What do you do when there is no work? When your children are dying, and you cannot afford to pay a doctor? In the Bagong Lupa slum area in the Filipino capital at least 150 men have chosen to sell one of their kidneys.

By John Einar Sandvand

Manila, Philippines

     Marlene Maico was only two years old at the time. Then she fell sick. Very sick - with several diseases at the same time. Her life could only be saved if she was treated properly at a hospital.

    - But I had no money, says the father, 31-year-old Satur Maico. The family lived in a shanty in Bagong Lupa, a large slum area close to the harbor in Manila, the capital city of the Philippines.

     Garbage and sewage are floating below the shanties. There is visible damage after a typhon hit a few months earlier, in which many of the families lost their homes. For many people it is a depressing life. There is no work. At least not every day. And when they get something to do, residents say, pay is a meager 3 to 6 dollars.

     In this neighborhood a desparate Maico helplessly watched his daughter on the brink of death. Finally he chose what he considered to be his only alternative: He accepted that one of his two kidneys was removed from the body and transplanted into a man who was willing to pay.

     - I received 70.000 pesos (1750 USD) for my kidney. That is the smallest amount anyone has been paid in this area. But I was desperate and did not have much to negotiate with, says Satur Maico.

     Thus the daughter, who now is six years old, was admitted to hospital. The father could afford the 15.000 pesos fee. And she survived.

     Today a long scar at the right side of his body bear witness of Maico's sacrifice for his daughter. And at least 150 other men have the same scar in this slum area, according to Dalmacio Zeta, who makes a living as broker in the kidney trade.

     - I receive 12.000 pesos (300 USD) for every kidney I provide, tells Zeta (picture to the right). According to him, several brokers operate in other slum areas in Manila.

     As in many countries, there is a great need for human organs for transplantation in the Philippines. Only a fraction of relatives approached after the death of a family member accept donating organs for people in need. And not all patients have relatives willing to sacrifice one of their own kidneys.

     This situation makes some rich patients choose to open their wallet in search of a person who is willing to help save their lives.

Despair

     In Bagong Lupa hardly anybody donates their kidneys out of compassion.  Instead painful poverty and human despair are the motivating forces behind their acceptance when a broker like Dalmacio Zeta approaches them.

     - I would not have done it again, one donor, 27-year-old Napoleon Custodio (picture above), says.

     For him, what was promised to be a simple surgery, caused a number of problems.

      - I spent one year recovering. And even today I am not able to do heavy physical work. I also have to observe a number of restrictions, for instance as to what type of food I can eat, he says.

      In what seems to be a typical explanation in the Philippines, he says he made his sacrifice for his family. He received 75.000 pesos (1875 USD), of which half was given to his parents and the rest shared between himself and his six siblings.

     - Sometimes I cannot get job assignments because of my poor health. That makes me feel like I was cheated, he explains.  His marriage also broke down because of the problems.

     - No, I would not have done it again, Custodio repeats.

     - Rather I would have killed myself.    

Preliminary ban

     So far no laws have regulated the trade in human organs in the Philippines, a fact that has encouraged patients from rich countries like Japan and Saudi Arabia to travel here for a kidney transplantation.

     Recently, though, it became a hot topic. Authorities have issued a preliminary ban as more permanent regulations are being prepared. Few people, however, seem to think legislation will have a significant effect.

     The reason is obvious: It is a question of money. And it has to do with life, death and despair for both donors and recipients.

     A patient must get hold of a kidney donor himself, explains medical doctor Antonio R. Paraiso at the National Kidney Institute.

     Those without relatives thus often approach people like Dalmacio Zeta, who is an intermediary between donors and recipients. Doctors at the National Kidney Institute have noted that an increasing number of agents operate in this business.

    Doctor Paraiso says most doctors, although they are well aware of the existence of the trade,  try to keep the issue at some distance from themselves.
    He explains:

    - Some years ago a patient of mine needed a new kidney. However, he explained that he felt he could not ask any of his own sons to donate. Then one day he appeared with a donor: His maid's son. At that time i refused to do the transplantation. Later on, though, I have learned to put aside my own prejudices. That makes my job easier.

    Kidney broker Dalmacio Zeto explains that he gets most orders through a woman who also does business with several other agents. The donors must pass several medical tests before being accepted.  

   Yet Zeto still has a long way to go before being a wealthy man. He lives in an small shanty at about five square meters close to the beach. His previous home collapsed in a typhon.

Unpopular

   He is not very popular in the slum area. As we ask about directions to his place, others just call him "the pig". 

   - Many are envious because I have bought expensive things after completing deals, such as an organ or a karaoke player. Now all my money are lost, though, he says.

    According to doctor Antonio R. Paraiso a kidney transplantation costs about 10.000 USD plus whatever the recipient has to pay for the donor. The latter fee is normally much higher than what the donor himself receives as brokers make sure to take their own share of it.

    The National Kidney Institute now tries to make it more difficult for kidney brokers to make money, for instance by making the donor and the recipient meet each other face to face at the hospital.

    Paraiso, however, does not completely object to the idea of some form of compensation to people who donate a kidney to a non-relativ. Even within a family gratitude sometimes is expressed in monetary terms, he points out.

  - Regulations must be adjusted to our reality, and that being that there is an enormous need for kidney donors, he says.

This article was printed in the Norwegian newspaper Aftenposten on Saturday November 27, 1999