No. 115, said, "The problem is that the buyer can make a deal with the seller before coming to the hospital and the latter affirms [that the donation is voluntary].

"It is absolutely out of the hospitals' control," she said. Her hospital asks for local authorities' confirmation and in case the donation is made by non-blood relations, commitments by the donor's family as well.

This is needed to provide legal protection for the doctors in case of post-transplant complications, she added.

Nguyen Huy Quang, deputy head of the Health Ministry's Department of Legal Affairs, also admitted the fact that people can sell and buy kidneys under the cover of voluntary donations.

However, he said that so far, they've detected no kidney transplant conducted in Vietnam with non-blood relations as donors, local newswire VnExpress news website reported.

High demand

Between 5,000 and 6,000 patients nationwide are currently in need of kidney transplants, said Quang.

The demand is great partly because other available treatments have limited effect on patients with severe kidney failure, according to Nguyen Thanh Liem, director of the National Pediatrics Hospital.

Even advanced treatment, peritoneal dialysis, for example, isn't suitable for the Vietnamese environment given the high risk of bacterial contamination during the process, Liem said.

Despite the great demand, just over 300 people have had kidney transplants since the country's first-ever kidney transplant was conducted nearly 20 years ago, Quang said.

Asked about the meager supply of kidneys, Luan said the country is wasting a great amount of kidneys from people who had suffered brain death. While they are eligible donors under the law, Vietnamese people believe that the dead must be buried with all their organs.

In the meantime, not many people are willing to donate kidneys, even to their family members, because of concerns over health risks after the transplant, said Do Tat Cuong, vice director of Military Hospital No. 103.

In fact, most of the kidney transplants conducted so far at the hospital were between mothers and children, Cuong added.

As a solution to the current shortage, Vietnam should establish a national center coordinating organ transplants to call for voluntary donations from the community, and sensitize the public that organs from brain-dead people are used to save lives, experts say.

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