It was hardly surprising when a Dutch TV network decided to brave a Europe-wide storm of controversy this month and air a TV reality show featuring a dying woman offering her kidney for transplant. From Chile to China, tens of thousands of kidney sufferers pinning their hopes on donated organs face waits of three to four years -- when they survive.
Eight Mexicans die a day hankering for organ transplants, and even in wealthier Europe, 10 deaths are registered daily for want of a donor. With demand outstripping supply, and medical red-tape differing from one country to the next, transplant tourism and trafficking in human body parts are rife -- areas under scrutiny by trade and ethical watchdogs.
The Dutch reality show, bagged for poor taste and questionable ethics, finally turned out to be a do-good publicity stunt -- an actress had been hired to play the part of the terminally-ill woman and the organisers said the aim was to spotlight the global shortage of organ donors. The strategy worked. The show attracted 1.2 million viewers and that same day 12,000 people in The Netherlands applied to donate body parts. "We worked on this stunt for a year," said Laurens Drillich, director of BNN channel, whose founder died waiting for a kidney transplant.
"We received a lot of international attention for a problem that does really exist." Oscar-winning Stephen Frears highlighted the drama of organ trafficking from poor to rich in his 2002 "Dirty Pretty Things," and Pedro Almodovar's Oscar-trophied "All About My Mother", touching on transplants, goes on stage in London's Old Vic in September.
But despite several transplant-themed prime-time Brazilian TV soaps, with titles such as "From Body to Soul," and an excellent website (ww.adote.org.br) aimed at drumming up donors, at the end of 2006 a total 66,019 people were still kicking their heels awaiting transplants in the South American country. Of these, 32,155 needed new kidneys. What were their chances? In 2006, there were a mere 2,950 kidney transplants in Brazil, according to the Brazilian Organ Transplant Association.
"In Peru too the problem is extremely serious," Hugo Torres, who heads the transplant office ESSALUD, told AFP. Only one out of a million people there is a registered donor. According to worldwide data collected by AFP, kidneys far and away top the transplant wish-list, but no global statistics are available on the number of people who die waiting. In the United States last year, 6,287 transplant-seekers died (more than 96,000 are currently registered), according to the Organ Procurement and Transplantation Network.
In China, 1.5 million people need transplants each year, but only 10,000 obtain them. Registration for donorship differs from country to country, but in many parts of the world endemic shortages are compounded by families refusing to hand over organs even against the deceased's wishes. In Chile, Cuba, India, Jordan and Thailand for example, relatives have the last say irrespective of whether the donor made a pledge when alive.
In Australia -- with one of the world's lowest organ donation rates but highest survival rates for recipients -- families veto one in three donations despite the deceased's wishes, according to Donate Australia. Churches generally support or even encourage organ giving, with Mexico's Catholic authorities for instance viewing donorship as an act of charity, self-sacrifice and brotherly love. Even Jehovah's Witnesses agree, while demanding organs be drained of blood before transplantation. Buddhism too considers donations a form of merit-making, said Yuwadee Attajarusit at the Thai Red Cross Organ Donation Centre.
But in officially atheist China, low donorship is in part blamed on cultural attitudes holding that the soul of a person buried in a form less than whole could court trouble in the after-life. The same applies to living donors in Japan, where life and death are not based on brain death -- the end of mental activity -- but on cardiac arrest, because body parts are seen as part of the personality or soul. One answer to organ drought would be to get people to opt out of donorship rather than to opt in - or register as a donor.
Under this system, body parts required for transplant would automatically be lifted from all deceased bar those "opting out" of the system -- or specifically refusing to donate. Austria, Argentina, Belgium and Spain have such systems. In a bid to increase supply, the European Commission last month called for an EU-wide donor card. While 81 percent of European citizens support the use of organ donor cards, only 12 percent have one.
"Thousands of lives are saved every year in Europe by organ transplants. Yet many more lives could be saved if we could reduce the current shortage of organs," said EU Health Comissioner Markos Kyprianou. Almost universal consensus has it that human organs not be for sale (though operations do come at a cost not all can afford). But failing a massive increase in supply, trafficking is bound to continue, with the poor selling parts of themselves to the rich.
Medical journal The Lancet says 66,000 kidneys were transplanted in 98 countries in 2005, or only 10 percent of the estimated need. Transplant tourism, the term often used for organ trafficking, accounts for around one out of 10 transplants, it said last week. China, which denies charges of harvesting organs from executed prisoners or allowing clinics to collect from road accident victims, last month introduced its first regulations banning trade in organs. But wannabe transplants may simply go elsewhere, such as Pakistan, where The Lancet quoted reports stating that in some poor villages, almost no one has two kidneys.
"As long as the demand for organs outstrips supply, punitive measures will be ineffective: organ trafficking will just go further underground," The Lancet said last week. "Initiatives such as the proposal for the EU-wide donor card are urgently needed," it said. "Otherwise, although ethically and morally suspect, the case for legalising and regulating the commercial sale of human organs may appear to have the upper hand."