Organ transplants: Your part or mine?

　　AS MARKETS in human organs go, the one which flourishes on Tehran's Vali Asr street, where Iran's main transplant hospital is located, is not the cruellest-and there is no lack of people willing to discuss their transactions. Gholamreza, a 44-year-old man from northern Iran, explains what he did when his dialysis started to fail. "I put an advertisement in the paper for a kidney, and a donor came straight to me. We reached an agreement on the price quite quickly. In these cases, the recipient usually takes care of the donor afterwards. So I still visit my donor and help him out."
　　Another man wandering round the district, aged around 30 and wearing torn, cheap clothing, is hoping he can find a buyer as decent as Gholamreza claims to be. He expects to get between $3,000 and $4,000 for one of his kidneys. "I need the money because I lost out in a pyramid investment scam. After the operation I won't be able to lift heavy things, but I can still live with only one kidney."
　　Iran's Association of Kidney Patients, a non-government organisation which obviously enjoys official favour, is responsible for all legal kidney transplants: it insists that commercial deals are the exception, not the rule. For one thing, it says, the religious authorities encourage voluntary gifts: in other words, cases where a patient receives a kidney freely offered by a friend or relative. Pious Muslims may also offer up a kidney to anyone who needs it.
　　For surgeons, patients and medical economists alike, the shortage of kidneys seems frustrating, because no organ lends itself better to transplant. As long as they receive decent after-care, kidney donors suffer only the tiniest increase in their own risk of dying of kidney disease. And transplants make economic sense: the cost of one kidney operation and a lifetime's supply of antirejection drugs equals that of three years' dialysis. Kidneys donated by a living person last for a median 22 years in another body; when they are taken from a fresh corpse, the figure is 14 years. 
　　Whatever solution they propose to the shortage of kidneys, nobody doubts that the black market, as it now works, has grotesque effects, both for donors and recipients. Rich westerners who go to South Asia or Africa in search of kidneys often receive organs that are diseased or unsuitable.
　　Nancy Scheper-Hughes, an American professor of medical anthropology and campaigner against organ trading, says the way poor Brazilians were induced to travel to South Africa is typical of the abuses a market in body parts, especially an international one, is bound to cause. She says donors in the Brazilian slums were given false promises about the money they would make, the care they would receive and the after-effects of the operation. 
　　Some senior figures in the medical world draw a different conclusion: as long as some people are determined to obtain kidneys and others are desperate enough to sell them, the trade will be impossible to stop-so it makes better sense to regulate the business than drive it underground.

　　参考译文：

　　器官移植：你的还是我的？

　　就人体器官市场而言，活跃于德黑兰瓦里阿瑟（Vali Asr）大街的市场还不算是最悲惨的，这里坐落着伊朗主要的移植医院--也从不缺愿意讨论交易的人。来自伊朗北部的44岁男子古拉姆瑞扎（Gholamreza）解释了他在肾脏透析治疗开始不起作用之后所做的事：“我在报纸上刊登了一则寻求肾脏的广告，就有一名捐赠者直接同我联系。我们很快就谈好了价格。在这类情况下，接受捐献者以后通常会照顾捐赠者。因此，我常看望我的捐赠人，并帮助他解决困难。”
　　另一名年约30岁、身穿破烂而便宜的衣服的人，则正在该区徘徊，希望能找到一个如古拉姆瑞扎所自诩的那种大方的买主。他希望自己的一只肾脏可以换得3000至4000美元。“因为我在传销骗局中失利，我急需钱用。尽管手术之后我不能干重活，但我还可以凭一只肾活下去。”
　　显然受到官方支持的非政府组织伊朗肾脏患者协会（Iran's Association of Kidney Patients）负责所有合法的肾脏移植事务：该组织坚持称，商业交易是例外，而不是常态。它表示，首先，宗教权威鼓励自愿捐献；此外，患者通常接受的是由朋友或亲戚免费提供的肾脏。虔诚的穆斯林也会将肾脏捐献给任何需要的人。
　　对外科医生、患者及医疗经济学家而言，肾脏的匮乏似乎令人沮丧，因为没有比肾脏移植更适合的器官移植了。只要接受适当的病后护理与治疗，肾脏捐献者死于自身肾病的风险只有微小的增加。此外，移植也有经济学意义：一次肾脏手术以及终生抗排斥药物的供应与三年透析治疗费用相当。活人捐献的肾脏在另一人的体内平均可以维持22年；而从新鲜尸体上获得的肾脏则可以维持14年。
　　无论对肾脏短缺提出怎样的解决方案，没有人怀疑黑市对捐献者和接受者双方带来怪诞的结果，正如目前的情形那样。去南亚或非洲寻找肾脏的西方富人们通常得到的都是带疾病的或不适应的肾脏。
　　南希•谢柏休斯（Nancy ScheperHughes）是一名美国医学人类学教授，也是一名反对器官买卖的活动人士，她说，劝诱巴西穷人前往南非旅行的方式是人体器官市场，特别是国际性的市场，所必然促生的典型弊端。她表示，巴西贫民窟的捐赠者只得到有关可挣钱款、所获照顾以及手术后果的虚假承诺。
　　医学界一些资深人物则给出了不同的结论：只要一些人决心获得肾脏，而另一些人铤而走险地贩售，交易就很难被阻止--因此，更理智的处理是规范交易，而不是消除它。