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Another Bellevue physician, Dr. Gerald Villanueva, sent Diflo a Chinese American woman who had appeared at the hospital, implanted with a death row kidney. Suffering from hepatitis, the patient became one of the complicated cases referred to NYU. Only after talking to Diflo did Villanueva realize the source of her transplant. "I guess we've all heard about things like this, but it kind of gets you when, for the first time, you see it," he says. "There are things we read about, but when you see it, it's still surprising. I guess it shouldn't be, huh?"
Diflo says that doctors seeing scores of patients daily simply don't have time to probe more deeply into their patients' histories, especially when language is a barrier. And they're not paid to argue with their charges. "I don't really see that confronting them about the ethics involved will really serve any useful function. In addition, we see them during our office hours, in which we can see as many as 50 patients in three hoursnot really time for prolonged ethical discussions," he says.
Most doctors interviewed for this article agreed that the majority of those organs aren't coming from China. There's a thriving black market in organs sold by live, willing donors in poorer nations with medical know-how, like India. "I believe that both are morally and ethically reprehensible," Diflo says. "If there are degrees of reprehensibility, however, China wins hands down" because the organs are coming from the executed, who are deprived the right of refusal, for profits. Unlike with desperately poor live donors, that's cash that neither the victims nor their survivors will ever see.
Nearly every country touched by the organ trade has laws barring the business; India and Japan are among those who've enacted them only in the past decade as the tide of the organ trade rose. In the United States, the practice of flying to China for organs becomes a crime if arrangements were made for a fee on American soil. But as with the war on drugs, many experts argue that the only real solution to fighting the organ trade is by addressing the demand. People need organs quickly, through humane means. Doctors interviewed floated several ideas.
The most ready cure is for more people to make provisions that their organs be donated at the time of death. Belgium achieves this by presuming organ donation, requiring that people opt out. The doctors noted that while organ donor cards (like those on drivers' licenses) might help tip the balance in discussions with family, the form isn't a binding agreement. Families can still have the final say. And even with that acceptance, familiesparentsmust be willing to say goodbye at times when they might falsely believe there's a shred of hope.
"Brain death is a hard concept to get across. Japan only recently accepted it as a legal definition," explains Dr. Dale Distant of the SUNY Downstate Medical Center. "How does a person take this action when their loved one is warm, his heart's going, a machine is making his lungs go up and down; when for all the world he's just in a coma?" In many corners of the world, including part of Asia, people hold strong, entrenched taboos against violating the body after death.
Dr. Neusy would like to create centers in less medically advanced nations where the needy might be screened and matched with potential donors, usually family members, and then prepared before finally being brought together to the U.S. and other rich nations for the operation. Others promote the free market as a way to meet the demand for organs. One group of supply-siders operates a Web site and on August 26, 1999, a kidney from a live potential donor was offered up on eBay before site managers closed the bidding down.
On the furthest fringe, some scientists are hoping to master techniques that might allow newborns in future generations to be equipped with a genetic repair kitstem cells or other tissue frozen at birth or even later for eventual cloning into needed organs. Enterprises like the longevity company YouthCell have been founded on this premise. Scientists are also trying to perfect transplants from livestock into humans.
But social and technological change takes time. Meanwhile, no one expects Chinese bureaucrats to readily forsake an easy source of income like selling organs from the laogai. "If you have a government more or less imposed on the people, you can do that, so in China it's not a problem," says Distant.
Diflo, for his part, says he came forward not to seek attention for himself but in hopes of kicking off public discussion and scrutiny of the issue. "I don't see myself going on a world speaking tour," he says. "The whole reason I spoke up about this is that I was having a difficult time taking care of these patients because of my own repugnance at what had gone on and how things had happened. It really comes from a more personal place. It comes from my own outrage."