TOKYO - When Hokamura Kenichiro's kidneys
failed, he waited more than four years for a
transplant before going online to check out rumors
of organs for sale.
As a native of Japan,
where less than 10 kidney transplants are
performed a year, the 62-year-old businessman was
desperate. "There are 100 people waiting in this
prefecture alone and there were just three
operations performed here last year. I would have
died before getting a donor."
He was
astonished by just how easy it was. Ten days after
contacting a Japanese broker in China in February,
he was lying on an operating table in a Shanghai
hospital receiving a new
kidney. A doctor had only
examined him that morning. "It was so fast I was
scared," he said.
The "donor" was an
executed man, the price 6.8 million yen (about
US$80,000). "It was cheap [in comparison to the
cost of my life]," said a recovering Hokamura, now
back in Kyushu in southern Japan where he runs a
construction-related business. "I can always earn
more money."
Hokamura is one of hundreds
of well-off Japanese who have recently made the
trip to China for kidney, liver or heart
transplants, drawn by the availability of cheap,
healthy organs and rapidly improving medical
facilities along the east coast of the mainland.
The so-called "transplant tourism" trade is also
attracting a growing number of Koreans, Americans
and other nationals.
There is no attempt
to conceal from recipients the origins of the
organs, the bulk of which come from prison
morgues. "My translator told me my donor was a
young executed prisoner," said Hokamura, who
claims he is unconcerned at the possibility that
prisoners were being executed to supply organ
brokers. "The donor was able to provide a
contribution to society, so what's wrong with
that?"
After paying a local broker, many
patients arrive in Shanghai and other cities to
find gleaming, well-equipped hospitals with
world-class staff. Rumors of problems with
follow-up care and patients dying within one to
two years of returning home have failed to stem
the tide. "I was surprised at how well everything
was run," Hokamura said. "I was expecting a lot
worse."
The black market in
organs Signs spray-painted on the walls
outside clinics and hospitals in many parts of
China are simple and direct: a mobile telephone
number and the character for shen (kidney).
Advertisements on bulletin boards and other
Internet sites also offer kidneys for sale. The
sale of organs for transplants is illegal in
China, as it is in most countries, but a black
market is flourishing. And it's not just the small
private hospitals and clinics springing up all
over the country - bigger hospitals in Beijing and
Shanghai also have ads in toilet cubicles and on
ward walls.
"We have to wipe off the
notices again and again," said Professor Ding
Qiang, head of urology at Huashan Hospital in
Shanghai's Fudan University. "They [brokers] even
visit doctors, make numerous calls or write
letters again and again. Such donations are surely
organ trading, but 'organ donation' for money is
strictly banned in China."
There is little
confirmed information about how the organs are
harvested but doctors have given accounts of
driving to execution grounds with specially
equipped ambulances carrying nurses and containers
for the organs. The body is picked up and carried
by ambulance to a hospital where the organs are
stripped.
Although Beijing does not reveal
how many people are executed annually, Amnesty
International put the figure at 3,400 in a 2004
survey, the world's highest. Some analysts reckon
it may be as high as 8,000.
Executions in
China are generally carried out by a bullet to the
back of the head, or in the heart. However, the
introduction of the lethal injection in the last
decade means that more organs are left intact and
advances in immunosuppressant drugs have reduced
the need for exact genetic matches.
China
only admitted very recently that the organs of
executed prisoners were sold to foreigners for
transplants. Huang Jiefu, deputy health minister,
told Caijing magazine that the government was keen
to standardize the management of the supply of
organs from executed prisoners.
A key
issue despite new legislation is how much control
prisoners have over whether to donate their
organs. Since the 1980s, government regulations
have required the consent of prisoners or their
families. The Chinese government says that all
condemned prisoners who agree to donate their
organs after their deaths do so of their own will
and in some cases their families are paid, but
many are skeptical of such claims.
Human
rights organizations accuse authorities in China
of scheduling executions to coincide with
transplant operations and some families have sued
the authorities for using the organs of executed
relatives without consent.
In March,
Beijing announced new transplant regulations
following highly critical reports in several
foreign newspapers and the deaths of at least
eight Japanese donor recipients after operations
in Chinese hospitals; patients from Malaysia,
Canada and the US have also reportedly died
following botched transplants. From July, donors
will have to provide written permission and
transplants must be carried out in
government-sanctioned hospitals.
Foreign
Ministry spokesman Qin Gang denied that executed
prisoners were the source of most of the organs,
or that they were removed without consent. "It is
a complete fabrication ... to say that China
forcibly takes organs from people given the death
penalty for the purpose of transplanting them," he
said. "China has rigorous laws and regulations.
Donors, recipients and hospitals must all firmly
follow laws and regulations in this area."
Mystery remains about the organ route from
prison morgue to operating theater but little
doubt that money helps lubricate the way in a
country where foreign patients jump to the head of
the queue despite a local transplant waiting list
of more than 2 million people. Tracing this route,
and regulating private clinics and small hospitals
is especially difficult.
