259Like most teenagers I was thrilled at the prospect of being able to sit behind the wheel of a car and experience the wide open road. I was determined to get my Learner’s Permit the moment I became eligible. The day of my 16th birthday found me standing in line at the Department of Motor Vehicles (DMV) in Washington D.C., hoping that I had filled-in all the necessary forms and had brought along all the required legal documents to be able to walk out of that office permit in hand. Of course, when I reached the front of the line, I was given yet another form. Upon first glance, it looked similar to all the others I had already completed with factual questions about my name, date of birth, and social security number. I started to fill it out without much thought; I had answered those questions so many times before that I barely needed to keep my eyes open. But then I stumbled upon a question that suddenly jolted me to wakefulness.

Would you like to be an organ and tissue donor?

As of February 14, 2010 at 8:58 a.m., there were 105,717 candidates on the waiting list for organs, according to United Network for Organ Sharing (UNOS). Every 90 minutes, one of these candidates dies. A large number of these candidates are victims of kidney disease and need a kidney transplant to survive. But the number of those in need of a kidney far exceeds the number of donors. The UNOS organ registry is used across our nation to match organ donors and recipients based on various compatibility tests such as age and blood type. But since the demand of organs is greater than the supply, a thriving underground market for organs has emerged in the last few decades which often exploits poor women in developing countries such as India.

I love going to India to visit my grandmother and cousins. I love the ubiquitous smell of spices wafting through the air and the vendors selling colorful fruits and vegetables at every street corner. I am fascinated by the busy drivers who stop their vehicles and wait patiently for cows to cross the streets, their lazy gait slowing down the traffic. I love riding in the zooming rickshaws, open-air, three wheel taxi cabs whose engines roar every time the gas pedal is pressed. But beyond these quirks that define India and that I know so well, there is another side to the country that I had never experienced before—until last year.


My grandmother first told me about Villivakkam or “Kidney Village” in southern India. There, poor women are often convinced into selling their organs—a practice illegal in India as in the United States. These vulnerable women are approached by middlemen who offer them between $2,000 and $6,000 for a kidney. For most of the women, impoverished and desperate as they are, an offer of even a few thousand dollars is hard to resist. Many of them have never seen so much money in their lifetimes – it could allow them to buy a sheep or goat, expand their farming patch, and pay off all their debts.

But the kidney harvesting procedure can be a dangerous one if not performed under the right conditions and with the proper equipment. Because trading in organs is illegal, the surgeons who perform this procedure are typically under-qualified and fail to take the necessary precautions. Not surprisingly, post-surgery complications – and even death – are common. What is more, the middlemen often pay the women only a fraction of what they had promised them.

After obtaining the kidney from the poor village woman, the middlemen sell it on the organ trafficking black market, ultimately destined for a wealthy recipient. The supply chain can, of course, be long and complex. The wealthy recipients are usually on organ waiting lists such as the one developed by UNOS, and have little hope of reaching the top of the list within their life spans that are shortened by disease. Depending on how badly they need the organ, the recipients are willing to pay up to hundreds of thousands of dollars for an illegal organ. If the transplant is successful, the recipients could lead long and happy lives while the exploited women in places such as “Kidney Village” might face a lifetime of ill-health and a much reduced capacity to scrape together a living.

Unfortunately, there are equivalents of “Kidney Village” all across the globe, for example, in Brazil, China, Indonesia, Israel, Pakistan, and South Africa. According to one estimate, roughly 15,000 kidneys are trafficked each year.

A clear solution to the illegal organs trade is to increase the number of organ donors worldwide. If the supply of organs meets the demand for organs, there would be no underground market for organs. Of course, convincing everyone to become an organ donor is not an easy task. Some believe that organ donation goes against their religion and others feel uncomfortable at the prospect of their bodies being subject to medical procedures, even if it is after death. One big misconception is that doctors will not try their best to save the life of a prospective organ donor because of their desire to use each of the organs of the prospective donor to save many more lives.

At school, I asked my friend if she would consider becoming an organ donor. I told her about the unending waiting list of people in need of organs and the poor victims of organ trafficking. At first she seemed enthusiastic about becoming one, but finally decided “Actually, I don’t know about this. What if it hurts? What if doctors see that I am an organ donor and instead of treating me and giving me my best shot at life, they only think about getting out my organs?”

My friend’s worry is not uncommon among teenagers, a representative of Washington Regional Transplant Community (WRTC) told me. One of WRTC’s main objectives is to educate youth in the greater Washington D.C. area about the myths and misconceptions about organ and tissue donation. Doctors are professionally-bound and trained to always do their best to save lives, whether or not their patient is an organ donor. People have the option to donate either organs (e.g., heart, lungs, kidneys, liver, pancreas) or tissue (e.g., skin, corneas, bone, tendons). A donor’s body is not disfigured after the procedure. Although the number varies from year to year, roughly 30,000 organ transplants and 1 million tissue transplants take place worldwide annually. The first successful transplant ever performed was for a cornea and took place in 1905. By 1967, great leaps in science allowed for the first heart transplant. Today, one organ donor can save the lives of up to eight people. As a WRTC representative explained to me, donating is costless to the deceased but priceless to the recipient.

If the majority of our nation’s youth simply tick-off that box on the DMV driver’s license form, the number of people falling victim to organ trafficking as well as the number of patients dying without an organ will both decline. A trip to your local DMV on your 16th birthday does put you behind the wheel on a wide open road. But beyond this privilege, you also have the chance to sign-up to be an organ and tissue donor, and give someone the biggest gift of all – the gift of life. You are in the driver’s seat. The choice is yours.

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