The Red Market (2 page)

Fatima has been searching for her daughter Zabeen for almost nine years. The cost of investigating the kidnapping has bankrupted their family, and they now live in a small concrete hutment on top of a building in Washermanpet, Chennai, India. Court records showed that Zabeen had been sent to Australia. Activists have been working to arrange a reunion for several years.

I
WEIGH JUST
a little under two hundred pounds, have brown hair, blue eyes, and a full set of teeth. As far as I know, my thyroid gland pumps the right hormones into the twelve pints of blood that circulate in my arteries and veins. At six feet two inches, I have long femurs and tibias with solid connective tissue. Both of my kidneys function properly, and my heart runs at a steady clip of eighty-seven beats per minute. All in, I figure I’m worth about $250,000.

My blood separates neatly into plasma, red blood cells, platelets, and clotting factor and would save the life of someone on an operating table or stem the uncontrolled spilling of a hemophiliac’s blood. The ligaments that keep me together can be scraped from my bones and implanted in the wounded knee of an Olympian athlete. The hair on my head could be made into a wig, or reduced to amino acids and sold as a leavening agent for baked goods. My skeleton would make a striking addition to any biology classroom. My major organs—heart, liver, and kidneys—could go on to prolong the lives of people whose organs have failed, and my corneas could be sliced off to restore sight to the blind. Even after death a determined pathologist could harvest my sperm and use it to help a woman conceive. The woman’s baby would have a value of its own.

Since I’m an American, my flesh sells at a premium; if I had been born in China, I would be worth much, much less. The doctors and brokers, no matter the country, who would move the pieces of my body through the markets stand to make a considerable sum—much more than I could as a seller—for their services. It turns out that the global laws of supply and demand are as fixed in organ markets as they are for shoes and electronics.

In the same way that a mechanic can swap out worn car parts for new ones and oil creaky joints to get an engine running again, a surgeon can prolong someone’s life by trading broken pieces for newer ones. Every year the technology barriers get lower and the process cheaper. But there’s no scrap heap for quality used human parts. Attempts to create artificial hearts, kidneys, and blood pale in comparison to the real thing. The human body is just too complex. At the moment the body can’t be replicated in a factory or lab. Which means the only way we can meet the demand for body parts is to find sources of raw materials in the population of living and recently deceased people.

We need great volumes of human material to supply medical schools with cadavers so that future doctors have a solid understanding of human anatomy. Adoption agencies send thousands of children from the third world to the first to fill the gaps in the American family unit. Pharmaceutical companies need live people to test the next generation of superdrugs, and the beauty industry processes millions of pounds of human hair every year to quench a ceaseless demand for new hairstyles. Forget the days of grass-skirt-wearing cannibals on tropical islands, our appetite for human flesh is higher now than at any other time in history.

There is a strange alchemy that happens when we decide that a human body can be swapped on the open market. Most people instinctively know that what makes humans special is more than just our physical presence—from the electrons and quarks that give us mass to the complex biological structures that sustain our every breath; there is also a sense of presence, which only accompanies life. For the purpose of this book and to make sense of it as I write, I give the human body the benefit of a soul.
¹
Losing that soul transforms a body into a jumble of matter.

Though we like to think that our bodies are sacred and above the hardscrabble logic of the market, the sale of human parts is booming. Several billion dollars’ worth of humanity changes hands every year. With almost six billion people in the world the supply is significant. There are just slightly fewer than six billion spare kidneys (or twelve billion if you are absolutely merciless) and almost sixty billion liters of blood in the global supply. There are enough corneas to fill a soccer stadium. The only thing stopping businesses from grabbing the potential profits are the rights to mine the resources.

Take, for instance, the market for adopted children. At the moment a family decides they want to bring in a needy child from a foreign country, they only have an abstract idea about that child’s identity. In their search for the perfect baby they refine their expectations based on the available baby market. They troll through online menus issued by international adoption agencies, read newspaper articles about desperate children in orphanages, and make difficult decisions about what particular set of characteristics will trigger the adoption.

Sure, at some point the child will be a member of the family, but to actually obtain one they have to engage with an often shady supply chain of middlemen and corruptible government officials, many of whom see children as little more than bodies. It is only after they have brought the child into their home that the child transforms from an abstraction into someone real.

It doesn’t matter what our moral position is on the subject, bodies are unquestionably commodities. And yet they are uncomfortable ones. As a product, bodies aren’t assembled new in factories filled with sterile suited workers; rather they are harvested like used cars at scrap markets. Before you can write a check and pick up human tissue, someone needs to transform it from a tiny piece of humanity into something with a market value. Unlike scrap, the price of a human body isn’t measured only in dollars. It is measured in blood, and in the ineffable value of lives both saved and lost. When we buy a body part, we take on the liabilities for where it came from both ethically and in terms of the previous owner’s biological and genetic history. It’s a transaction that never really ends.

LAW AND ECONOMICS RECOGNIZE
three types of markets: white, gray, and black. Black markets trade in illegal goods and services like guns and drug running while bootleg DVDs and nontaxed income fall into legal gray areas. White markets are the territory of everything legal and aboveboard—from the groceries that are purchased at a corner bodega to the income taxes that are dutifully filed every year. All three of these markets have two common features: the things being traded have real-world values that can be easily reduced to dollars and cents, and the transactions end the minute money changes hands. Markets in flesh are different because their customers owe their lives and family relationships to the supply chain.

