The Red Market (7 page)

The 2006–2007 Young Brothers catalog takes care to inform customers that it abides by the law. It lists a wide assortment of bones at wholesale prices, noting that they’re “for sale in India only.” Yet Indian skeletons are somehow making it out of the country anyway.

In Canada, Osta International sells human bones throughout the United States and Europe. The forty-year-old company offers to fill orders immediately. “About half of our business is in the States,” says Christian Ruediger, who runs the business with his father, Hans.

Ruediger admits that Osta stocks bones from India, presumably smuggled out of the country in violation of the export law. Until a few years ago, he got them from a distributor in Paris, but that source dried up in 2001—around the time Javed Khan raided Young Brothers. Since then, he has bought his stock from a middleman in Singapore. He declines to provide the name. “We want to keep a low profile,” he says.

Of some thirty institutions I contacted in the course of research, the handful that admitted to buying bones in the past few years declined to reveal their sources or speak on record—though Osta’s name did come up twice. “I bought a complete skeleton and a dissected human demonstration skull from Osta,” a professor at a prestigious Virginia college says. “Both were excellent.”

Another Osta customer is a firm called Dentsply Rinn, which offers a plastic model head containing a real skull, used for training dentists. “It’s very difficult to procure human bones,” marketing manager Kimberly Brown says. “Our requirements stipulate that the skulls must be of a certain size and grade and without certain anatomical defects. But we have no requirement for their origin.” The skull is a bestseller in both the United States and the United Kingdom.

Indian authorities express a similar lack of concern. Although the international bone trade violates the national export law and local statutes against grave desecration, officials look the other way. “This is not a new thing,” says Rajeev Kumar, West Bengal’s deputy inspector general of police. “There’s no evidence that they were killing people.” The police took an interest in Biswas only because the bodies of a few important people went missing. “We are trying to implement the law based on the stress society places on it,” he adds. “Society does not see this as a very serious thing.”

The need to study human bones in medicine is well established. The need to obtain the informed consent of people whose bones are studied is not. The reemergence of India’s bone trade reflects the tension between these requirements. While the supply of human skeletons targets the recently dead, the even more dangerous practice of collecting living kidneys from slum dwellers is merely a modern incarnation of an ancient Indian practice.

Meanwhile, the bone factories of Kolkata are back in business.

The outside of Young Brothers, an anatomical supply company in Kolkata, India. Witnesses said that this run-down office building was a center of the Indian red market in human bones after the 1985 ban. The workers here used to dry human bones on the roof and clean the corpses of their flesh inside. The office is still active, but it is difficult to know what happens behind its closed doors.

Kala Arumugam shows a long scar along her abdomen where surgeons extracted her kidney. Although the surgery took place several months before this photo was taken, she still has trouble working. She earned $1,000 for selling her organ.

T
HE DAY AFTER
Christmas 2004, an earthquake occurred off the coast of Banda Ache, Indonesia, sending shockwaves racing across the ocean floor and culminating in a massive burst of energy that smashed into the shores of India and Sri Lanka. The tsunami claimed more than two hundred thousand lives and left a cataclysmic wake of families torn apart and a seemingly endless stream of refugees. While NGOs and governments poured aid into the area to rebuild the lives of victims, a few entrepreneurial hospitals and organ brokers saw the tragedy as an opportunity to make a fortune peddling the kidneys of refugees.

In Tsunami Nagar, a desperately poor refugee camp for tsunami survivors in India’s Tamil Nadu province, Maria Selvam is the most respected man. For two years this former fisherman has spent most of his days arguing with government bureaucrats for basic resources that had been promised to them by the international community. All he wants is for the people in the three settlements that he presides over to once again be able to make their livings from the sea. When I meet him almost two years after the tsunami, the camp is little more than a holding area with hopeless concrete rows of dismal houses. Raw sewage runs in the gutters by people’s homes, and employment prospects are as scarce as the resident children’s access to education.

As the village’s only elected official, Selvam is the closest thing the refugees have to a celebrity. His photograph is plastered on the sides of buildings and above the wide iron gate that is the camp’s official entrance. But his popularity has begun to wane. Local youths have thrown rocks through his posters and carved away the eyeballs from the images on their walls. His crime: Trying to stop the flow of organs out of Tsunami Nagar.

