Blood Banking

Scott Carney

Tissue and organ transfers are assumed to go from the healthy to the sick — not the poor to the wealthy.

Interview by
Cyrus Lewis

It’s surprising that more ink has not been spilled on the subject of tissue and organ economies. Blood farms in India, the human egg trade in Cyprus, the spike in kidney sales in post-tsunami Indonesia, the clinical labor performed all over the world for pharmaceutical companies — every year, several billion dollars’ worth of human fragments and fluids exchange hands, in exchanges that are as often as not illegal.

We typically envision this transference from the healthy to the sick. But it is just as often a transfer from the poor to the wealthy. Consequently, new biotechnologies and their underlying economic and juridical systems will have a large part to play in the unfolding of international and national social orders.

These issues hang like a pall over two recent studies that have partially corroborated the pop culture conviction that vampirism holds the key to elixir of life. Demonstrating that blood from young mice rejuvenates the muscles and brains of old mice and temporarily reversing aging, these studies seem to point to an exciting panacea against dotage and death.

Until one considers: Where would all the young blood come from? It’s easy to imagine a vampiric elite plugging into blood bags from plebeian youth at the end of a long day.

We can already see a collective sense of dubiousness to the idea of organ and tissue commodification in the international use of the word “donor” rather than “seller” in almost all instances of organ procurement. Unfortunately, as Scott Carney illustrates in The Red Market, a disturbing book of reportage from the frontline of organ and blood trade, this altruistic language is a fig leaf that covers highly exploitative practices.

Given that Matt Damon won’t be able to save us when the elite move into their compounds and refuse to share their med-bays, we must raise the profile of organ and tissue trade. Jacobin assistant editor Cyrus Lewis spoke recently with Scott Carney about his views on red markets and the vampire mice studies.

Cyrus Lewis

The history of blood trade in the latter half of the 20th century in many ways sets the stage for the problems belonging to organ and tissue economies today. This history leads to the passing of the National Organ Transplant Act of 1984, in large part a result of the impact made by Richard Titmuss’ 1971 book, The Gift: From Human Blood to Social Policy.

You note that this was a game-changer for trade in tissue and blood globally. Can you outline what precipitated the passing of this legislation?

Scott Carney

Once the technology became available to move blood from one person to another safely, there were two or three basic schools of thought about what the best way to do it would be. The American solution was to buy blood from the community at large. The offer of cash attracted mostly poor people from skid rows around major urban centers. The other way to get blood was on a volunteer basis.

What Titmuss showed was that when you buy blood, you have increased risk for certain blood-born illnesses like Hepatitis. The volunteer system, which was more popular in the UK, was safer because it drew on people in less desperate circumstances.  There’s a new book out by Kara Swanson called Banking on the Body that really dissects the history of the blood business that is worth a read for its historical analysis.

Cyrus Lewis

You argue that the idea of the “gift” economy that underwrites tissue and blood economies is basically a canard. As you point out, costs do not disappear, but in fact migrate to the attendant operational services where the cost of procurement is simply tacked on to bills for procedures.

The situation is further aggravated by medical privacy standards which make it impossible to discover the links between “donor” and recipient. In the worst instances, this creates shockingly exploitative black markets. You’ve seen the worst of the worst in this regard. Can you briefly discuss the blood farm you came across in Gorakhpur?

Scott Carney

Right. Just because someone gives blood to a place like the Red Cross doesn’t mean that the Red Cross won’t sell that blood to the highest bidder. There’s a real double standard in all the body parts businesses where so-called volunteer tissue is still incredibly profitable. The situation is only exacerbated by the fact that the medical establishment anonymizes tissue and blood donors in order to “protect” their identities. The problem with that protection is that it provides fantastic cover for criminals who source flesh unethically.

In the case of Gorakhpur, one particularly heinous crime happened when a man started kidnapping people from a railway station and keeping them locked up in iron sheds behind his house. He drained them of a couple liters of blood until they were minimally conscious. He kept them as one might a cow, draining a pint of blood every week or so. He made a lot of money that way and when the cops finally busted him they found seventeen men in his custody. The survivors said that many others had died.

Cyrus Lewis

Are enterprises like the one in Gorakhpur especially anomalous? Or do they merely represent a more egregious example of business as usual? And to what extent are seemingly far distant and barbaric practices enmeshed with medical networks of the global north?

Scott Carney

The blood farms in Gorakpur were definitely on one end of the spectrum. They rank right up there with the Chinese detention centers where prisoners are executed on demand for their organs. For a long while — and possibly still today — you could call up a military hospital in China and buy a kidney for as little as $50,000. The prison officials had blood typed all the prisoners in custody and would get you a matched organ in as little as a week.

The problem is that once you start looking at the body as if it is a commodity there is no limit to the inhumanity that one person or government might enact on its less protected citizens.

What happened in Gorakpur is certainly an extreme example, but I wouldn’t say that it’s impossible for similarly terrible things to occur in developed countries. Indeed, it’s still reasonably common for American pharmaceutical companies to enlist in the global south in potentially lethal clinical trials that would never get green-lit back at home.

I’m not so sure how different the blood farms in Gorakpur really were from the time that prisons in Arkansas sold inmate blood to shore up their budgets [in the 1960s and 1970s]. In fact, that episode helped spread HIV around the world (see here.) Yes, Gorakpur was an oddity, but the reason it happened boils down to the structure of the overall system.

