Yesterday, I was at a well-known hospital in Quezon City to visit an ailing relative. It was also an occasion for me to chat with the hospital staff who were waiting for their shift to end.

I learned that the hospital has a thriving business in kidney transplantations with patients flying in from the Middle East. Is this part of our medical tourism program, I asked? They couldn’t say for sure but commented that the Arabs in need of kidney transplants occupy the biggest rooms in the hospital. They avail of a higher-priced package which includes the matching of donors with the patients.

Intrigued, I probed deeper into what the hospital staff observed. Most of the donors are in the prime of their lives, from 18 to 35 years old. Some of them have agents that facilitate the transaction. Donors are paid from P150,000 to P200,000, they said, but only once the transplantation is done.

I did a google search on organ donations in the Philippines and found out that kidney donations fall under the Philippine Organ Donation Program, a unit under the Department of Health. This program produced a manual of procedures to prevent strangers from walking into a hospital to sell their kidneys.

The process includes attending a pre-transplant seminar, psychiatric evaluation, a medical evaluation and another evaluation by a hospital ethical committee composed of a social worker, a priest, a civilian with experience on transplantation, a transplant physician, and another doctor unrelated to the procedure. Only after passing through this elaborate process can a donor’s name be included in the National Kidney and Transplant Institute’s registry of donors and patients.

This being the Philippines, however, not all hospitals follow this manual of ethical guidelines. Arabs and other tourists come here, wealthy and sick. Kidney donors are compensated, in cash and a long scar as a permanent reminder of a missing organ. The donor will have to watch his diet, refrain from lifting heavy objects, be more conscious of his vulnerability to kidney and other ailments. He or she cannot work as overseas Filipino workers when their physical condition is made known to foreign employers.

One of the hospital staff told me that at one time there was a whole barkada of young men who came to donate their kidneys. An Internet search would also yield so many other real-life stories about organ donors who sell their kidneys out of desperation. Rather than talk about this in whispers, I suggest that a frank discussion among health experts and policy wonks be encouraged on the issue of organ donations.

On the part of impoverished kidney donors, they say that what they do with their bodies are their own business. Some medical practitioners  try to finesse the whole exchange by preferring to use the word “gift” or “gratuity” instead of “payment”.  Call it by any other name, the truth is that poverty drives the jobless and desperate to be “generous to a fault” with their organs. The question from a policy perspective is: will this now be added to our list of competitive advantages under the benign category of medical tourism? And if truly, the sale of kidneys and other organs by the poor to the wealthy and dying cannot be stopped or regulated, then how do we balance patient care with donor’s rights? Our Times believes that only a frank discussion of the ethical, financial, moral, and medical aspects of this issue at the national level can yield the best answers.