Hektoen International

A Journal of Medical Humanities

The color of organ markets

Howsikan Kugathasan
Toronto, Ontario, Canada

Dark Room, Single Light: the contrast between black and white markets

Nawaraj Pariyar from Nepal is promised thirty thousand dollars for “a piece of meat” that will grow back. Only later does he find out that he was duped twice. He received less than 1% of his promised money and that piece of meat was not any ordinary flesh: it was his kidney.1 Halfway across the world in Oregon, Khang Nguyen engages in a similar transaction, but instead he donates his plasma for money. After two hours of testing and drawing plasma, he receives his promised forty-five dollars for his plasma and leaves.2

Both Nguyen and Pariyar experienced the human inevitability of dealing with markets. Markets arise anywhere there is a need and are as much a part of the human experience as death and taxes. Even the most restrictive environments are not immune to the human desire to trade and profit; prisons face internal drug trafficking problems and U.S. dollars manage to find their way through the seemingly impenetrable borders of North Korea.3,4 In medicine markets come up in many places, from drug and vaccine development to kidneys and human plasma.

But when markets are drawn by humans, they are shaded in either white, gray, or black. In white markets all aspects of the transaction are under the scrutiny of the law. Gray markets are one step below: legal goods and services are traded through atypical channels such as buying and selling cars from newspaper classifieds.5 The black market deals in the sale of illegal goods and is thus kept well away from the eyes of the legal system.6 Consequently, black markets are all too prone to fraud and theft through the lack of penalties for lying and stealing. Nawaraj Pariyar felt the burn of this behavior when he sold his “piece of meat” in the black market and received less money than promised.

The plasma industry is an example of how white market organ sales can exist. Potential plasma donors are empowered by the vast competition of over 600 plasma centers across the U.S., Canada, and Europe,7 which allows donors a choice of interactions. Donors are also guaranteed payment as promised through contract law. Beyond that, the law also allows donors to speak out against alleged injustices, as did Jennifer Tombow of Mississippi who sued a plasma center for medical malpractice.8 Unfortunately for kidney sellers, the fear of being treated like criminals keeps them from seeking justice.

The presence of so many types of organ markets compels us to examine the ethics of each of them. For policymakers, white markets are the most ethical since they include market competition, the ability to seek justice against fraud and malpractice, clear contracts, and informed consent. However, the prevalence of black organ markets is a call for us to protect those in the shadows that have been left in the dark for far too long.

End Notes:

  1. Sugam Pokharel, “Nepal’s Organ Trail: How traffickers steal kidneys,” CNN.com, http://www.cnn.com/2014/06/26/world/asia/freedom-project-nepals-organ-trail/index.html.
  2. Khang Nguyen, “My experience with selling/donating plasma,” Khang-Nguyen.com, http://khang-nguyen.com/?p=406.
  3. Andrew O’Hagan, Rachel Hardwick, “Behind Bars: The Truth About Drugs in Prisons, ” Forensic Research and Criminology International Journal 5, no. 3 (2017).
  4. James Pearson, “North Korea’s black market becoming the new normal,” Reuters.com, https://www.reuters.com/article/us-northkorea-change-insight/north-koreas-black-market-becoming-the-new-normal-idUSKCN0SN00320151029.
  5. “Grey Market,” Investopedia.com, https://www.investopedia.com/terms/g/greymarket.asp.
  6. “Black market,” Investopedia.com, https://www.investopedia.com/terms/b/blackmarket.asp.
  7. “Plasma Collection,” PPTAGlobal.com, http://www.pptaglobal.org/plasma/plasma-collection.
  8. Kyle Barnett, “Woman who passed out after donating blood plasma sues donation facility,” LouisianaRecord.com, https://louisianarecord.com/stories/510582540-woman-who-passed-out-after-donating-blood-plasma-sues-donation-facility.


  1. Andrew O’Hagan. Rachel Hardwick. “Behind Bars: The Truth About Drugs in Prisons. ” Forensic Research and Criminology International Journal no. 3 (2017).
  2. “Black market.” com. https://www.investopedia.com/terms/b/blackmarket.asp.
  3. “Grey Market.” com. https://www.investopedia.com/terms/g/greymarket.asp.
  4. James Pearson. “North Korea’s black market becoming the new normal.” https://www.reuters.com/article/us-northkorea-change-insight/north-koreas-black-market-becoming-the-new-normal-idUSKCN0SN00320151029.
  5. Khang Nguyen. “My experience with selling/donating plasma.” Khang-Nguyen.com. http://khang-nguyen.com/?p=406.
  6. “Plasma Collection.” http://www.pptaglobal.org/plasma/plasma-collection.
  7. Sugam Pokharel. “Nepal’s Organ Trail: How traffickers steal kidneys.” http://www.cnn.com/2014/06/26/world/asia/freedom-project-nepals-organ-trail/index.html.

HOWSIKAN KUGATHASAN is a mathematics student at Fisk University in Nashville, Tennessee, originally from Toronto, Canada. He has a strong interest in bioethics, economics, and the intersection of the two subjects. After graduating, he intends to go to graduate school to study medical science.

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