Organ trade is prohibited everywhere in the world, except in Iran. Frederike Ambagtsheer wanted to find out why someone would still try to buy a kidney, how doctors would deal with patients who obtained a kidney abroad and how organised organ trade takes place. Last month she was granted her doctorate with distinction for her research in organ trade.

You’re at a birthday party. How do you briefly explain your research in just a few sentences?

“I interviewed patients who buy kidneys and the doctors who treat them. And we studied how doctors and organ traffickers collaborate in South Africa, Kosovo and Israel. People often have a very grim view of organ trafficking: ‘Is it true people wake up in an ice bath with a kidney missing, or is that just an urban legend?’ It’s an urban legend. What is true is that there are people who sell their kidney. These are often poverty-stricken people who see no alternative and receive very little money in return. But sometimes there are good outcomes. A win-win situation is also possible if a donor has made a favourable deal with the patient, especially when it is properly regulated.”

Do people buy kidneys abroad because of a lack of donors?

“That’s just one side of the coin. In Macedonia, for example, people had no other option. Simply put, no transplants took place there at the time our interview subjects left the country for a new kidney. When the Dutch patients we interviewed bought a donor kidney abroad, the waiting list was more than twice as long as it is now. But it should also be noted that a quarter of those people left before they were even placed on a waiting list. For those people, a shortage of donor kidneys wasn’t the most important reason, or in any case it wasn’t the only reason.”

Do you have an idea of the scale of organ trade in the Netherlands?

“No, identifying the scale of trade was never the intention and it would be almost impossible to do. We only know that some doctors have encountered this a few times in the course of their careers. They would see a patient with a new kidney. The origin of this kidney would be sketchy or unknown.”

How do doctors deal with patients who have an illegally obtained kidney?

“They often don’t know how they should respond. This is due in part to a lack of knowledge: they don’t know whether this is punishable. And they don’t view it as their responsibility: ‘It’s not up to me as the attending physician to find out if the kidney was bought.’ Furthermore, they are bound by doctor/patient confidentiality, so they are not allowed to report a patient who presumably bought a kidney.”

Do you feel that this is something that needs to change?

“Absolutely. Yes. It would be good if doctors gave some thought as to how such a patient obtained that kidney. It should be made easier for doctors to report a case with revealing the patient’s name to the police and legal authorities. For example, they should be able to trace the clinic in Pakistan where someone obtained a new kidney. Working with police and the authorities, you could determine if that clinic is above board. Sometimes organ trade occurs in conjunction with human trafficking or exploitation.”

Don’t you think patients contribute to this through their willingness to pay for a donor kidney?

“Perhaps, but that doesn’t mean they should be punished. Sometimes they’re even the victim, for example if complications or infections occur because the donor was not properly screened. Police and the authorities would also prefer to use the patients as witnesses.”

What was the first thing you did when you finished your doctoral dissertation?

“I really needed to take a walk in the park. I had expected I would be so relieved when I wrote the last word, but instead I felt quite sad. Is this it? I wasn’t ready to part ways with science yet and that took me by surprise, because I’ve always said I would do something different after completing my dissertation.”

What are your plans now?

“Luckily I’ll be doing research for a while. Towards the end of August I’ll be leaving to be a visiting scholar at Northeastern University in Boston. I’ll be conducting research with the data I still have sitting on the shelf. And I’m going to try to obtain a grant. There are rumours that migrants sell a kidney to pay their passage to Europe, and I would like to do ethnographic research on that subject.”

Why are there no acknowledgements in your doctoral dissertation?

“I’m very grateful to many people and I would have liked to write something about that, but I feel it’s not anybody else’s business. That’s why I wrote a personal word of thanks to everyone I wanted to acknowledge. Each person received a handwritten word of thanks from me.”

cover proefschrift frederike ambagtsheer

The cover

“At first I didn’t want an image on the cover. When it comes to organ trade, you almost always end up with those cliché pictures. But everyone kept asking me why I didn’t have a cover illustration. One of the people asking was a good friend who then proceeded to sketch an oil painting of kidneys. I personally wanted a barcode on the kidney. This would symbolise that the kidney has monetary value – something we shouldn’t ignore. If you acknowledge that an organ is a piece of merchandise, we won’t make such an issue of paying for a donor kidney. It’s a political statement. ”