Cyrus Lewis

Given the unsavory nature of much of red market sourcing, the recent experiments conducted on mice that demonstrate the rejuvenating nature of young blood injected into older mice seems to offer food for thought. Human tissue would be solicited with no resort to a life saving rationale (to say nothing of the class dynamics that would inevitably be in play in the absence of socialized health care).

Do you think that such developments could drive a more engaged public interest? If not, what steps do you think can be taken to create a broader dialogue about red markets?

Scott Carney

These experiments offer a sort of hope that is both tantalizing and quite dangerous. Surely, if the technology matures and really is as life saving as the hype says it will be, then everyone can and should be happy.

However, this techno-optimism has a real dark side that I write about in the book. What happens when we all believe that these medical miracles are right around the corner? While we’re waiting for them, people on transplant lists feel entitled to the best regenerative medicine available at the moment — which is to say, they feel entitled to the body parts of other people.

The revolution of stem cell medicine has been just “ten years away” for almost fifty years now. We’ve grown up reading about their speculative benefits. We assume that one day we’ll be able to order up a perfectly matched kidney or reverse our aging process with an innovative lotion of some sort.

In this futuristic world, body parts won’t come from people, they’ll be ethically grown in a lab. I hope this happens. But faith in the progress of medicine doesn’t answer the ethical problems of the present.

What I think we need right now is a conversation about where organs and body parts actually come from. We need to rip back the veil of anonymity in body part transactions and allow a public auditing of every single kidney transplant, bone graft, and pint of blood. People’s body parts shouldn’t be widgets in a giant medical infrastructure — they should be treated as if they retain some level of personhood. Otherwise the person who donated, or had their body part stolen, is invisible.

Cyrus Lewis

Titmuss’s work belongs to the British postwar welfare state. His conception of blood as a public resource is very much in keeping with the postwar creation of a comprehensive National Health Service and an ethos of allocation according to need. His work, seen in this light, appears yet another victim of increased clawbacks, deregulation, and fiendishly complicated financialization.

What contemporary public protections do you see as necessary in the face of the additional complications to red markets created by intellectual property developments in biomedicine and biotech?

Scott Carney

We need to make the market for human body parts completely transparent. If you are suffering from kidney failure, the doctor should not say to you that “you need a kidney” or you will spend the rest of your life on dialysis. Instead the doctor should say that “you need someone else’s kidney.” Patients need to realize that parts of people are not interchangeable, but that they require real sacrifices.

In practice, this means that every recipient and donor should be able to trace the path of the organ or tissue all the way along the supply chain. It’s a pretty radical idea, but I think it’s the only way to limit the abuses.

Cyrus Lewis

Anthropologist Nancy Scheper-Hughes has written extensively about bioethics. She describes the commodification of organs and tissue as a “new form of late modern cannibalism.” She calls for all organ donation to be voluntary and uncoerced and greater medical oversight in this regard. What do you think of a moratorium on organ sales? In what way would this be different than the scenario that exists now?

Scott Carney

I don’t think I would have begun researching this topic if I hadn’t first read Nancy Scheper-Hughes’ work when I was in graduate school. I agree with much of what she says, but might be a little more flexible on the issue of organ sales. It might just be impossible to completely remove the market from the system of tissue exchange that exists today. You might be able to stop payments to donors, but a transplant recipient will still pay hundreds of thousands of dollars to the hospital for their medical services.

So what I propose is making the market transparent. Let everyone know exactly what is happening, and who exactly is participating in the exchanges. Open up the path that every body part takes through the medical system to public scrutiny. I think you’ll see a lot fewer abuses if middlemen are held accountable for their actions rather than being hidden behind a cloud of anonymity.

Cyrus Lewis

It is arguable that determining the coercion experienced by donors is impossible, given existing inequalities at both the national and international levels. What do you think of this apparent impasse? Are there reforms for which you would like to see greater advocacy?

Scott Carney

If you make markets for organs legal, then the first problem will be how you deal with international economics. Why would anyone in America buy an organ here for $50,000 when they could get a perfectly good one in India for $800? The same sorts of economic pressures that make outsourcing sneaker production to the third world — and make sweatshops inevitable — will apply to organ markets.

This is a real problem and I don’t have a solution for it. It is why I’ve always been hesitant when think tanks like the American Enterprise Institute suggest a legal and regulated market for organs in the United States. Once people are comfortable with the concept of purchasing flesh, then they’ll immediately go abroad.

Take surrogacy for example. In the United States, it costs upwards of $80,000 to hire a surrogate mother. In India, where hiring a surrogate is legal, it costs $20,000. A few years ago only a handful of Americans went to India for the procedure. Now, that the practice has been embraced by people like Oprah, tens of thousands of people are lining up to hire Indian women to bear their children. It’s almost considered normal.

It’s not hard to imagine a dystopian future where middle and upper class Americans simply don’t bother with pregnancy anymore. It will be affordable to outsource the risk of birth and trouble of pregnancy to poorer people in some other country. They’ll think it’s a fair exchange: the surrogate gets money, and the American will get a baby. We’ll all talk about it as if it’s normal. And that’s really, really scary.