Ruth Evans

Interviewed by: Harry Wang

Ruth Evans is a broadcast journalist and filmmaker currently working for BBC in London, United Kingdom. Her article ‘Pakistani police rescue 24 from organ trafficking gang’ published on BBC News offers compelling first-hand accounts of illegal organ trafficking and transplant tourism. She emphasizes how the organ trade, something that is perceived to only occur in less-developed countries, is quite prevalent a lot closer to home. 

Q: What motivated you to investigate the organ trade?

I’d read a local BBC article about a raid on a kidney center in Pakistan. It sounded really crazy and hadn’t had much coverage in the UK. I started looking into it and read that they found 24 people imprisoned in a building nearby to the Kidney Center. I spoke to a few surgeons who said they knew of British patients who had been to Pakistan to buy organs and had come back, in some cases, in a really terrible state. When I realized there was a British connection, it really sparked my interest and I thought, “we should do something on this”, so I pitched it to my editor and she was really keen. I decided to work closely with Nosheen Abbas, who is a colleague in the BBC Urdu Service.

Q: How do you go about starting a project like this – do you contact people at the Kidney Center, people that have been affected…could you lead us through this process?

The first thing was to speak to Nosheen, because I knew that she would be vital for the Pakistan-based work. We devised a strategy, coming up with a list of everyone we wanted to talk to. The two of us then called everyone we could think of. I mostly covered the UK side and she mostly covered the Pakistani side. She was speaking to police contacts – she managed to find the officer who was there at the time of the raid, who rescued the [imprisoned] people. She also managed to find a couple of the victims. I spoke to surgeons who specialized in kidney issues and people from the organ donation sector in the UK. I also started looking for people who were affected by this issue and were interested in buying organs. I found a couple of people who were looking for organs online, and I really wanted to speak to someone who had gone abroad for [an organ transplant].

Q: What preconceptions did you have going into this project, if any, and did they change at all after the investigation?

I thought it was a shadowy, underground trade involving criminal organizations… the Hollywood gang story. What was scary was how matter-of-fact the [organ harvesting] was. This was not some backstreet hospital; the kidney center was a massive, shiny hospital right in the center of the city – it wasn’t hidden away. I couldn’t believe how blatant and open it was – people advertising their kidneys online…people so desperate that they would sell an organ for very cheap. 

Q: After having interviewed another individual who investigated the organ trade last year in Southeast Asia last year, there seemed to an ethical dilemma wherein many communities depend on selling their organs in order to provide for their family. Would you say there is less of a gray area in which people are being kidnapped for their organs, and wealthier individuals are coming to pay for the organs that are being harvested?

From speaking to Pakistani doctors who have been fighting against the trade there, it seemed to be a matter of if people got paid, and that’s a big if, they only get a tiny fraction of what is charged for the organ. It seems like such an unfair deal and it is grim that that’s the only option people have. I wouldn’t even say it’s a gray area – if people are being kidnapped, it’s just plain immoral. Having said that, I’ve never been in the situation where a family member requires an organ. However, having heard the stories of two men, one who nearly lost a kidney and one who actually did, the situation they were left in seems very appalling. They were tricked [into having their kidneys removed] – one of them was told that he was having a treatment that would help him as he was already unwell, while the other was told he was taken for work. He was desperate for work to support his family, and so he was tricked into going to court and signing documents that would then allow him, he thought, to have a work permit. He didn’t understand the process of what he was signing up to do – [in reality], they were providing a paper trail to allow the organ transplants to go through.

Q: It seems as if there is almost a protocol for every step in the process of organ harvesting, creating a paper trail to intentionally have a legal basis for doing what is a very illegal task. 

Absolutely – there must have been involvement from all kinds of people to make this happen.

Q: What was the greatest challenge you encountered while working on this project?

I’d say there were two – from Nosheen’s side, there was finding the victims to talk to in Pakistan, as they lived in very rural, remote areas and were very nervous to talk [about their experience]. From my side, the biggest challenge was finding a British person who had either tried to buy a kidney or had bought one. The woman who I ended up speaking to spoke very powerfully about what happened – it wasn’t actually her, it was her brother who had gone to Pakistan and she had helped him. I think they paid 16,000 pounds for a kidney. While he was on dialysis [in Pakistan], waiting for a kidney, he contracted Hepatitis C.He had to come back to the UK and later died as a result of the disease. As a result of complications caused by buying this kidney, he died. She was incredibly open about talking about it, and spoke very powerfully about how desperate he had been. 

The interview I reported with her was very interesting in the ethical dilemmas that people go through – her brother had been waiting on the list for a very long time and was very ill. They were also [presented with the ultimatum] that if they don’t take the kidney, someone else will. They thought that they were paying a lot of money for the kidney and that [the donor] would be getting a fair deal.

