By the time her work brought her back to the United States, Nancy Scheper-Hughes had spent more than a decade tracking the illegal sale of human organs across the globe. Posing as a medical doctor in some places and a would-be kidney buyer in others, she had linked gangsters, clergymen and surgeons in a trail that led from South Africa, Brazil and other developing nations all the way back to some of her own country’s best medical facilities. So it was that on an icy February afternoon in 2003, the anthropologist from the University of California, Berkeley, found herself sitting across from a group of transplant surgeons in a small conference room at a big Philadelphia hospital.
By accident or by design, she believed, surgeons in their unit had been transplanting black-market kidneys from residents of the world’s most impoverished slums into the failing bodies of wealthy dialysis patients from Israel, Europe and the United States. According to Scheper-Hughes, the arrangements were being negotiated by an elaborate network of criminals who kept most of the money themselves. For about $150,000 per transplant, these organ brokers would reach across continents to connect buyers and sellers, whom they then guided to “broker-friendly” hospitals here in the United States (places where Scheper-Hughes says surgeons were either complicit in the scheme or willing to turn a blind eye). The brokers themselves often posed as or hired clergy to accompany their clients into the hospital and ensure that the process went smoothly. The organ sellers typically got a few thousand dollars for their troubles, plus the chance to see an American city.
As she made her case, Scheper-Hughes, a diminutive 60-something with splashes of pink in her short, grayish-brown hair, slid a bulky document across the table—nearly 60 pages of interviews she had conducted with buyers, sellers and brokers in virtually every corner of the world. “People all over were telling me that they didn’t have to go to a Third World hospital, but could get the surgery done in New York, Philadelphia or Los Angeles,” she says. “At top hospitals, with top surgeons.” In interview after interview, former transplant patients had cited the Philadelphia hospital as a good place to go for brokered transplants. Two surgeons in the room had also been named repeatedly. Scheper-Hughes had no idea if those surgeons were aware that some of their patients had bought organs illegally. She had requested the meeting so that she could call the transgression to their attention, just in case.
Hospital officials told NEWSWEEK that after meeting with Scheper-Hughes, they conducted an internal review of their transplant program. While they say they found no evidence of wrongdoing on the part of their surgeons, they did tighten some regulations, to ensure better oversight of foreign donors and recipients. “But that afternoon,” Scheper-Hughes says, “they basically threw me out.”
It’s little wonder. The exchange of human organs for cash or any other “valuable consideration” (such as a car or a vacation) is illegal in every country except Iran. Nonetheless, international organ trafficking—mostly of kidneys, but also of half-livers, eyes, skin and blood—is flourishing; the World Health Organization estimates that one fifth of the 70,000 kidneys transplanted worldwide every year come from the black market. Most of that trade can be explained by the simple laws of supply and demand. Increasing life spans, better diagnosis of kidney failure and improved surgeries that can be safely performed on even the riskiest of patients have spurred unprecedented demand for human organs. In America, the number of people in need of a transplant has nearly tripled during the past decade, topping 100,000 for the first time last October. But despite numerous media campaigns urging more people to mark the backs of their driver’s licenses, the number of traditional (deceased) organ donors has barely budged, hovering between 5,000 and 8,000 per year for the last 15 years.
In that decade and a half, a new and brutal calculus has emerged: we now know that a kidney from a living donor will keep you alive twice as long as one taken from a cadaver. And thanks to powerful antirejection drugs, that donor no longer needs to be an immediate family member (welcome news to those who would rather not risk the health of a loved one). In fact, surgeons say that a growing number of organ transplants are occurring between complete strangers. And, they acknowledge, not all those exchanges are altruistic. “Organ selling has become a global problem,” says Frank Delmonico, a surgery professor at Harvard Medical School and adviser to the WHO. “And it’s likely to get much worse unless we confront the challenges of policing it.”