“It used to be that only one woman a month would sell a kidney to a broker, but lately it has gotten a lot worse,” Selvam says. “Now it’s two women a week, and I know I have to do something.”

While we talk a woman in a blue and highlighter-yellow sari frowns at him from across the courtyard. She looks like she is in her midforties, but I suspect that rough living in an Indian slum might mark her closer to thirty. The edge of a foot-long scar crests across her exposed abdomen over the fold in her sari. Selvam tells me that just about every adult woman here has a scar like that. “I haven’t been able to stop a thing,” he says.

Weeks after the wave swept away his village, the government relocated the twenty-five hundred residents from their fertile fishing grounds to this worthless patch of land. The settlement is next to a giant power station that pumps electricity to Chennai, and yet power outages are still common here. The villagers’ needs are modest: they want fishing nets and a small three-wheeled rickshaw so that the fishermen can haul the community’s catch to market. Ever since they were relocated, Selvam has lobbied the high courts to send the cash and resources they promised.

His pleas fell on deaf ears until January 2007, when he had had enough. That was when he decided to play the only card he had left at a meeting scheduled to take place in front of one of Chennai’s most powerful high-court justices.

The plan was simple enough. By using the testimony of poor women who were forced to sell their organs, the court would be shamed into finally administering aid. After all, how could the court
not
empathize with his village’s plight once it learned about the level of desperation fostered by government inaction.

In a crowded community hall the judiciary listened to Selvam’s breathless testimony and the stream of courageous women who volunteered their stories. They said that kidney brokers had always been a problem—even before the tsunami—but now they were relentless. They showed their scars and Selvam waited eagerly for the judge to open up the state’s coffers.

Things didn’t go according to plan. The judge listened carefully, but the aid was tied up in India’s obscene bureaucracy, not because of a lack of judicial will. To make matters worse, the five hundred men and women in the audience nearly rioted when they realized that Selvam had betrayed their secret. Showing the women’s scars shamed the entire village. Everyone knew that they were poor, but being poor enough to sell organs was another thing. Youths shouted that he had dishonored the women of his community by exposing what they felt should have been a private matter.

The revelation didn’t push the government into sending the camp the nets and vehicles he requested. All it did was expose the village’s dirty secret to the press. Local newspapers began covering the scandal, and soon the state’s Department of Medical Services uncovered evidence that fifty-two Indian hospitals were involved in what amounted to one of the country’s largest coordinated organ thefts ever.

Even though Selvam had failed in his goal, the investigation was an opportunity to turn the tide against the practice of kidney selling and bring brokers and corruptible health officials to task. Public outcry against the scandal forced the state-level ministers to form an offical response.

The job fell to Tamil Nadu’s health minister, K. K. S. S. R. Ramachandran.
¹⁰
A former political party street tough who is known by the impenetrable string of initials in front of his name, he earned his stripes with the government after a political rival threw a jar of acid in his face. (The scars make him noticeable at party meetings.) To the surprise of locals he forwent police action. Rather than try the issue in the courts, he planned to resolve it through mediation. He gathered the state’s top transplant doctors in a room in a spur-of-the-moment conference and made them swear to stop selling organs and try to use more cadavers instead. Resolved to let the doctors police themselves, he let the community off with only a token slap on the wrist.

But he had to make some concessions to a public that was out for blood. To show that he was tough on crime, the ministry closed two of the smallest and most ill equipped nursing homes that were tangentially linked to illegal transplants. The rest of the city’s transplant teams breathed a sigh of relief. Even though clear paper trails linked dozens of surgeons to the previous year’s more than two thousand illegal kidney transplants, within a few months Chennai was back to business as usual.

For Selvam and thousands of other poor Tamilians who never got their equal share of India’s rising fortunes, selling organs still sometimes feels like their only option in hard times.

“In other parts of India people say that they are going to Malaysia or the United States with a glimmer of hope in their eyes. In Tsunami Nagar people speak that way about selling their kidneys,” he tells me.

