Jeffery Avila looks nervous. At 16, he’s preparing to “donate” his kidney to a wealthy foreigner.
“I am a bit worried,” he admits, clutching his blood-type card, “but I haven’t got a job, and I want to help my family.”
Avila lives in a barrio in the South Port area of Manila called Baseco. The slum in the Philippines has a few nicknames – among them “The Kidney Market” and “One Kidney Island” – because so many of the men who live in the slum’s flimsy houses and around its open sewers have sold their kidneys to escape the dire poverty.
“My cousin, Nog Nog, sold his [kidney] and he’s fine,” Avila says of the 18-year-old relative. “I am sure I’ll be fine, too. The other men in this village seem healthy after the operation.”
As he speaks outside his ramshackle home, his father puts an arm around the teen reassuringly, but Avila still looks terrified.
The cash-for-kidney trade is flourishing worldwide. But it thrives the most in countries like the Philippines, where abject poverty and unclear laws combine to make the country a kidney market.
A loophole in the law allows foreigners to make a “voluntary gift” to a “donor” as an expression of gratitude, rather than a payment. In the eyes of the law, there is no trade.
Predictably, the loophole has been exploited by various “agents” and hospitals doing a thriving business – and, many argue, by the desperate foreign recipients buying kidneys and exploiting the poor.
Mark Schofield, a 43-year-old father of two from Wales, waited more than four years for a kidney transplant before, desperate and frustrated, he flew to the Philippines with $81,000 in savings to buy an organ from a living donor.
“I’m not prepared to lie down and play dead,” the former surfing champ said. “I know the moral argument about buying and selling organs, but I also know I have two young children whom I want to see grow up.”
He and his wife, Jayne, a nurse, investigated buying a kidney on the Internet. He said he was offered one in China and rejected it. Last year, China acknowledged most of the human organs used in transplants are taken from executed prisoners.
Instead, Schofield, who has a rare blood type, flew to the Philippines and found a Manila surgeon confident he could find a donor. When that happens, Schofield said, he will return for the surgery in a private Manila hospital, where conditions are clean and, for some, even luxurious.
As the industry grows and more foreigners – unable either to wait or afford their medical bills – increasingly rely on organ donors from elsewhere, the Philippines is one of the few places where paying a living kidney donor isn’t illegal as long as no third parties are involved.
According to the country’s National Kidney Transplant Institute, there are about 3,000 to 5,000 registered kidney transplants a year. Most of the recipients are Japanese, Chinese and Arab. There are a handful of European and American recipients.
It’s unknown how many Americans are going to the Philippines, China, India or other developing countries for transplants they can’t get at home. But American doctors warn that the organs may not be screened for infectious diseases – and that the quality of care after surgery is questionable.
It’s illegal in the United States to pay a donor for an organ.
Nancy Scheper-Hughes, the co-founder of Organ Watch, which tracks global trafficking in human organs, calls the trade “neo-cannibalism.”
“There is obviously no scarcity of organs you can buy from desperate people in the shantytowns who are willing to dismember themselves piece by piece,” she said.
Though it will cost Schofield his life savings, the living donor will get no more than about $2,100. At One Kidney Island, of 20 people interviewed, the most any donor had ever gotten was $2,300.
While $2,000 for a kidney seems a small amount, to the people of Baseco, it’s a small fortune. More than 16 percent of the Filipino population live on less than a dollar a day; 40 percent live on less than $2.
Take Jerry Villegas, 33, who heads a family of seven. He sold his kidney four years ago for $2,300 to a Japanese man. After the agent took his fee, Villegas received less than $2,100.
“My house had just . . . burned down in a fire,” he said. “There was nothing left – just the stone base. I had five kids at the time, and I was desperate to rebuild the place, so I went ahead with the operation.
“At the time, I really needed the money. I wouldn’t have done it if my house hadn’t been destroyed. We had nothing left, and my kidney was the only thing that I had to sell.”
Villegas’ house, like most others, is a collection of scraps of wood nailed together – it houses his seven kids.
“I still have nothing,” he said wistfully. “All the money has gone. But my health is OK. I’ve had another two kids since the operation.”
Juanlerio Avila, 38, is one of several “kidney agents” looking for business in the port slum. He lives in a small house that blends in with the rest of the ramshackle housing.
