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Suddenly, what had existed largely as a kind of urban legend, a science-fiction horror story from a distant world, has become very, very real, right here on the streets of New York. Activists say that if it's happening here, it's likely happening in other large cities of North America, from Boston and San Francisco to Vancouver and Los Angeles.
The Chinese government published regulations in 1990"On the Use of Dead Bodies or Organs From Condemned Criminals"stating that for a prisoner to be a donor, prior consent must be given by that person or remaining family, unless the body is unclaimed. Human rights activists scoff at that statement, noting that since prisoners are often kept from communicating with family members, there is no one to claim the body, which is harvested and cremated almost immediately. The government also requires that medical teams involved in the procurement of organs act stealthily: "Surgical vans must not display hospital logos; surgeons must not wear hospital uniforms when at the execution site; guards must be present until the organ is removed; and the corpses should be promptly cremated following the removal of the organs."
Human rights groups seeking to determine the source of organs might try matching the dates of operations to dates of executions in the same city, but the method isn't reliable, especially since the government has taken to selectively publicizing its tallies. The Laogai Research Foundation says doctors speaking for the Chinese government claim regulations against contacting the family of a donor prevent them from revealing to patients where the organs come from.
The harvesting enrages physicians like Dr. Diflo. "I think it's a gross violation of human rights and very much at odds with what the transplant community tries to promulgate as the way to go about things. This does not involve appropriate consent. I don't think prisoners are given the option of donating or not donating. It's not done from an altruistic point of view," Diflo says. Even putting aside his reservations about the death penalty, Diflo says, "The central issue is the nonconsensual taking of organs and making human body parts a commodity."
The Laogai investigator agrees. "It's very obviously profit-motivated because if the person can pay extra then they might be able to move up an execution date, or have it arranged for later," she says. "And those who pay more get better treatment." She cites a case where an ethnic Chinese patient from Malaysia was allowed to die without anti-rejection medications when his money ran out.
The economics of human organtrafficking are powerful. Patients can live active lives on dialysisthanks to this technology, most don't need a kidney to survivebut the inconvenience and discomfort are considerable. Diflo says his patients were "obviously much more troubled by being on dialysis than by getting organs this way."
For patients, the cost of a transplant is far cheaper than a lifetime of dialysis, says Dr. André-Jacques Neusy, head of the dialysis unit at Bellevue and director of the NYU School of Medicine Center for Global Health. Both Bellevue and NYU Medical Center work with Gouverneur hospital in Chinatown.
Bellevue is a public hospital, so it takes all comers. Many of the city's sick immigrants end up here. "We call it the 'Bellevue Express,' " because patients head there directly from the airport, remarks Neusy. In addition to being the designated facility for the president and visiting dignitaries, the hospital offers extensive translation services.
Affiliated with the NYU Medical Center, Bellevue is Dr. Diflo's chief source of referral patients who have Chinese prisoners' organs. People who receive a transplant must remain under a doctor's care for an extended period. Thus, patients who buy a kidney from China's death row end up seeking treatment in American hospitals, where the cost can be supported by public funding. Diflo says his patients pay for their anti-rejection drugs with Medicaid and Medicare.
Though no patient would be denied treatment at Bellevue when arriving with an organ of mysterious origin, candidates for domestic transplants must be legal American residents. Even for those eligible candidates the wait for an organ can be extraordinary. There are now more than 75,000 people on waiting lists for organs in the U.S., according to the United Network for Organ Sharing, which maintains the national Organ Procurement and Transplantation Network under contract with the U.S. Department of Health and Human Services.
Fewer than a third of those people are likely to get their organs this year, the group said in March. Immigrants, both legal and illegal, will sometimes visit home rather than relocate, naturalize, or wait, Neusy says. "We've had patients disappear from the dialysis unit and reappear with a kidney," he notes. He was unaware of any who'd gone specifically for kidneys from executed prisoners in China. "It's disturbing to think we have professional colleagues on the other side that would condone this kind of thing," he says.
Dr. Nathan Thompson, also of Bellevue, concurs. "We have had patients who have gone against our advice and come back with transplants. Where they've gotten them I have no idea," Thompson says.