Businessweek Book Review

The Red Market by Scott Carney

by Daniel Grushkin

Bloomberg-Businessweek, August 4 2011

In 2008 police officers smashed open the doors of a dairy farm in northern India and found 17 people hooked to IV tubes, being drained of blood, too weak to run away. The farmer and his staff had kept them alive simply to milk their veins and sell off the contents to local blood banks. This is just one of the horrifying everyday tales of the body trade documented in Scott Carney’s The Red Market—his coinage for the mostly legal and sometimes creepy multibillion-dollar business of buying and selling the stuff of human life, including organs, bones, embryos, and blood.

As Carney explains, the body industry adheres to the same basic trade rules as “shoes and electronics.” New types of transplant surgeries, coupled with globalization, however, have conspired to create a loosely regulated, seedy enterprise that ruins lives even as it saves them. While patients wait on interminable donor lists in some countries, medical tourists are traveling to developing regions to take advantage of a nearly endless supply of “donors.” According to a McKinsey study, up to 85,000 U.S. patients dabbled in the red market in 2008.

It isn’t always pretty. When the Indian government moved victims of the 2004 tsunami into the Tsunami Nagar tent camp in Chennai, illegal organ brokers descended en masse. Carney reports that women at the camp, eventually known as Kidneyville, were offered up to $3,000 for their organs, though they often got far less. “Almost every woman in Tsunami Nagar has a story about how organ brokers took advantage of her during her most desperate hour,” he writes. Within a year, Carney notes, doctors from 52 Indian hospitals performed 2,000 illegal kidney operations—with recipients paying up to $14,000 per surgery. “Inevitably, red markets have the nasty social side effect of moving flesh upward—never downward—through social classes,” Carney writes. “Even without a criminal element, unrestricted free markets act like vampires, sapping the health and strength from ghettos of poor donors and funneling their parts to the wealthy.”

Yet the red market isn’t necessarily a bad thing. Kidney transplants extend lives. Surrogates who carry an embryo to term give couples who can’t conceive the opportunity to have children. Yet the real question has become how to regulate the market. Theories fall into two extremes. Some countries, such as Iran and the Philippines, recognize the trade with the belief that clear laws bring an already thriving business out of the shadows. Still, a regulated body market doesn’t necessarily lead to a successful business. When selling blood was legal in the U.S., from the 1940s through the 1960s, for-profit blood banks consistently failed both donors and recipients. Brokers turned up in slums to tap the poorest of the population for the lowest prices. As a result, the quality of blood stores suffered, donors and blood banks disregarded basic cleanliness, and disease spread into the supply. Eventually, hospital administrators and doctors became frustrated and turned to volunteers.

For many Western countries, a ban on the sale of body parts isn’t ideal, either. In the U.S., the exorbitant cost to transplant a liver ($523,000) or intestines ($1.2 million) often drives patients to countries with murkier regulations. Carney estimates that about 10 percent of the red market operates illegally. And the widespread exploitation—ranging from the rental of Indian wombs to the adoption of slum babies—hinges on the industry’s insistence of anonymity: The medical system seals the identities of donors and recipients, to protect both parties. Yet anonymity gives rise to a chain of middlemen who work unseen and get away with cheating, or worse. Carney argues for exposing the whole system by simply creating openly accessible pedigrees. Imagine IV bags with blood donors’ names on them, he argues, or adoption centers that list the birth parents. Parts of the red market might not survive, he suggests. Though it also might just shift to countries where the supply chain is even less regulated.

Growing industries rarely reform themselves when they’re making a fortune, and the red market is unlikely to be any different. “Who we are as a society depends on how we address the remaining 10 percent,” Carney writes. “Do we let blood brokers and child kidnappers ply their trade and write off the human fallout as just another cost of doing business?” The rhetorical answer is no, of course, but the realistic answer is that the supply side will vanish only when demand does. It’s up to potential customers—perhaps as much as law enforcement—to halt the growth of the red market’s illicit side. Promising advances in cell science might soon make organ transplants obsolete, but until a breakthrough comes—and is cost-competitive—the red market will continue to thrive. That’s just plain economics.

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