Interviewed by: Jae Lee1, Harry Wang1, Kevin Zhao1, and Daniel Cui1

1Bachelor of Health Sciences (Honours) Class of 2021, McMaster University

Simcha Jacobovici is a New York Times bestselling author and three-time Emmy award winning Israeli-Canadian investigative journalist and filmmaker. His film, Tales of the Organ Trade (2013), explores the underground kidney trade that permeates medical care throughout the world. We had the pleasure of interviewing Simcha Jacobovici about his documentary and experiences in and around the organ trade as a whole.

You have previously worked on documentaries that vary in terms of topic. What drew you towards the issue of the organ trade specifically?

Simcha: I come from a world of investigative journalism and documentaries, and the organ trade is another topic for investigation. My personal reason was that I had a very dear friend who needed a kidney transplant. By virtue of getting involved in his life, I became interested in this because it’s one thing if somebody is diagnosed with a problem that has no cure. But if you need a kidney, there are people willing to give you a kidney. So what’s the problem? That guy wants to give a kidney or sell a kidney, so what’s the problem? Then you start getting into this whole issue of “should anybody sell [organs]”. In Canada, they make it very difficult. Even if they want to donate a kidney to their friend, they need to go through psychological tests – [to] check whether they’re not being coerced. Somebody can die while you’re trying to give your best friend a kidney that you don’t need. People are waiting for years and go through dialysis… just an amazing topic. So that’s what drew me, that personal involvement of my friend, into this topic.

What most shocked you while producing “Tales from the Organ Trade”?

Simcha: At the end of the day, what made our documentary different is that we get the doctors, the sellers, the buyers… just everybody. That was what we set out to do, and we did. At the end of the day, what was [important was] how much people are suffering and waiting for the kidneys – how many lives are lost during the waiting process, and how many people are willing to give up the kidney by volunteering or selling it. I didn’t realize how many lives were involved on both sides of the issue.

Can you give us a brief overview of the filming process?

Simcha: We come from a world of investigative journalism. The idea is always to track down whoever we need to track down. So when Felix, the co-productor, and Ric, the director, were looking into this particular doctor, a Turkish doctor, who was wanted by interpol, they could find his name. He was in the phonebook. So, some of these people are accessible. They just – Interpol, for example, can’t arrest them in territory that they don’t have jurisdiction in. So, Ric befriended this doctor’s mom. [She] vetted the mom and figured she would give her son a fairer interview. And once the mom gave the blessing, Ric was able to interview him. So, here’s this doctor that’s wanted by the international police. They can’t get him, and our director has him on camera.

How and why did the documentary team choose the Filipino village which the film focused on?

Simcha: I think there are certain villages that are notorious with middle people – the middle people that recruit these people. They’ll tell you where they’re getting their best kidneys from. There are entire villages in Ukraine as well, where probably every male has the scar because it’s one way of actually financing your livelihood or upgrading your apartment.

Interestingly, the majority of the organ trade donors in the Filipino village were males. Why?

Simcha: I think it varies from place to place, and I think you should direct that to Ric, but what I can tell you generally, in those cultures, it’s the males that are supposed to be the bread providers. And if you have no way to put bread on the table, it’s the males that go out there. Unfortunately, in many of these destitute villages, it’s the men that are selling their kidneys and it’s the women that are selling their bodies.

In your documentary, many of the Filipino donors voluntarily join the organ trade due to their financial circumstances. Do other countries face similar situations? Which is more common: forced organ harvesting or donating?

Simcha: I don’t think people need to force people. You hear about these urban myths. Of someone waking up in the tub, in the hotel, packed in ice. A lot of people are willing to sell their kidneys, for example. We in the west, we automatically have a reflexive reaction: selling your kidney – bad bad bad. But when you go into these societies, where every one of us can sell – we only need one kidney and we have two. A dad wants to sell his kidney in India or the Philippines. And by selling his kidney, his daughters are not going to go into prostitution. You come from the West, all the way away, and you say “No, you should not be allowed to sell your kidney. And to hell with it, even if your daughters end up in prostitution. One of your kids ends up dead ‘cause they don’t have proper medical attention. And you could change your whole life. You could give an education to your children.” It kind of makes you wonder, who are we to tell them that what they are doing is wrong. And when we go back to our comfortable homes, we condemn them to eternal poverty because we’ve decided that it’s immoral for the dad to sell his kidney. So, I think that our film is not advocating for legalizing kidney sales, but it’s certainly showing the moral ambiguity of this whole issue. People are dying that could be saved. And some people might say, “Yeah but, people who sell their kidneys often die.” Well, they die because of lack of aftercare. If this was regulated, some infection that now kills people would be cured by a simple antibiotic. One could argue that by criminalizing the sale of kidneys, we are actually condemning the poor people who are selling to death sometimes, because they’re not getting proper aftercare. It’s a lot like marijuana. You could look at it like, “It’s the first step to heavy drugs. All these people that are criminals.” And several decades later, we say, “To hell with it. Let’s legalize it. Let’s regulate it.” And in Canada, the LCBO, they’re selling dope. So, I think one of the issues that is raised, that is being debated worldwide – our film was screened in the Danish parliament as part of the debate – is whether the sale of organs should be criminalized or regulated. Sick people are not selling, healthy people are getting the proper aftercare, and people are not coerced. I think that this whole criminalization, it’s actually a very big problem.

