A Suitable Donor: Harvesting Kidneys in the Philippines

1. Along the coast of Manila Bay in the Philippines, behind the grand Manila Hotel, there is a slum district called Baseco. Hidden by towering container yards and cargo ships, this shantytown had been virtually unknown until a few years ago when a television report broadcast nationwide put a red pin on the map of Manila.

Describing it as “a place where the people of damned souls (mga halang ang kaluluwa) sell their kidneys to survive,” Baseco brought to public attention the scandal of what is essentially a human organ farm.

This vote-rich village—where local and national politicians occasionally paid visits (and often made fantastic promises)—has been quietly providing fresh and healthy organs for moneyed foreign and local patients. Recipients have come from the Middle East, North America, Hong Kong, Japan, Korea, and most recently, Israel.

Originally the name of a shipping company where most of the men had worked as part-time stevedores, repairmen, and laborers, Baseco is a community of some twenty thousand people living literally on the margins of the sea and society.

2. There is no sign that leads to Baseco. Why should there be? Why would the Manila government waste its resources in drawing attention to a spot better hidden than seen? Nor is there any jeepney or bus on an officially sanctioned route to this place. Indeed, there is no single means of transport that says: “to Baseco” or “Baseco Express.” Baseco, it seems, simply does not exist. For the twenty years I have lived in Manila, I had not heard of Baseco. When I searched for it in December 2000, it took me two days to find it. It was only a thirty-minute drive from my parents’ residence!

3. He is walking on the narrow breakwater under the midday sun. Fire had just ravaged and reduced to coal and ashes a large part of the slums. Periodic fire often broke out here and many believe they had been deliberate and aimed at clearing the area of slum dwellers. Fire, occasionally, has been an absolute tool that the authorities employ when reason and force became inutile. The ruins are still smoldering and many residents are trying to salvage any piece of junk they could use to assemble a mosaic-like dwelling.

Leo is walking on the breakwater half-naked, wearing only a pair of loose basketball short pants. He has wrapped his head with a white towel. At a distance, he looks like just another skinny and undernourished young man living in the slums. But on closer look, after my guide had pointed it out, he bears the trademark of an operado—the foot-long, centipede-like scar on his left side. He had “donated” a healthy kidney! He wears his cut like a badge of honor or a brand of manhood. He was never ashamed of it nor even tried to make it less conspicuous. In fact, he is proud of it. He looks tough and confident.

4. He had “donated” his kidney on 8 June 1996. He was eighteen years old. His recipient was a Japanese man in his mid-twenties. His name, as far as he could remember, was Kusunori. And in gratitude for Leo’s heart of gold, Kusunori had handed him directly peso bills amounting to a hundred thousand pesos. The transplant operation had taken place at the world-class and elite St. Luke’s Hospital in Quezon City.

Leo’s education went as far as elementary school. He had no knowledge at all about organ transplant, organ donation, and much less about organ harvest. But of course, now that he has only one kidney, he knows a little better. Experience, after all, is the best teacher.

5. In addition, experience has taught him that if ever God would bless him with one more kidney, he would never ever part with it again. Not for any religious or ethical reasons, but for the simple and naked fact that to function as a normal human being, we need two kidneys. Now, he is only thirty-three but he already looks forty-three years old! He is toothless and his left eye is always red. He is skinny and every morning at dawn, especially when it is cold, he feels a stabbing pain in his abdomen. He is supposed to be in the prime of his life, but now he tires easily, just like an old castrated water buffalo. He used to work in the docks. Now, he can only do light errands for a sari-sari store.

6. Leo has lived in Baseco for over twenty years. His family came here when he was eleven. He is the eldest of three children. His father, from the province of Pampanga in central Luzon, was a junk collector and an itinerant vegetable and fruit vendor; his mother, Teresita, from Imelda Marcos’s city of Tacloban in the Visayas, was a laundrywoman. During their early years as squatters, Leo helped his mother do the laundry. His father eventually left them to live with another family. His two brothers sold newspapers and cigarettes in the streets of Divisoria in Manila.

Baseco was still an emerging squatter colony when Leo’s family decided to try their fate in this hidden edge of the city. He and his mother had struggled hard to erect the posts of a hut. Most of the materials were fashioned from bric-a-brac dregs from the city. They roamed the city and sifted garbage to collect materials. His two brothers were left in the streets of Tondo, selling tabloids and Marlboro. His father had the habit of appearing and disappearing like an urban guerilla. At a young age, Leo was already acting as the father to his younger brothers and partner to his mother. He never had a chance to give his affection to a girl; he was forced to take family responsibility at a young age.

7. One day in 1982, a tall, slim Japanese man in his forties known only as Fushimi came to Baseco with his teenage Filipino girlfriend. Fushimi’s young lover, who is from the Visayas like Teresita, had several relatives in Baseco. She introduced her cousins to Fushimi, who then asked her cousins if they would like to volunteer for blood tests. He promised three hundred pesos a day plus transportation expense for each volunteer. Several men instantly agreed. Three hundred pesos, after all, is not a bad idea for generally unemployed men. The blood tests remained blood tests. They did not lead to any further medical procedures.

In 1984, Fushimi came to Baseco again. This time, he was known as Dr. Fushimi, the Japanese doctor. He came with his girlfriend again. This time, a new person joined them. His nickname was Bakla, meaning “homosexual.” He was from the neighboring slum of Balut, Tondo. Fushimi gave Bakla the job of recruiting potential “kidney donors.” Bakla started to recruit in Baseco. Immediately, he found ten able-bodied men. One of them was James.

