On the other side is people who are living in abject poverty – people who will never get their hands on a large sum of money. When I spoke to those people and said, "We think this is bad. We don't want to use people in poverty as body parts." Their reaction was: "Who are you to judge? Walk a mile in my shoes. You don't know what it's like to live in poverty." These men weren't bothered by their choice. Some of them changed their lives, others squandered the money. All of them say, "I made money, but I also saved a life."
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Were any of the patients concerned the film could be used as evidence to prosecute them for doing something illegal?
There haven't been many prosecutions for organ trafficking. There is no appetite to prosecute recipients or the sellers, even though they did something illegal. The rhetoric around this issue is that people selling their kidneys are coerced to do so. That implies force. The truth is, those I interviewed are coerced by their poverty. They are so poor, this is their only chance at money, and that offer is coercive.
One-by-one I approached them and told them I wanted to hear their story. It is hard convincing people to talk.
One woman in the film was a match for her father but decided not to donate a kidney. Why do some people choose not to be organ donors?
I don't judge her. It was brave of her to talk about that. Choosing not to be an organ donor is more common than we think. I know from talking to surgeons that there can be pressure to give. Doctors take the person who agreed to be a donor into a private room. They will tell them, "If you really don't want to do this, I'll give you a medical out so it's not your fault." Sometimes people are scared or are worried about the surgery.
Some people don't register to be organ donors because of procrastination, some might have religious reasons, others are afraid that if they are an organ donor then maybe they won't get treatment at a hospital and their organs will be harvested. The medical establishment has accepted that we can live well with one kidney. Many people are born with one kidney and never know it. Even if everyone registered to be an organ donor, however, there wouldn't be enough kidneys to go around.
What role does money play in the film? Why is donating a kidney heroic, while receiving money for a kidney is controversial?
You're considered a hero if you donate a kidney, but the minute money enters the transaction it becomes something else. I do believe money changes the transaction. As there have been advances in medicine, our ethics evolve. I intuitively think it's repulsive to think about selling a body part, but then I step back and look at some of the people who did it and benefited from it. Maybe selling your kidney isn't the worst thing in the world.
Your film shows proponents for a government-regulated organ trade that would compensate donors financially. What is your position?
The film is not an advocacy film, but I mentioned it because I wanted audiences to know there are people arguing for it. I don't think we should simply dismiss the issue as exploitative, and only crack down on the black market. That is not a solution. Why not try a trial project? The current system is not working, and there are needless deaths.
Have you heard of anyone giving away a kidney because of your documentary?
We surveyed people at film festivals to ask whether they would consider buying a kidney. We also asked after the film whether they were moved to register as organ donors. Sixty percent of the audience said yes. I saw people on our Facebook page write that they saw the film, registered to be an organ donor and encouraged others to follow. I have received emails and phone calls from people thanking me for the story. Some have chosen to be altruistic donors. I think we have to do everything we can to move people to donate, and I hope the film continues to do that.