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'Tales from the Organ Trade' is a Terrifying Story of the Vast Disparities in Desperation

Even apart from the crass motives in the market of human kidneys, the stakes for recipients and donors remain brutal and urgent.

Tales from the Organ Trade

Director: Ric Esther Bienstock
Cast: Jonathan Ratel, Erçin Sönmez, Raul Fain, Walter Rassbach, Mary Jo Vradis David Cronenberg (narrator)
Rated: NR
Studio: HBO Documentary Films
Year: 2013
US date: 2013-11-04 (HBO)

"All they need now is someone who is desperately ill." Joboy and his wife live in a crawlspace underneath someone else's shack in a town in Manila. Unable even to stand upright in their home, they're desperate to find a way out. And so they've made a deal with Diane, a broker who promises to help Joboy sell one of his kidneys.

In Tales from the Organ Trade, premiering on HBO on 4 November, Joboy crouches close to the ground, as he explains his decision, his wife silent and tearful in the dark frame beside him. He would never do "something illegal and against the Lord's will" if they had a choice, he says, but they have two teenage sons, who need "a house where they can stand up when they're inside." Diane has offered Joboy $2,500 for the organ, double what he might make in a year working as an unskilled laborer. Diane's experience in the business includes selling her own kidney, as well as those of some 12 members of her extended family. But for all her efforts, her family's situation is hardly better than Joboy's, as the documentary reveals their impoverished, crowded conditions. They can stand up in their home, however.

Following early images underlining the desperation of those who sell pieces of themselves on this $600-million-a-year black market -- handheld frames showing unpaved streets and outdoor vendors and cockfights -- Ric Esther Bienstock's film cuts to the operating rooms where the organs are harvested. These are not the spaces that fill urban legends, the bathtubs or filthy bedrooms where bodies are left cut up and unconscious. Rather, these rooms are staffed by surgeons and attendants with masks and gloves, their utensils sterile and their labor properly compensated.

In this juxtaposition, the movie makes clear the terrible dynamic that structures the organ trade (while many organs and body parts are available, the film reports, kidneys are by far the best seller). It's a dynamic premised on need and inherently imbalanced. As European Union prosecutors Jonathan Ratel puts it, the sources of organs are "the indigent, the poor, the vulnerable, and the persons who want this are rich, wealthy Western nations who can pay 100,000 US dollars for a kidney."

Buyers don't necessarily seek this arrangement, but as they're waiting on lists for years, their circumstances only deteriorate. "A foreign situation is not our first choice," says one potential recipient's wife, but her husband wants to live. These "foreign situations" can allow ways around legal prohibitions, and buyers can pretend not to know that sellers are paid; "I cannot profess to know for what purpose these people did it," says kidney recipient Raul, "So that's why it can never be one hundred percent [that you] say, 'This is bad.'"

And this is the film's primary focus, this complex moral question. As much as buyers might deceive or agree to deceptions in order to survive, so too do sellers. Joboy and another of Diane's clients in Manila, Eddieboy, both listen carefully as she coaches them on how to bluff their way through a pre-surgery interview, to fool authorities into thinking they are donating their kidneys out of altruism, not because they're being paid. (These donors do exist, the film notes, but while their stories are inevitably moving, they are also exceedingly rare.)

Some interview bluffs pay much more money than Diane's trade offers; "They had their suspicions," reports Jason Chamberlain of Philadelphia, who sold his kidney to a buyer he found online, for $20,000. The film cuts from his interview, in his nice suburban home, with a lawn and a driveway, to one with his girlfriend, Dianne, who sits on a couch with her cat in her lap, remembering that she thought he was crazy: "You know," she says, "There's a lot involved in it." Jason lied to the interviewer, he says, to get money to start a business, and now says the deal served the needs of both parties. It was, he says, "a one hand washes the other situation."

That such a "situation" remains illegal galls "organ donors issues" activist Robby Berman of New York City. He argues that medical institutions insisting on a structure of organ donations (whether by live donors or by corpses) encourage unregulated black markets. "Why not offer incentives for doing a good thing?" he asks, deriding the "paternalistic" establishment who makes such arbitrary rules as "the government and the people who think they know better."

By contrast, the surgeon Bienstock interviews doesn't pretend to know better, or much of anything. A fugitive from justice, pursued in particular by the prosecutor Ratel, the surgeon Erçin Sönmez, Cronenberg points out, yet has his own website too. After Cronenberg goes on to wonder out loud whether the doctor will answer his emails, it turns out that he does, and also agrees to an interview at his home in Kosovo (a country where organ transplants proliferate), and offers up his wife and mother as subjects, as well. Though he says he's heard himself called "Dr. Vulture", he somehow missed the headlines dubbing him "Dr. Frankenstein". Acknowledging that Bienstock has read "all the beautiful things about me on the internet," he points out, "You still came." Yes, she says from offscreen, because he's "the only one" who will speak on camera.

The film shapes his appearance into something like a debate with his opponents, primarily, Ratel. A cut to his interview reminds you that he calls Sönmez's practice, and the organ trade more generally, "an exploitation of the human condition that has to stop." Sönmez's patient, Raul, appears next, asserting, "Obviously I'm selfish, but I don't see it in a terrible way, as long as you don't exploit it." This philosophical roundabout indicates that the dilemma won't be easily solved. Even apart from the crass motives, the money to be made and the deceptions to be managed, the stakes for recipients and donors remain brutal and urgent. As Tales from the Organ Trade exposes these stakes, it asks that you understand them before you judge them.


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