For kidney patients in Vietnam, it is either hemodialysis or organ black market

By Thanh Lam, Do Manh Cuong   May 11, 2018 | 04:11 pm PT
Social insurance only funds the cost of kidney dialysis, so those who need a transplant have to pay for it.

One morning in April, an organ "donor" was brought into an operating room in Hanoi, all alone.

Not long after, the recipient was brought in, with a whole family waiting outside, and a man in suit.

By the afternoon, the kidney had been successfully transferred from one person to the other. The man in the suit received a load of cash from the recipient’s family, and off he went.

For doctors and nurses, the long hours just meant another to hundreds of operations they perform, but for the poor family waiting outside, they had just spent every penny they had on a kidney for their son.

The son, Binh*, is a 24-year-old engineer.

On the verge of losing a bright future at such a young age due to chronic kidney disease, Binh made the call himself to buy a healthy kidney from the black market. He wanted to leave the chapter of hemodialysis behind.

Days of needles

For the past five months, Binh had been on hemodialysis every Monday, Wednesday and Friday.

Two large needles were laid out waiting by the bed, and Binh closed his eyes, trying to relax through the four-hour process.

Four kilometers from where he was lying, a mother was struggling in the capital's heavy traffic to get her daughter to Bach Mai Hospital for the same blood filtering procedure.

Her daughter Lan's arm was three times bigger than normal and had turned purple due to all the needles.

That day, her mother did not have the VND200,000 (nearly $9) she needed to buy Lan a special needle that can reduce the pain, so she had to undergo the process with the normal needle provided by the hospital. As Lan struggled with the pain, her mother couldn't bear to look. She directed her eyes towards the hall, where a crowd of patients’ relatives were also waiting for the procedure to be completed.

Lan and her arm after undergoing too much hemodialysis. Photos by Do Manh Cuong

Lan and her arm after undergoing hemodialysis. Photos by vnExpress/Do Manh Cuong

More than five million people have chronic kidney disease in Vietnam, and every day across the country of 90 million, around 100,000 patients have their blood filtered by machines, just like Binh and Lan.

Looking at Binh's cheerful face, no one could tell he had just gone through four hours of pain.

His life was good, if not to say perfect: He graduated from one of the top universities in Vietnam with excellence, and had got a job at the company where he did his internship. And after a year at work, he was promoted to manager.

In autumn 2017, when Binh’s parents were preparing his wedding, he started to find it hard to breathe and felt tired and chest pains, while his hands and feet started to swell. He was diagnosed with stage three of chronic kidney disease.

After three weeks of hemodialysis, his situation jumped to the final stage.

The first two months of treatment cost Binh and his family thousands of dollars. After that, thanks to health insurance, he only needs to spend VND4 million ($175) each month on medicine, but the young man still tries to keep on working so that he is not a burden for his parents.

That is also Lan’s wish, but it is far from her reach.

At the age of 24, Lan says: “People like me do not have the right to think about the future.”

From a girl who loved to wear makeup, Lan no longer wants to look in the mirror. 

When she first started hemodialysis two years ago, Lan could still ride a bike and take care of herself. These days, her mother has had to ditch a small paddy field in rural northern Vietnam for Hanoi to look after her daughter, who can barely walk. They rented a place in an area of Hanoi that is also home to other poor kidney patients from the northern region.

The mother and daughter rarely have meat and rely on rice and vegetables because by saving money on food, they can afford the special needles Lan needs to ease her pain.

The kidney business

Binh, as what he wants to remain on the newspaper, finish paperwork at a hospital in Hanoi before the kidney transplant on April 1, 2018. Photo by VnExpress/Do Manh Cuong

Binh completes paperwork at a hospital in Hanoi before the kidney transplant on April 1, 2018. Photo by VnExpress/Do Manh Cuong

Binh had asked for VND550 million ($24,100) from his parents after he registered to wait in line for a legal kidney from a brain dead patient at Viet Duc Hospital, because national health insurance does not cover the procedure.

But he lost hope and patience after waiting for four months, and decided to turn to the black market.

“I have two packages for you. The first one costs VND450 million ($20,000) and covers everything from A to Z. The second one costs VND400 million, but you'll have to cover the fees for testing the donors,” a broker told Binh.

The broker, 29, always wears a suit and leather shoes, and people often mistakenly think he is an office worker or businessman, but what he actually does is hold the fate of Binh and many other patients like him in his hands. The broker himself used to sell his organs on the black market. When he first started his business, he had to make friends with patients’ relatives by going from hospital to hospital, but now he just sits at home and waits for "donors" and recipients to come to him.

