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Kidney Sellers Don't Improve Their Health or Wealth

Indian study finds them sicker and still in debt

TUESDAY, Oct. 1, 2002 (HealthDayNews) -- Selling a kidney for cash is bad business for poor people in the Third World, says a researcher who finds that for-pay donors in India remain deep in poverty and damage their health at the same time.

Dr. Madhav Goyal, a native of India who now practices in Pennsylvania, says he did the study because some proponents have said the practice helps the donors economically and the recipients medically.

"They were saying that the practice should be beneficial for both, but the key question was whether the people who were selling benefited," Goyal says. "Our study shows that the notion that you were helping the buyer and not harming the seller was wrong."

The study is expected to add to the debate over whether a kidney-selling operation should be launched in the United States. About 50,000 people are awaiting a kidney transplant, yet fewer than 15,000 will receive one this year. Those favoring the sale say that money will help the donors as well as the recipients, while opponents see such a move as exploiting the health of the poor, who would be the most willing donors for cash.

Goyal, who is an attending physician with Geisinger Health System, a nonprofit health care group in Pennsylvania, did the study with his own money. He and his colleagues interviewed 305 men and women in Chennai, a city in southern India, who had sold kidneys. Almost all of them said they did it for the money, which averaged $1,070 a kidney.

That might not sound like a lot to an American, Goyal says, but "these were people making a few hundred rupees a month, and suddenly they throw 30,000 rupees at them." The hope that this money would get the donors out of debt -- the usual motive for the sale -- was generally disappointed, says a report in tomorrow's issue of the Journal of the American Medical Association.

Three-quarters of the sellers were still in debt when they were interviewed, an average of six years after the procedure. The percentage of them below the poverty line increased from 54 percent before to 71 percent after -- and this was the Indian poverty line, Goyal says.

"In India, the poverty line is measured by how much is enough to meet nutritional needs," he says. "It does not include housing or clothing or anything else. These people still had to take out loans to meet their day-to-day requirements."

More troubling was the fact that only 40 donors, 13 percent of the total, reported no decline in their health. On a five-point scale ranging from poor to excellent, 38 percent reported a one-to-two point drop and 48 percent reported a three-to-four point drop.

Those numbers indicate that living kidney donation is a far different proposition in developing countries such as India than in the United States, Goyal says. Studies here have found no adverse effects from living kidney donations, but "our study shows that this assumption may not be correct for Third World countries," he says.

It also shows that the selling of kidneys, legally banned in India, is a thriving business, Goyal says. Despite efforts to keep such sales secret, he and his colleagues were able to find the more than 300 donors in less than a month.

In the United States, most kidneys are transplanted from cadavers; no such program exists in India. Also, dialysis is nowhere near as common as it is in the United States, sparking an underground economy in kidney sales.

Those sales pose a serious ethical issue for American physicians, says David J. Rothman, a professor of social medicine at the Columbia College of Physicians and Surgeons and the author of an accompanying editorial. "Patients are going to China and India to get kidneys," he says. "When they come back, the issue for the physician is whether to keep on treating those patients."

Goyal's study removes one justification for overlooking the source of the kidney, Rothman says. It has been presented as a win-win situation, in which both the buyer and seller benefit, he says -- "the recipient gets the organ, the donor gets the money to take him out of poverty" -- but it now has been shown to be a zero-sum situation, in which what is gained by one party is lost by the other.

What To Do

You can learn about living kidney donations from the National Kidney Foundation. Learn more about transplants in general from the United Network for Organ Sharing.

SOURCES: Madhav Goyal, M.D., attending physician, Geisinger Health System, State College, Pa.; David J. Rothman, Ph.D., professor, social medicine, Columbia College of Physicians and Surgeons, New York City; Oct. 2, 2002, Journal of the American Medical Association
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