He became an agent more than 10 years ago, when he was also in “the lineup” – the queue of recruited, waiting and willing kidney donors. While he was at a hospital for a blood test, he met “Lynn,” a secretary who had contacts with doctors in all the big hospitals. She wouldn’t reveal her last name.
“She came to see the village and asked me to arrange for people to go there for donations,” Avila said. “She makes sure I have credit in my phone. She normally calls once every couple of months.
“She’ll call and ask is it possible for me to arrange for certain blood types. I round up some of the people I have recruited and take them for a blood test. All of the people get about $12 expenses, and I get about $17 expense for each trip I make. For each kidney donor, I make 10 percent, about $239.
“I have taken hundreds of people to the hospital, and about 70 of them have donated their kidneys.”
He said the kidney trade is “fiercely competitive.”
“There are agents touring the slums promising cash in hand for a few nights in hospital and a few weeks of pain,” he said. “There are many more willing donors around here.”
That includes Avila’s neighbor, Ricky, who wants to sell his kidney.
“He’s just waiting and hoping,” Avila said.
“I have people coming here all of the time asking me if I can help them [to arrange to sell their kidneys]. We need more recipients because there is a big supply of kidneys.”
A recent study by the University of the Philippines found that 3,000 people from the Baseco slum alone have donated one of their kidneys in exchange for as little as $1,670.
The fact that children are being recruited as kidney donors illustrates the competition among agents at Baseco to provide the best-quality organs.
And as a result, the population has become like a group of walking kidney incubators for foreigners suffering renal failure.
Recent reports highlighting the number of donors at Baseco have attracted the attention of authorities, who have stepped up surveillance in an attempt to capture agents cashing in on the trade.
“I have to keep myself hidden away here,” Avila said. “The police are sometimes investigating and the [National Investigation Bureau] has been here a few times. “Recently the local detachment police commander came here and ordered villagers to stop donating kidneys. When I take a group to the hospitals, we have to use a back door.”
One of the top Manila hospitals, St. Luke’s, where Avila has taken many of his recruited donors, has recently come under investigation. It’s alleged that doctors and nurses there are involved in recruiting and profiting from the trade in organs.
Slums like Baseco show few signs of having benefited from the kidney trade; men who donated kidneys a few years before remain poor and dispossessed. The best the donors can hope for is a brief respite from the acute poverty and daily struggle to survive.
Romeo Roga, 42, bought a house, but it was swept away during a typhoon. Another man bought a karaoke machine.
Celedinio Pindengi, 32, donated his kidney five years ago for $2,029 and was in the bed next to the recipient.
“Once you get back from the hospital, you are a rich man for a while,” he said. “I bought myself a small house in Sama Province, my hometown, and some equipment for the hairdressing salon I worked in.
“The recipient is the Filipina wife of a Brazilian,” Pindengi explained. “She was 42 at the time. I feel better because my kidney saved her life. I still have that feeling, even if I’ve spent all the money and I am poor again. I just wish my kidney would grow back, and I would happily donate it again.”
The country only recently seems to have admitted the problem.
Last February, the Philippines Department of Health admitted to “rampant” trafficking in human organs. But the subject is a prickly one.
Some lawmakers are urging guidelines to protect Filipinos against the commercial export and sale of human kidneys. But others want the country to become an Asian hub for “medical tourism,” the practice of traveling to other nations for health care.
“We end up with a ‘bidding war,’ where the healthy organs are up for sale to the highest bidder,” Philippine Sen. Richard Gordon recently said. Gordon is pushing for guidelines on the trade.
“It is a sign of very dark times for the Filipino people when reports show our country to be one of the top sources of organs for sale.”
As the country pushes to become a major player in the medical tourism industry – worth about $60 billion annually – it’s likely the numbers of foreigners coming to the Philippines looking for kidney donors will skyrocket.
Currently, there are 50,000 Americans and 6,500 British waiting for a kidney transplant.
In Manila, the departments of health and tourism have joined forces to promote the trade in the Philippines, hoping the country will compete with Thailand, Malaysia and India.
“If the growth of health resorts in Asia, including the Philippines, is anything to go by, there would seem to be a huge potential to develop health tourism,” said Tourism Secretary Roberto Pagdanganan.