Considering the complex nature of this issue, what do you think is the most feasible way that governments of developed countries can tackle the illegal organ trade? What do you think the next steps for our government should be?

Simcha: [The government should] match people who need kidneys with people who are willing to sell kidneys. So, let’s say there’s somebody in the Philippines that is appropriate. We could sponsor them here, where they would undergo medical and psychological tests, to make sure that they’re not coerced, and they’re capable of making a decision, and that they’re healthy. We’re talking about a few thousand people. It’s not an insurmountable problem. We wouldn’t have to go to India and tell them what to do, or to the Philippines and tell them what to do. Our governments have so many issues. There’s the World Health Organization. If a flu breaks out, there’s a coordinated international approach to it. Right now, the only people gaining from this present situation are the people who make those dialysis machines. They make a lot of money while torturing the people who are on them, and lobbying against the people that would put them out of business.

Do you think that your proposed solution may create other ethical barriers where individuals find that selling their organs, illegally or legally, may be the only pathway out of poverty or their current social economic condition?

Simcha: It does create ethical issues but we face ethical issues all the time. I am not saying that there are no problems with this solution. I’m just saying that the problem to me is the present situation — where people are dying when they don’t have to; that to me is an ethical issue. We all assume that if you legalize the sale of organs, all the donors will come from third world countries. However, there are people from the United States and Canada that would also be willing to donate to save a life, and also upgrade their apartment. Right now it isn’t just the sale of organs that is discouraged – everything about organ transplants is discouraged. If someone steps forwards and says “I want to donate”, the suspicion is immediately that you are selling. There is no mass campaign, no church, synagogue or mosque to say “Hey we can save lives, let’s get some volunteers out here”. Volunteering is regarded with suspicion. I just think that the most ethical thing to do is to go into war against the present situation where people who are allowed to die could be saved. Then, you get smart people in a room and say “Okay, this is the way we can limit ethical problems. We are not going to let certain people donate, et cetera”.  However, if someone with a sound mind and body wants to save a life and we have both volunteers and first world sellers, then this is certainly something we should entertain as a possibility when the alternative is death.

Considering the current situation of the organ trade, where do you think the legal organ trade is headed in the next five to ten years?

Simcha: Again, I’m not here as an advocate for one particular issue, I’m here as an advocate for doing something and changing the status quo. I think that practically everybody who says that buying kidneys is repulsive, if one of their loved ones was facing death, would buy a kidney. This is just the truth. They would do it. They would try and do it in the healthiest possible way and make sure to give the donor a fair price and give them the best clinic and aftercare. But all of these kinds of things can be put in place. As long as there is a need –  and there is a need because people are dying – there will be suppliers, and I believe that just like with drugs such as marijuana, this does not need to be criminalized. Criminalizing marijuana, alcohol, or the organ sales just drives it into the hands of bad people.

How do you think university students can make a difference in the organ trade, trafficking, and help those who are impacted?

Simcha: I think the establishment on this issue is very complacent. Everybody goes to work, does their job, [while] people die and people are tortured. Do you see what happens year after year if you are on dialysis? Your whole body gets contorted. Everybody is complacent, but I think that students have the time and energy and youth and desire to make a difference. I think that you guys lobbying, and the status quo being disrupted, can result in a new status quo. And I think the establishment will try and discourage you but when you guys have got energy and can be courageous, you guys can make noise.

What was the main message your film was trying to convey?

Simcha: People that can be saved are dying and the issue is not as black and white as we thought it was.

So, there is moral complexity surrounding organ trade?

Simcha: Yes, it’s moral complexity and the issue is highly ambiguous. That doesn’t mean that you shouldn’t act. When things are clear cut, you are fine but when they are not, we need to find a solution.

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From an outsider’s perspective, it is easy to deem the organ trade illegal and support its abolishment. However, it is clear that there are countless factors that contribute to its moral ambiguity, as revealed by Simcha Jacobovici throughout this interview. His work is crucial in highlighting the diversity of individuals affected by the prevalence of the organ trade, and the cultural, economic, and medical influences that play a role. Simcha provides insight into such influences through his documentary, and allows the general public to develop their own understanding through providing a detailed account of the various facets of the organ trade.

 

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