LIMA, Peru — A sordid scenario has often been played out at the kidney dialysis unit of Lima's state-owned Rebagliati Hospital in recent years.
Patients and organ "brokers" barter over how much a donated kidney is worth. Standing nearby, meanwhile, are the prospective donors--often destitute--getting their blood types checked and negotiating the supply-side fee.
Kidney for $1,000 Cash
The selling of body tissues is legal in Peru, and until recently the purchase of a kidney for up to $1,000 cash was a recourse for patients with the means to pay.
In June, Peru's Congress attempted to end the shady business of organ selling and alleviate a shortage of organs for transplants. It passed a far-reaching law that permits doctors to remove organs from any person declared dead, even if relatives object. The law took effect in early October.
The legislation has outraged the nation's chief medical examiner and prominent members of the medical community and drawn concern from Peru's Roman Catholic church.
'Nationalization of Cadavers'
Opponents have dubbed it the "nationalization of cadavers," a snide reference to a recent move by President Alan Garcia to take over the nation's private banks.
A lack of donors had limited doctors to performing only 30 or so kidney transplants a year, even though 800 Peruvians currently need kidneys, experts said.
Under the new law, doctors may remove organs from accident victims as soon as they are declared brain dead. Only one doctor is required to make such a determination.
Peruvians who do not want to donate their organs must register at organ offices to be set up in major cities.
No Relatives' Rights
If a victim has not registered opposition, doctors may use his or her organs and tissue for transplants. The law eliminates the legal right of next of kin to block removal of organs after the death of their relatives.
"The right of relatives (to object to organ removal) should be put aside once and for all," said Sen. Esteban Rocca, who sponsored the legislation.
"With all the respect that a cadaver deserves, we must understand that we provide a service to humanity by permitting the removal of organs so that others can live," said Rocca, a retired neurosurgeon.
A former minister of health, Dr. Uriel Garcia Caceres, called the law "a monstrosity." He said it could lead to abuses, including cases of doctors removing organs while victims still have biological signs of life, or of doctors covering up cases of malpractice.
The Roman Catholic Church in Peru has asked the center-left Garcia government to provide more rigorous norms for determining the death of possible donors, most of whom would be traffic accident victims.
"Often, the indicators are not very clear," said Bishop Augusto Vargas Alzamora, spokesman for the ruling Episcopal Conference.
"Even though we greatly respect the medical profession as a whole, a few doctors are a little nonchalant. Who is to say that any given one does not rush headlong and hurry the death of a person?"
Vargas said the church is concerned about the failure to consider opinions of next of kin and the state's assumption of the "presumed willingness" of a victim to have his organs removed if he has not registered opposition.
Requiring Peruvians to register their objection "is impractical and unrealistic," he said. Many poor Peruvians do not obtain even basic documents, such as birth certificates, because of government red tape, he added.
The new law is more liberal than any other in Latin America and perhaps the most far-reaching in the world, said Victor Maurtua Vasquez, the nation's chief medical examiner and an opponent of the measure.
Maurtua contended that the law permits authorities to remove the organs of tourists who might die while visiting Peru.
Other Latin nations, such as Chile, have attempted to liberalize laws permitting organ removal as a way to curb organ selling. There, organ removal requires the consent of relatives unless the dead person specifically stated, in a will, that he or she wanted to be a donor.
An association of kidney specialists is pushing for more flexible legislation.
"Indecision and family arguments usually delay authorization for us to use a dead person's organs," said Dr. Jorge Morales, president of the association. "Many organs are lost. They are cremated or rot away."