Hot Docs 2013: Tales from the Organ Trade

I never knew what an arm looked like after its been on dialysis. For a person with kidney disease, they have to be hooked up to the dialysis machine every other day for eight hours to clean their blood. It’s a half-measure: it won’t cure their disease; it will only prolong their life as they wait to get a donor (if they can even get a donor). Dialysis requires the insertion of a needle into a vein in your arm to draw the blood out. After six years of treatment, you get a bruised welt and a raised hole where the needle is placed. For one woman, eighteen years on dialysis, she has a protruding bump (it looks like an oozing tumour) that has the unfortunate side-effect of sometimes bursting – like it did at a family dinner one night, gushing blood. It’s an absolutely horrible disease. There is only one cure – a fresh, healthy kidney. And for the sick, they have two choices while on dialysis: wait an unforeseeable length of time for a donor, or buy a kidney on the black market. Tales from the Organ Trade investigates that very dilemma.

This is probably the most well-balanced and even-handed documentary I’ve ever seen. It doesn’t take sides and leaves it up to the viewer to decide where they stand on the issue. Talking to such a diverse group of people – from those who sell their organs, the doctors and surgeons who perform these operations, the dogged prosecutors trying to shut the trade down, and the ordinary individuals just looking to prolong their lives, the film allows every side to share their story, revealing the morally ambiguous truth about this issue.

When we think of organ trafficking, we think of organized crime, organ harvesters, and the exploitation of the poor and the indigent. But it’s more complicated than that. The first scenes in the film are shots of various Filipino men, each lifting up his shirt to reveal the exact same lower abdominal scar. They all made the same conscious decision – to sell their kidneys on the black market for money. It’s a shocking image, presented plainly, without suggesting answers – only questions. Like: Is this wrong? Were these men exploited? Or was this simply a conscious choice, made out of desperation?

The first part of the film is challenging our expectations. Most of the donors in the organ trade decide to sell their kidneys. They are not coerced into doing so (although the argument is made that their circumstances – extreme poverty and desperation – are coercion enough. Why else would all the donors come from poor countries rather than wealthy ones?). There were several stories about what these men did with the money afterwards. Some started businesses and made a better life for their families, others bought homes, some just spent it on drinking and paying off debts, and others got more deeply involved in the black market as “Organ traders” – acting as intermediaries for other individuals looking to sell their kidneys.

But then there are the other stories – of a man who sold his kidney, only to realize shortly afterwards that he has kidney disease and is in desperate need of a transplant himself. Or the other donors who agree to sell for a certain price, only to be paid less than agreed upon after the organ is taken out (certainly we can argue that they have been exploited at this point?). So whether these “donors” are exploited is a bit of a gray area – almost all the subjects in the film have chosen to sell their organs, but in the circumstances of their lives, did they really have a choice?

This is an incredible film. I would characterize it as more of a piece of investigative journalism than anything else, and the efforts of the filmmakers of tracking down all the various supporting players and following up on leads probably deserves an entire documentary in itself. They track down (and get interviews with!) two of doctors wanted by Interpol for performing the illegal operations. It’s especially interesting to watch the interview with the surgeon vilified as “Doctor Frankenstein” in the international press, who seems a lot more mild-mannered than the papers make him out to be (how he agreed to be recorded and interviewed: he took the filmmaker out to dinner with his parents and family. Only after his mother told him that she trusted and liked the filmmaker did he agree to speak on camera). They also track down an important donor who is a key link in the prosecutor’s case and get unprecedented access to key players in the black market.

Selling your organ is illegal. Donating it for purely altruistic reasons is legal. The money trumps the altruistic reasons: donating for altruistic reasons, but being compensated for doing so, amounts to selling your organs, and is illegal. The question is: did we get the ethics of this right, or did we get it wrong? Tales from the Organ Trade will demonstrate what a complicated question that is.

Grade: A