UN secretary general Ban Ki-moon is facing calls to reject reports calling for laws on the sex trade to be relaxed. Photograph: Brendan Mcdermid/Reuters
Former prostitutes and groups campaigning against sex trafficking will launch an international protest against UN reports that recommend the decriminalisation of pimping, brothel-keeping and the purchase of sex.
As global leaders gather in New York for the UN general assembly, the protesters claim that decriminalisation of the sex trade will endanger women.
“Governments around the world look to the United Nations to determine their policy and I am dismayed that any part of the UN would call for the decriminalisation of pimping and brothel-keeping,” said Lauren Hersh, the New York director of the women’s rights group Equality Now.
The pressure group is writing to Ban Ki-moon and other branches of the UN on Sunday with co-signatures from lobby groups in the UK, US and around the world.
“We don’t believe these reports’ recommendations will make women safer and decriminalisation provides an attractive environment for traffickers, pimps and organised crime,” said Hersh.
Having lobbied privately in vain to change the recommendations since the reports came out last year, she is now taking an expanded protest to the secretary general.
Stella Marr, a former prostitute and founder of the US group Sex Trafficking Survivors United, said few people are prostitutes by genuine choice, too many end up murdered and the vast majority would leave the trade if they felt there was a viable alternative.
“I was sex trafficked in New York for 10 years. Decriminalisation empowers punters and traffickers and perpetuates the humiliation and abuse of the young and vulnerable by the richer, older and more powerful,” she said. The reports come from the UN Programme on HIV and Aids (UNAids), which wants to battle the disease among prostitutes by helping them demand condom use and report abuse to the police.
The UN’s Global Commission on HIV and the Law calls for countries to “repeal laws that prohibit consenting adults to buy or sell sex” and that ban “immoral earnings” and brothel-keeping, and also demands measures “to ensure safe conditions for sex workers”. A UNAids report on the Asia-Pacific region recommends removing offences relating to soliciting, procuring, pimping and management of brothels – but only among those in the industry voluntarily.
“I don’t think we’re trying to let everyone off the hook, but the reports were trying to reduce Aids. The secretary general has always taken a clear stance against all forms of human trafficking,” said Farhan Haq, a spokesman for Ban.
A London School of Economics report last year by a development professor, Eric Neumayer, claimed that legalisation of prostitution in the Netherlands, Germany and New Zealand and the subsequent growth in demand had led to increases in human trafficking, or coercion of people into the industry. The report called this “the dark side of globalisation”.
But a statement from UNAids disputed that its recommendations would put women at risk.
“We do not view sex work as the same as trafficking or sexual exploitation, which are clear human rights abuses and crimes,” said the statement.
In the UK, individual consenting adults are allowed to buy and sell sexual services but activities such as organising prostitution, kerb-crawling and soliciting in public places are illegal.
Groups co-signing Equality Now’s letters to Ban and UNAids include Eaves, the British pressure group against violence and trafficking; Barnardos Ireland; the Coalition Against Trafficking in Women in the US, Philippines and Australia; the Social Democratic Party in Denmark; and anti-trafficking organisations in Canada, South Africa, India, Italy, France and Japan.
A Dutch government report in 2007 found that, despite prostitution being legal and regulated in the Netherlands, prostitutes’ emotional wellbeing was lower than pre-legalisation and “the use of sedatives has increased”.
The LSE report concluded that since 1999, when Sweden decriminalised prostitutes selling sex but cracked down on men buying sex, the illegal trafficking of women into the country to meet demand had dropped below 400 a year, while it was four times that in Denmark and was more than 15,000 women a year in Finland, where laws are more lax. While acknowledging reluctantly that it would be tough ever to stamp out prostitution, Hersh insisted that prosecuting clients was the most effective route, along with funding exit strategies for prostitutes into housing, job training and related services. “If you eliminate demand you are going to reduce exploitation and sex trafficking. It’s as much about prevention as anything else in the hope that fewer women and girls are going to end up in prostitution in future,” she said.