By ERIC NAGOURNEY

ome advocates of loosening laws against selling kidneys for transplants describe such agreements as winning arrangements. Some people improve their economic standings with few risks to their health. The others receive organs that can mean the difference between life and death.

But a new study in The Journal of the American Medical Association paints a much darker picture of the organ-sale business, at least in India. Indians who sold kidneys, in violation of Indian law, ended up no better off financially in the long run, the study said. And many reported health problems that they attributed to the surgery.

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The research was conducted among the desperately poor people of Chennai, India, where 96 percent of the kidney donors said they had hoped to get out of debt.

But the findings hold meaning for Americans as they debate how to address the serious shortage of donor organs, said the lead author of the study, Dr. Madhav Goyal of the Geisinger Health System in State College, Pa. The sale of a human organ, he said, is not a transaction between equals. "When you give financial incentives for people to give a piece of their body to someone else, who are the people who are most likely to respond to that financial incentive?" he said. "It is not people who are well-off. It is going to be the poor."

Some 305 donors were located by the researchers in February 2001. On average, each had sold a kidney six years earlier. The amounts promised for a kidney, the donors said, ranged from $450 to $6,280. The amount received averaged $1,070, the study said.

Although most donors had hoped to get out of debt, many of those interviewed reported that their family incomes had actually declined.
More than four of five reported that their health had deteriorated.