Binh was introduced to the broker by a nurse. He chose the first package and called home asking for VND750 million ($33,000) from his parents, including the VND300 million for the operation. His parents borrowed money from anyone they could and sold a small piece of land they had been saving for their sons.

Then, the family met with potential providers. The first candidate was a woman named Trang, 32.

“So you need money and you've just decided to sell your kidney?” Binh’s mother asked her.

“I need money to build a house. People in my neighborhood have done it before and told me how to get into the business. I don’t think it’s a big deal,” was the reply.

In the end, Trang was not a match for Binh, and a month after meeting Binh’s family, she donated her left kidney to another patient in Hanoi.

Not long after that, Binh's savior appeared. His name was Tien. He needed money to pay off a gambling debt, and was selling his kidney for VND200 million ($8,700). Tien was not a talkative man, and on the day of the operation in early April, he was all by himself.

In Vietnam, where organ donation is considered a taboo as many believe one should die wholy for the afterlife, black market kidney transactions like Binh and Tien's are not rare. They have even become more frequent and professional, said Lieutenant Colonel Khong Ngoc Oanh from the Criminal Police Department under the Ministry of Public Security.

Oanh said the department has discovered operations in which brokers gather people who are willing to sell organs into "centers" stationed near big hospitals in Hanoi and Hue in central Vietnam, waiting to find suitable recipients.

Each broker is in charge of a ring that ranges from 20 to 30 people including those who want to sell their organs, he said.

Every person in the ring has a specific duty: finding potential organ providers, picking them up to and from coach stations and hospitals, taking care of their accommodation, keeping a close watch on them, booking air and coach tickets, and forging legal documents.

Most operators, who always stay under the radar, are family members or friends of people who needed an organ transplant in the past, and know how high the demand is.

The recruitment process for organ providers, however, is quite open. Trang, the first to meet Binh’s family, found out how to sign up through a post on social media.

In most cases, people who want to sell their organs are people in difficult circumstances, but others like Trang think it is an easy way to make money, because “it would not affect the health.”

Those people have one thing in common: they hide what they are doing from families and friends. When hospitals require legal verification from families and local authorities, a team from the black market will take care of forging the paperwork and even pretend to be the patients’ relatives if needed.

According to the police, kidney transaction rings usually conduct 30-50 cases per year.

In July 2015, when one of these rings was busted, Nguyen Viet Dung, the operator, was only charged with “forging documents” because back then, the organ business was not mentioned in Vietnam's criminal code.

But despite the trade in human parts now officially considered a crime, with punishments ranging from several years to a lifetime in jail, Lieutenant Colonel Oanh said it is still "difficult" to stop it from happening because there is an inadequate source of legal organs.

What social insurance can and won’t do

“After undergoing hemodialysis, most patients can continue to work and contribute to socio-economic development, and the health insurance fund does not have to spend a lot on covering the cost of an organ transplant. In cases where patients cannot afford the operation, they still have many other choices,” said Le Van Phuc, deputy head of policy at Vietnam’s social insurance department.

But Lan does not have “many choices.” Paying for an operation, even a legal one using a kidney from a brain dead donor, is something she can only dream of.

The only choice for poor patients like her is wasting away with the pain, needles, medicine, strollers and debt.

What Phuc said about “working like a normal person and contributing to socio-economic development” does not ring true for anybody who has visited the community of kidney patients where Lan and her mother are living at 121 Le Thanh Nghi Street in Hai Ba Trung District.

The population never stays stable. Around ten die every year, some in their 50s and some in their 20s. The small rooms they leave behind are quickly filled up with new patients.

And this community's “contribution to socio-economic development” ranges from washing dishes, working as xe om drivers and handing out flyers, to selling goods and polishing shoes on the streets.  

Phuc said the social insurance fund spends an estimated VND100 million ($4,390) each year to cover the cost of hemodialysis for each kidney patient.

A kidney transplant costs between VND200 million and VND300 million, which means it is much less than the total cost of treating a kidney patient for 5 years. But transplant procedure is not covered by insurance.

Nguyen Hoang Phuc, deputy director of Vietnam's National Coordinating Center for Human Organ Transplants, said “the benefit of organ transplants is undeniable.”

More than 95 percent of kidney transplants in Vietnam are successful and the kidney can operate healthily for 10-15 years. Patients can go back to a normal life and not have to spend three days a week having their blood filtered.

“We all have to wait for a more reasonable policy from the social insurance fund.”

But no one can tell how long the wait will be.

“Last year, 15 people died here,” Lan said about the community she is living in, still unsure of her own fate.

*The patient's name has been changed to protect his identity.

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