Q: Was there any regret for the sister in this process, or did she think it was justified given how sick her brother was?

Knowing more about the process, she said that they wouldn’t have done it, besides the fact that it indirectly led to her brother’s death. With everything that she knew, she said that it just wasn’t the right thing to do. She was aware that someone was probably doing it so they could pay a dowry, or pay for something that they needed – my reporter pointed out that sometimes they’re in debt and that they’re paying the debt. 

Q: What is the biggest aspect of the organ trade, from your experience, that is less known to the general population?

I think the fact that there are British people involved – the person that I ended up interviewing lived very close to me. We think of this as something that happens in films and occurs abroad, but it affects communities in the UK and there are probably things that the government could be doing better that would help the situation. 

Q: You mentioned in the article that there are lower proportions of organ donation in people from minority ethnic groups – what do you believe is the cause for this? 

I’m not from those communities so it’s difficult to speak for them. Adnan, the young man who I spoke to who was in his twenties and had been on dialysis for five years, was desperate for a kidney. We spoke to him while he was on dialysis, and he said he thought that there was a reluctance from his own community to give kidneys to strangers. We also spoke to the person who is in charge of the [National Health Service]  Blood and Transplant Organization, and she thought that the reason there are longer waits is that Asian people have higher rates of kidney problems, overrepresented on the list – issues including diabetes and blood pressure. She said that there isn’t a tradition amongst those communities for deceased organ donations. 

Q: Where do you believe the organ trade is trending towards in the next 5-10 years? You mentioned the Taking Organ Transplantation to 2020 strategy to increase organ donations. Do you believe this is a step towards the right direction?

If [Taking Organ Transplantation to 2020] manages to increase the rate of consent after death and improve rates of donation across all faiths and communities, then it would be a really good step in the right direction. This isn’t something that I have been working on in the past couple of years so I wouldn’t want to predict where the trade is going, but one area I’m really interested in and I’d like to do more work with is the opt-out organ donation system in Wales, where I’m from. Instead of people signing up to be an organ donor, you have to opt out if you don’t want to be [a donor]. It’s a really small country, so I don’t know whether this has had an impact on communities who have been waiting longest for donors in the past statistically. It would be really interesting to see what the impact of that has been, and whether that is something that can work across the whole of UK.

Q: To compare to Canada, for example, there is an opportunity to sign up to consent for organ donation after death when you are getting your driver’s license. I think the strategy is moreso to incorporate these opt-ins into tasks that the majority of the population will go through at some point in their life. Is there anything similar like this in the UK?

There is – it’s kind of the same in the UK where one point where you can sign up [for organ donation] is when you are getting your driver’s license. I think there’s been a problem, from speaking to doctors and nurses involved in organ transplantation in the course of [the opt-in program], where even if someone has signed up, families can override that person’s decision. You’re being asked about [donating your organs] at probably the worst time in your life, when you are near death, and it is an incredibly stressful situation. If your loved one is about to die and you’re in the hospital and someone is asking you whether their organs can be donated, it’s kind of the last thing you want to hear. The decision in Wales, along with having the opt-out process, you are getting a conversation going on a national level when you say that “it will be presumed that everyone in the country has opted in unless you have formally opted out and you have spoken to your family about opting out”. The idea is that it will, as well as having a formal register, it will also help in starting family conversations [about organ donation]. However, I don’t know what impact this strategy has had yet – it would be really interesting to explore. 

I think that as people become more accepting [of organ donation], and I can see younger communities are more open to these topics, we will hopefully see higher rates [of donation]. 

Q: Given this interview is to be published targeting a largely university student demographic, is there any message that you’d like to send that in regards to the organ trade and illegal organ harvesting?

I think there is so much going on – we only touched on one tiny area. If you’ve got the time and the proper connections to investigate these matters, it is a very important subject to look at, from an investigative journalism point of view. From a general point of view, raising awareness around the importance of having conversations with families and being signed up [for organ donation registries] is really important as well. 

As a side note – the guy I ended up speaking to who was on dialysis waiting for a kidney, the reason I found him was he posted on Facebook saying “I need a kidney”, and I’d seen this thread and someone in Pakistan had offered to sell him one. He was tempted – he had been on dialysis for five years at that point. I stayed in touch with him, and I spoke to him last year and I had found out that he had just had a kidney transplant in the UK and was doing really well. He was starting a college course, as he was not able to study while on dialysis. It showed that, although he had a longer wait, he did get his kidney in the end. 

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The organ trade and illegal organ trafficking is commonly thought to occur in only poorer, less-developed countries in sketchy, Hollywood-esque back alleys. However, through her investigative work, Ruth has revealed the widespread nature of the organ trade, and how commonplace it is in many countries. Ruth provides significant insight into the great lengths to which individuals are compelled to go to in order to receive a life-changing transplant, and by doing so raises many questions about the root causes of the organ crisis.