In China, criminals fill the kidney donor deficit

In China, criminals fill the kidney donor deficit
An online plea can put a desperate patient or a donor short of yuan in touch with agents exploiting a shortage of human organs

Nicola Davison in Shanghai
guardian.co.uk, Sunday 27 May 2012 15.00 EDT

Chinese doctors perform a legal kidney transplant in Changsha city, Hunan province. Patients have a 0.5% chance of a transplant each year. Photograph: Fu Zhiyong/Imaginechina
By the time Hu Jie changed his mind about selling his kidney it was too late. The 25-year-old migrant worker had travelled to a distant province and had medical checks. A recipient had been matched. If he pulled out now, the web of doctors and agents brokering the illegal operation would lose a lot of yuan.

So the night before Hu's operation in January 2011 an agent kept watch. "I saw the agent couldn't stop rubbing his waist; he was suffering," Hu says. "He told me he had sold his kidney two months ago."

At that moment Hu considered the enormity of what he was about to do. "I tried to flee but didn't succeed; there were agents and strangers surrounding me. The next morning my phone, ID card and bank card were confiscated. That afternoon I was taken to the local hospital – it was shabby, more like a township health centre. I protested, crying. I tried to run twice more but the agents were guarding the door."

Hu was stripped and put under general anaesthetic. When he woke the next morning, trembling with cold, a 10cm scar arced his torso and his left kidney was gone.

Hu Jie, 25, changed his mind about selling his kidney but it was too late. Photograph: Nicola Davison
In China there is a severe shortage of organ donors. A million people need a kidney, but just 5,253 got one in 2011, according to the national kidney transplant registry. This gives patients a 0.5% chance each year; in the UK that chance is 43%. Kidneys are the most in-demand organs in China. Two-thirds of the 1.5 million people the health ministry say needs new organs (hearts, lungs, livers, kidneys and corneas) are waiting for a kidney.

In lieu of a public donor system, demand is met by harvesting organs from executed criminals, despite criticism from human rights advocates who question the degree of consent. In February, Huang Jiefu, a health minister, announced this system will be abolished within five years, in part because condemned prisoners' organs are more likely to carry infections. China is also being more prudent with the death penalty. About 4,000 prisoners were executed in 2011, an estimated 50% fewer than in 2007.

With dismal chances of getting a donor kidney, and high prices (kidneys cost 200,000 yuan, or £20,000, in hospitals), many patients turn to the parallel economy. Buying or selling a kidney is simple: typing "donate kidney receive payment" into Sina Weibo, China's Twitter, reaps about 550 posts. Typically, agents arrange deals in league with corrupt doctors and hospitals.

When Hu Jie woke from his operation his agents had scarpered. "Three days later, I received 27,000 yuan, not the 40,000 yuan I was promised," he says.

"I met the patient [who received Hu's kidney] in the hospital office, he told me he paid 300,000 yuan. Most of his money was divided between these agents. The doctors had a finger in the pie too."

When the Guardian contacted an agent dubbed Monk – who advertises his services with "donate a kidney, buy the new iPad!" on Weibo – he said the procedure could performed in 10 days for 25,000 yuan. Any blood type was acceptable, but donors must be taller than 1.65m, over 55kg and aged under 28.

For Wang Wei, a 27-year-old construction worker from Shandong province, the sale of his kidney will give his daughter, who has leukemia, a chance. "The reward [for my kidney] needs to be more than 180,000 yuan, as my daughter's treatment has already cost around 150,000 yuan, and the next cycle of treatment costs a great amount of money," he says. "I earn 200 yuan a day, which merely covers my daughter's current medicine expenses."

Sellers have differing motives. Earlier this year there was a public outcry when a 17-year-old sold his kidney for an iPad and iPhone.

China's donor deficit reflects tradition, which dictates that bodies should be buried whole. "It will be very difficult to solve the [organ donor] problem in the coming years as it will mean changing something fundamental in Chinese people's minds", says Liu Changqiu, a professor at the Shanghai Academy of Social Sciences who is working to establish organ donor laws. "First, the government should encourage organ donation – there's still a lack of motivation."

The health ministry and Red Cross Society of China launched a pilot scheme in 160 hospitals in 2009 to spur public donations. So far there have been 207 donors through this scheme. In the UK the NHS Organ Donor Register has almost 18 million people registered.

Consequently, Mr and Mrs Zhang don't harbour much hope. Mr Zhang has suffered from renal failure for five years and is on the transplant waiting list. He visits Shanghai's People's First Hospital, the city's busiest for kidney transplants, three times a week for dialysis.

"My husband is over 50 now", says Mrs Zhang. "Where to find a kidney? Even in the best hospital in Shanghai we don't know how long we must to wait. In 10 years or more my husband will be 70 and then it's meaningless for us".

Down the corridor on the toilet doors are scrawled the characters: "Kidney for sale, no agent", complete with blood type and mobile number.

Hu Jie's money is now nearly spent. "Some was used to pay for medicine to help me recover. I felt a gnawing pain from the wound and I couldn't stand straight when walking for months."

Seeking justice, Hu reported his case to the provincial health bureau. The head nurse was charged (no agents or doctors were) and the clinic forced to suspend business "to bring up standards"

.

"What makes me really angry is that they didn't even inform me when the court held the trial for my case," Hu says. "When I asked the court why I didn't even receive notice of the trial the reply was: 'This case has no civil compensation. There is no victim.'"

Additional reporting by Xia Keyu

http://www.guardian.co.uk/world/2012/may/27/china-kidney-donor-shortage-crime?intcmp=239