Tsunami Nagar is far from unique. The ample supply of available organs in the third world and excruciating long waiting lists in the first world make organ brokering a profitable occupation. Not only has demand for kidneys risen steadily over the last forty years, but poor people around the world often view their organs as a critical social safety net.

Since the inception of antirejection drugs like cyclosporine, international cabals of doctors and corruptible ethics boards have slowly transformed slums in Egypt, South Africa, Brazil, and the Philippines into veritable organ farms. The dirty secret of the organ business is that there is no shortage of willing sellers.

A nephrectomy taking place at a hospital in Chennai, India. In 2006 and 2007 almost all of the women in a tsunami refugee camp nicknamed “Kidneyvakkam” sold their organs to a cabal of brokers and middlemen. Patients from India and abroad flock here to buy human organs at a discount and to escape long wait times in their home countries.

For someone living on less than a dollar a day, $800 is almost an unthinkably large sum of money. The payment offers an unfair incentive, coercion that pits abject poverty against a global capitalist enterprise.

If the organ shortage could be reduced to numbers and figured like an algebra problem, it would not be difficult to find living donors for the one hundred thousand people on the United States’ organ transplant waiting list. Third world sellers are easy to find, and they offer a cost-effective solution to the problem. A transplant at an Indian hospital costs about one-twentieth of what it does in the United States.

The economic logic is so persuasive that several American insurance agencies want a piece of the action. Two of them, IndUShealth and United Group Programs, estimate that it is cheaper to cover the cost of a cheap kidney transplant abroad than paying for years of expensive, and ultimately lethal, dialysis treatments at home. These and other companies have relationships with hospitals in India, Pakistan, and Egypt that can arrange organ transplants almost on demand. Outsourcing plans like theirs were so persuasive that in February 2006 the West Virginia legislature considered a formal health-care plan for state employees that offered rebates to patients who chose to get their transplants done in a foreign hospital. By the time of publication the law was still pending, and yet little seems to have changed in the overall situation. (It should be noted that IndUShealth’s website states that while the company will pay for the transplant, patients seeking live-donor tissue have to arrange for their own donor, something relatively easy to do with the right hospital contacts.) For recipients, the red market has a clinical leg up on the legal competition. Living-donor transplants are by and large more successful than cadaver donations. Patients who get kidneys from paid donors live longer than those who receive their organs from brain-dead patients.

Despite the cost and health benefits of live organs, there is simply no ethical justification to cross legal jurisdictions and buy tissue. Brokers can make purchasing an organ easy, but organ sellers don’t talk about how selling organs changed their lives for the better.

Almost every woman in Tsunami Nagar has a story about how organ brokers took advantage of her during her most desperate hour. One woman, Rani, complains that since her operation even walking across the village’s dirt road hurts so severely that she has to break it up into small, manageable steps.

Rani’s troubles began when her husband lost his fishing job and took up drinking full-time. Perpetually without money Rani was unable to provide even a modest dowry when her daughter Jaya got married, and Jaya’s mother-in-law and new husband took out their disappointment on Jaya. They forced her to do extra work, doled out beatings when they saw fit, and generally made her life as miserable as possible. Within a month, she came home to her mother, said good-bye, and then tried to take her own life by drinking a quart of pesticide.

When Rani found her daughter passed out on the small family cot, she gathered her up in her arms and carried her to a local hospital. Doctors there had seen their fair share of suicides-by-pesticide and had neutralizing agents ready. In a few hours they stabilized her, but she would have to remain in the intensive care ward for more than a week. Rani couldn’t afford the extended hospital stay, and staff members said they would have to stop treatment without a payment guarantee. Rani had to come up with money quickly or, they told her, her daughter would die.

Over the years so many people had sold their kidneys in Tsunami Nagar that wry locals began calling the camp “Kidneyvakkam” or “Kidneyville.” Brokering kidneys was a cottage industry, with women who already had sold their kidneys brokering sales for their friends. Brokers routinely quote a high payout—as much as $3,000 for the operation—but usually only dole out a fraction of the offered price once the person has gone through it. Everyone here knows that it is a scam. Still the women reason that a rip-off is better than nothing at all.