Michiko Kakutani


Whereas black markets trade in illegal goods like guns and drugs, the “red market,” the journalist Scott Carney says in his revealing if somewhat scattershot new book, trades in human flesh — in kidneys and other organs, in human corneas, blood, bones and eggs. Many of the real-life examples he cites in this chilling volume cannot help but remind the reader of a horror movie, or of Kazuo Ishiguro’s devastating dystopian novel “Never Let Me Go” (2005), in which we learn that a group of children are clones who have been raised to “donate” replacement body parts.


In “The Red Market” Mr. Carney recounts the story of a police raid on a dairy farmer’s land in a small Indian border town that freed 17 people who had been confined in shacks and who said they’d been bled at least two times per week. “The Blood Factory,” as it was called in the local press, he writes, “was supplying a sizable percentage” of the city hospitals’ blood supply.


Mr. Carney also investigates the bone trade in India — for almost 200 years, “the world’s primary source of bones used in medical study” —and tries to track down the head of a grave robbing ring in West Bengal, who, according to police, was pilfering corpses from cemeteries, morgues, and funeral pyres and employed “almost a dozen people to shepherd the bones through the various stages of defleshing and curing.”


A contributing editor at Wired magazine, Mr. Carney writes with considerable narrative verve, slamming home the misery of what he has witnessed with passion and visceral detail. His book does not attempt to provide a comprehensive picture of red markets in the world today. Much of Mr. Carney’s reporting focuses on India (where he lived and worked for a decade), while dealing only cursorily with human organ trafficking in other hot spots like the Philippines and Brazil.


In one chapter Mr. Carney describes an impoverished Indian refugee camp for survivors of the 2004 tsunami that was known as Kidneyvakkam, or Kidneyville, because so many people there had sold their kidneys to organ brokers in efforts to raise desperately needed funds. “Brokers,” he writes, “routinely quote a high payout — as much as $3,000 for the operation — but usually only dole out a fraction of the offered price once the person has gone through it. Everyone here knows that it is a scam. Still the women reason that a rip-off is better than nothing at all.” For these people, he adds, selling organs “sometimes feels like their only option in hard times”; poor people around the world, in his words, “often view their organs as a critical social safety net.”


Toward the end of the book Mr. Carney notes that “criminal and unethical red markets are far smaller than their legitimate counterparts.” According to the World Health Organization, he writes, “about 10 percent of world organ transplants are obtained on the black market.” But he emphasizes that “red markets are now larger, more pervasive, and more profitable than at any other time in history,” and that “globalization has made the speed and complexity of these markets bewildering.”


The most alarming allegations cited in this book come from a 2006 report released by David Kilgour, a former member of the Canadian Parliament, and the human rights lawyer David Matas, which suggested that vital organs (including kidneys, corneas and livers) had been harvested on a large scale from executed members of Falun Gong, a banned spiritual group in China. The Chinese government denied the allegations.


“No one is saying the Chinese government went after the Falun Gong specifically for their organs,” Mr. Carney writes, “but it seems to have been a remarkably convenient and profitable way to dispose of them. Dangerous political dissidents were executed while their organs created a comfortable revenue stream for hospitals and surgeons, and presumably many important Chinese officials received organs.”


Mr. Carney is not able to verify the Kilgour-Matas report independently. For that matter, his overall approach here tends to be heavily anecdotal and selective, focusing on horror stories like the kidnapping of a young Indian boy, who, the police said, was brought to an orphanage “that paid cash for healthy children” and then “exported the children to unknowing families abroad.”


As Mr. Carney sees it: “Eventually, red markets have the nasty social side effect of moving flesh upward — never downward — through social classes. 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.”


His book is filled with harrowing stories in which the destitute and desperate end up sacrificing their bodies for the sake of a few dollars that fail to change their lives.


In one chapter Mr. Carney writes that most egg donors in Cyprus —which “had more fertility clinics per capita than any other country” —come from the relatively small population of poor Eastern European immigrants who are “eager to sell their eggs at any price.” A donor in Cyprus will probably get paid a few hundred dollars for her eggs, Mr. Carney estimates, while customers — often from Western Europe — will pay $8,000 to $14,000 for full-service egg implantation with in vitro fertilization in Cyprus, “about 30 percent less than the next cheapest spot in the Western world.”


Globalization has also brought what Mr. Carney calls the “fertility tourism industry” to India, which, he says, “legalized surrogacy in 2002 as part of a larger effort to promote medical tourism.” At the Akanksha Infertility Clinic (which was featured in an “Oprah”  segment), he says, surrogates, who make between $5,000 and $6,000, live in residential units, where “they will spend their entire pregnancies under lock and key.” The clinic charges between $15,000 and $20,000 for the entire process, he reports, “whereas in the handful of American states that allow paid surrogacy, bringing a child to term can cost between $50,000 and $100,000.”


“Before India, only the American upper classes could afford a surrogate,” Mr. Carney writes. “Now it’s almost within reach of the middle class. While surrogacy has always raised ethical questions, the increasing scale of the industry makes the issue far more urgent. With hundreds of new clinics poised to open, the economics of surrogate pregnancies are moving faster than our understanding of its implications.”


In addressing such ethical questions throughout this grisly but fascinating volume, Mr. Carney forces the reader to think about the moral issues raised by advances in medicine. His book also asks us to re-evaluate the roles that privacy, anonymity and altruism play in the current “system of flesh exchange” — which, as disturbing as it is to contemplate, is subject, like those for other commodities, to the brutal marketplace equations of supply and demand.

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