The Red Market: On the Trail of the World's Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers

  • Scott Carney
William Morrow: 2011. 272 pp. $25.99 9780061936463 | ISBN: 978-0-0619-3646-3

You've heard of the black market. Now here's the The Red Market, a book describing the global trade in body parts and people that props up the health, fertility and adoption industries. In his exposé of the crimes and human-rights violations that are committed to supply the trade, investigative journalist Scott Carney probes a business that is now “larger, more pervasive, and more profitable than at any other time in history”. The World Health Organization estimates that 10% of world organ transplants are obtained illegitimately; Carney argues that it is a good rule of thumb for estimating exchanges of all body parts.

Blood, organs and children have long been traded. Thanks to globalization and advances in technology, so too now are human eggs and surrogate wombs. Carney describes two factors that red markets have in common: first, the transaction is not over when the money changes hands because buyer and seller become biologically linked; and second, because people are squeamish about swapping flesh for money, those buying the human parts tend to describe the exchange euphemistically in terms of altruism — they receive 'donations'.

As there is not enough altruism in the world to supply the insatiable demand for body parts, morally dubious or criminal elements step in. Carney investigates, for example, how the human egg trade in Cyprus exploits poor women from eastern Europe. He also uncovers and carries the distressing news from India to the United States that the adopted son of a midwestern family was stolen from his biological mother while her back was momentarily turned in a Chennai slum.

Three Pakistani men show their scars from selling a kidney — such organ donation was banned in the country in 2007. Credit: A. TANVEER/REUTERS

Other shocking cases include the reported execution of political prisoners in China to provide organs on demand — highlighted in 2006 by United Nations delegate David Matas and retired Canadian politician David Kilgour. Or the blood farm on the India–Nepal border, where a dairy farmer imprisoned poor Nepalese refugees and literally bled them dry, prompting Carney to delve further into India's murky blood trade.

The Red Market is an excellent piece of reporting, but the book is framed around a flawed concept. Carney describes the “specialness” that defines a living person. “There is a clear difference between the living and the dead and that specialness — whatever it may be — is the rock that I've built this book upon,” he writes. But there is no such division: death is a process, not an event. Over the centuries, the arbitrary line that society has drawn between life and death has shifted.

Drawn out death

It used to be that the heart had to stop beating before death could be declared. Now brain death is the usual criterion, and a dead person's heart can continue to beat for a while. As death encroaches on life, more and more people are considered to be eligible for organ harvesting. Carney does not specifically mention this trend, but it inevitably affects organ supply.

He does, however, allude to the blurring between life and death by describing the trade in a waste product: human hair. Although hair contains DNA, it hardly represents a biological link between donor and wig-wearing recipient, thus failing to satisfy one of his red market factors. It still meets the other criterion: the hair is 'donated', while increasing sums are exchanged for it as it moves up the supply chain.

Temple-goers in Tirupati, India, have their heads shaved for religious reasons, and are not paid for the raw material that ends up in expensive salons in Brooklyn. Likewise, in many countries, women who 'donate' their eggs are prohibited from receiving payment beyond their expenses. Organs too are given away, while every physician, nurse and health coordinator involved in transplanting them is paid for their contribution.

Every child, kidney or bag of blood should be labelled with the name of the person who provided it.

Because the buyers insist on using the language of gifts, the recompense for the donor — from clinics, hospitals or brokers — is tiny. So only the poor and desperate are tempted. Profiteers increase the supply through coercion.

Protecting donors' anonymity enables buyers to turn a blind eye to the source of their flesh. And as Carney puts it: “The one-two punch of anonymity and donation means that profit-taking middlemen control the entire supply chain.”

The global industry in body parts exploits the varied regulations and economic conditions in different countries. The fact that body parts have often travelled across continents also obscures their source. By the time an Indian child's papers reach an adoption agency in the United States, for example, there is often no easy way of verifying whether that child was given up voluntarily.

Banning organ commerce will not help, Carney says, because the red market would be driven further underground and the poorest would continue to supply it in return for risible fees. Nor will fully embracing the market work, as demand will rise alongside supply. Physicians will find new indications for transplants as more organs become available, and as they hold out hope for ever-smaller improvements in the lives of very sick patients. A third option, to grow synthetic body parts, is appealing but remains science fiction for now.

Carney does argue that the market should be transparent, with every child, kidney or bag of blood labelled with the name of the person who provided it. The supply pool might shrink, but the criminal middlemen would be eliminated. The richer members of society — those creating most of the demand — could also learn to accept their mortality, and to question whether, in every case, the extended life that a transplant promises is worth the human suffering it costs farther back along the chain. It's not much of a sticking plaster, but The Red Market is a reminder that there are some problems that science alone cannot solve.