Chen Zhonghua, a
transplant specialist at Tongji Hospital in Wuhan,
who was a government consultant in the drafting of
the new regulations, told the South China Morning
Post in March that they failed to properly address
the origins of organs in the "messy and
disordered" transplant market.
A single
broker has helped more than 100 Japanese make the
trip to China for transplants since 2004 and the
trade is growing. A survey published in March by
the Japanese health ministry said 453 Japanese had
transplants of the heart, liver or kidney abroad,
with the US, Australia and China topping the list
of destinations. Official figures almost surely
underestimate the number of people availing
themselves of the service, many of whom fly
beneath the government radar.
The
experience of Hokamura and other recipients points
to a growing underground market in human organs
across the world, fueled by income disparities,
relaxed border controls and ineffective central
government control. With medical facilities
improving in urban pockets of the Third World,
wealthy, ill people have a powerful incentive to
board a plane to India, the Philippines, Peru and
China, where cash often speaks louder than
whatever weak regulations exist.
According
to the New England Journal of Medicine, a human
kidney can be purchased in Manila for
$1,000-$2,000 and "in urban Latin America for more
than $10,000". The Voluntary Health Association of
India reports that about 2,000 Indians sell a
kidney every year. More than 1,000 rich residents
of the Arab Gulf States have traveled to India and
other countries for transplants; wealthy Israelis
go to Egypt, Bulgaria and Turkey, and Americans -
about 200-300 a year - go to China, the
Philippines and South America.
The ethics
of paying for human organs are often trumped by
the prospect of a few more years of life. Hokamura
said his family is so pleased his daughter has put
his experience on the Internet. In her blog she
said she feels sorry for others to have to wait
years for transplants and provides a link to a
support center in Shenyang. "Other people should
know about this."
But not everybody is as
enthusiastic. "I can understand the
self-interested motives but I personally wouldn't
do it," said Louis Carlet, a long-time resident of
Tokyo who has been on kidney dialysis since
November. "I highly doubt that executed prisoners
give their consent. If it was totally consensual I
might think about it, but the fact that there is
profit involved turns me off."
Organ
transplants in Japan Many patients in Japan
are bitter about the underdeveloped state of
transplant health in a country that has seen fewer
than 50 cases of donated organs since the revised
1997 Organ Transplant Law. "Doctors in Japan are
happy with their patients being on dialysis
because it is profitable," Hokamura suggested.
"They get 5.1 million yen a year to treat people
like me."
According to Health Ministry
statistics, there have been a total of 998 kidney
transplants in Japan but the bulk of these - 800 -
have been from living persons. The rest are from
people who died of brain death or whose heart
stopped. A single death can on average now save 10
people, but with too few donors and 12,000
patients waiting for matching donors (according to
the Japan Organ Transplant Network, the government
is again preparing to revise the law.
Meanwhile, increasing numbers of Japanese
are turning to China. Sources say the cost of a
kidney transplant in China runs to $66,500 and a
liver up to $157,000. A Taiwanese broker called
Yeson Healthcare Service Network recently told the
Japan Times that a heart transplant at the
Zhongshan Hospital in Shanghai can be had for as
little as $119,000, a fraction of the $860,000
such an operation would cost in North America.
Hokamura negotiated the deal through a
Japanese broker in Shenyang that operates under
the name of the China International Organ
Transplant Center, which maintains a professional
website [1] with detailed information about its
services for donors in English, Japanese, Korean
and Russian. The website provides the following
information on the sources of organs: "If you send
your personal data to this center by email or fax
and accept the necessary body examination in
Shenyang, China in order to assure a suitable
donor, it may take only one month to receive a
liver transplantation, the maximum waiting time
being two months. As for the kidney
transplantation, it may take one week to find a
suitable donor, the maximum time being one month.
Although the procedure to select a donor is very
strict, the transplant operation will be
terminated if the doctor discovers that there is
something wrong with the donor's organ." The
source of the organs, however, is not specified.
Calls to the center were answered by a
Japanese-speaking Chinese secretary who handed
them over to a man identifying himself as Dr
Mitamura. "We cannot talk to the press because
media attention last year caused a lot of
problems," he said. The center has attracted a
growing number of Japanese media organizations and
was recently filmed by a network TV crew.
Mitamura said his colleagues would discuss
money only after a return address and telephone
number in Japan was provided.
Several
Japanese groups have traveled to China to
investigate the trade, including the Japan
Transplant Recipients Organization, a non-profit
organization that lobbies for legal changes to
increase the number of donors. "We do not approve
of receiving organs from executed prisoners, but
personally I can't simply disapprove of it,"
chairman Suzuki Masanori said. "There are just too
few donors in Japan."
Last May, Suzuki
visited a hospital in a "major city" (he declined
to specify which city) and learned that 95% of its
transplant patients had received organs from
executed prisoners. The hospital had conducted
2,000 organ transplants last year alone, Suzuki
said. Some 30 or 40 were Japanese and 200 were
Korean. "For many patients, this is their last
chance."
David
McNeill is a Japan Focus coordinator and
writes about Japan for the London Independent and
other publications. Clifford Coonan is the
Independent's correspondent in Beijing.