Welcome to the red market.

Red markets are the product of contradictions that arise when social taboos surrounding the human body collide with the individual urge to live a long, happy life. If commodity markets can be figured with algebra, red markets require calculus. Every equation holds both a zero and infinity. Red markets occur on the cusp of major life-changing events for either the supplier or the buyer. Whether the buyer acknowledges it or not, flesh creates a lifelong debt to the person who supplied it.

Because of this bond and because we tend to reject the language of commercialism when dealing with bodies, all red markets also share a curious language of altruism throughout the transaction. Kidneys, blood, and human eggs are “donated,” not sold. Adoptive parents take in needy children, they’re not adding to the size of their own family.

And yet, despite these links, the dollar prices for human bodies and body parts are well established and the supply is, thanks in part to burgeoning populations in impoverished parts of the world, nearly limitless.

In Egypt, India, Pakistan, and the Philippines, entire villages sell organs, rent wombs, and sign away rights to their bodies after death—not only under duress, but also in mutually agreeable transactions. Middlemen who deal in human parts—often hospitals and government institutions, but sometimes the most unscrupulous criminals—buy for the lowest possible price while assuring buyers that the parts come from ethical sources. Though procurement is sometimes abhorrent, the final sale is often legal and usually sanctioned by the implicit moral dimension of saving human lives. The crimes are covered up in a veil of altruistic ideals.

Unlike any other transaction we are likely to make in our lives, buying on the red market makes us indebted to all of the links between the source of parts and the final outcome. There are few other transactions that immediately raise ethical red flags as buying parts of other people. The question of what makes an “ethical source” is one that every potential beneficiary of the red market needs to take seriously.

If we need our body to live, then how can any part of it possibly be spared? In a case of live organ donation, how can a sick person become entitled to the organs of a healthy person? What criteria have to be met to move a child from the third world to the first? Inevitably red markets have the nasty social side effect of moving flesh upward—never downward—through social classes. Even without a criminal element, unrestricted free markets act like vampires, sapping the health and strength from ghettos of poor donors and funneling their parts to the wealthy.

Proponents of unrestricted red markets often suggest that people who willingly sell their tissue benefit from the transaction. The money will supposedly pull them up from the depths of poverty into a higher social station. After all, shouldn’t we all be able to make decisions about what happens to our own bodies? The logic, presumably, is that human tissue is a last-ditch social safety net, and when sold can act as a lifeline to lift a person out of a desperate situation. The reality is that people who sell bodies and body parts rarely see their lives improved. Sociologists have long known that this is a fantasy.
²
There are no long-term benefits to selling parts of your body, only risks.

There is only one situation where someone’s social station can rise at the same speed as the price of a body part. And it only happens when the whole body is sold all at once: when babies enter the international adoption market.

With millions of orphans in the world, adoption alleviates, on the face of it, an important social problem. Children invariably move from precarious positions on the edges of society into financially stable, caring homes. But like any other market, adoptions are subject to the pressures of scarcity. The West, which accounts for the most international adoptions, demands lighter-skin babies, leaving orphanages racially skewed. Domestically, orphanages become an unfortunate lens into racial politics in America. White orphans tend to get adopted almost immediately by eager parents, while black orphans often grow up in the foster care system.

The problem is worse abroad, where the primary criterion isn’t the ethnicity, but rather the health of the child. In India, China, Samoa, Zambia, Guatemala, Romania, and Korea, poorly resourced orphanages are known to stunt child development. As terrible as it may sound, in these places—and across much of the third world—the business model of adoption most closely resembles the market for bananas. If either a child or a fruit spends too much time in storage, it isn’t worth much on the market. Only children who have had short stints inside the institutions have a chance of finding a home, and orphanages often reap lucrative adoption fees for every international adoption. While children do move upward in social standing through adoptions, the discrepancy between storage and a bill of sale means that adoption agencies need either a high turnover rate or an innovative way to acquire children on short notice. The problem has both legal and illegal solutions.

UNTIL THE 1970S THE
world experimented with open commerce in body parts. The battles over whether flesh should be legal or illegal were fought first, and most conclusively, over blood. In 1901 the Viennese scientist Karl Landsteiner discovered that there were four discrete blood types and helped usher in the era of safe blood transfusions. Prior to that, getting a blood transfusion was like playing Russian roulette. You might live, or you might die painfully, on the operating table, while baffled surgeons scratched their heads as the incompatible blood types coagulated. Landsteiner’s discovery was just in time for World War I, when hundreds of thousands of direct person-to-person transfusions helped keep soldiers alive on the battlefield. By World War II, blood banks had the storage capacity to make blood an essential weapon of war that kept soldiers alive to fight another day. Blood-collecting clinics met the surging demand by offering cash to anyone willing to give up a pint. The immediate benefit of readily available blood meant that doctors could perform more extensive surgeries than they had before. Blood loss was no longer an impediment to surgery. The development led to advances across the field of medicine.