According to James who is forty-nine years old, Bakla brought the ten of them (now known locally as the Magic Ten) to a hospital in Pasay City. There, they met Fushimi and his girlfriend. The Magic Ten were subjected to thorough medical examinations: blood, urine, stool tests, ECG, CAT, and others. For a week, James and his fellow “hopefuls” were taken to different hospitals in Metro Manila for more tests. Each day, each of them was given a hundred pesos, exclusive of meals and transport expenses. Fushimi had paid all the medical fees.

“Nobody among us knew,” James said, “what the real objects of the tests were until the final day. Those who had passed all the tests satisfactorily were offered one hundred fifty thousand pesos (about US$7,000) for a kidney!”

James, who said he passed all the tests “with flying colors,” backed out at the last moment. A former soldier with a good build at 1.78 meters tall, he could have been an ideal specimen.

“I wanted the one hundred fifty thousand pesos,” he said, “but my mother refused it. ‘We are poor,’ my mother told me, ‘but I don’t want you to exchange for money what God has given you.’” James’s Christian belief prevented him from selling his kidney. At forty-nine, James, a carpenter, is still strong and fit and youthful. In fact, he looks a lot younger than many of the operados.

8. James introduced me to Dalmacio, now fifty years old, another member of The Magic Ten. Dalmacio, who once lived in Baseco, is now living in another slum district in Quezon City. James and Dalmacio used to be neighbors until a furious typhoon devastated their dwellings along the breakwater. Dalmacio now lives with his children, stepchildren, and grandchildren.

Dalmacio has had several mild strokes, now stammers, and speaks in a childlike manner. Unlike James, Dalmacio did not pass the medical examinations. Though he wanted very much to sell his kidney, he was not considered a suitable donor. Despite this failure as a “volunteer donor,” he had discovered a scheme to make money. Like Bakla, be became a recruiter, eventually becoming Fushimi’s right-hand man in Baseco. From 1989 to 1999, Dalmacio confessed, he had recruited more than a hundred kidney donors for Fushimi. Most of the recipients of these kidneys, Dalmacio told me, were Japanese, Arabians, Koreans, and rich Filipino-Chinese.

Dalmacio’s first recruits were members of his immediate family. He started with his sons-in-law. Next, his stepsons (children of his wife by her two earlier husbands). Later he expanded to his relatives, neighbors, and friends. It was a double-edged nepotism—immediate family members were the first to benefit and the first to suffer.

The first recipient, he remembered well, was a Japanese patient named Mr. Kubota. The organ came from his son-in-law. The operation in 1989 was conducted at the University of Santo Tomas (UST) Hospital. With his first client, Dalmacio had received twelve thousand pesos from Fushimi. “It was the biggest amount I had ever received in a single day,” he said.

And how did he spend his first “commission”?

“I love good clothes,” he said. “When I got the money, immediately I bought some clothes.”

Wearing his new clothes, Dalmacio and his family went to UST Hospital to monitor the progress of the transplantation. The operation was a success.

A day after Mr. Kubota received the new kidney; he raised his hands and said: “I’m already strong, I’m already strong.”

“We were all very happy,” Dalmacio said. “Mr. Kubota was like a member of our family.” They cheered him, told him stories, and cracked jokes with him.

But on the third day after the operation, Mr. Kubota suddenly became weak. And toward evening, he became unconscious. The following day, Mr. Kubota no longer opened his eyes, nor was he able to speak—he died. On the fifth day, Dalmacio and his family kept vigil at Mr. Kubota’s wake. They waited for his family to arrive from Japan.

The recipient of Dalmacio’s first recruit did not survive but his enthusiasm to find more “donors” did not die. For a decade, he scoured every small corner of Baseco and delivered more than a hundred “kidney donors” to Fushimi.

“Almost every month,” he said, “I have a donor. And after every transplant operation, we would have a good time. Fushimi loves young girls. I like brandy and Scotch. Now, I’m broke. No more good times.”

Penniless and partly paralyzed by strokes, he cannot work, nor does he have any savings. He depends on the mercy of his children and stepchildren.

“He is cursed,” James told me. “God had punished him for selling the organs of his fellow men.”

In 2007, he was laid to his final resting place in Bataan where he had moved with his own daughter.

9. Leo’s shanty stands by the sea. It is within spitting distance from the hut of Dalmacio who is better known as “Agent Baboy.” Baboy is always dressed like a politician, his hair heavily pomaded, and a Marlboro perpetually between his thumb and index finger. Every day he could be seen walking between the tiny gaps of houses in search of a potential “donor.” Moreover, there was never a dire shortage of more-than-willing and able-bodied young men wanting “to help” moneyed patients near death or with end-stage renal problems.

Baboy is a sweet talker. He wears his money on his sleeve; his look is money; he smells of money—and he displays it with outrageous flagrancy. He is always wearing brand-new shirts, double gold chains around his neck, and leather shoes. In the quicksand of squalor, shit, and filthy poverty in Baseco, Baboy stands out like a mushroom on cow dung.

Baboy promised Leo an amount if he agreed to “donate” his kidney. It is a figure that to Leo sounded like winning the lottery jackpot. Leo did not think twice. After all, he was not a newbie in selling parts of his body. He “donates” (i.e., sells) his blood.

During this time, Leo’s mother, Teresita, had been going in and out of the Philippine General Hospital—the biggest public hospital in Manila, if not in the country. Her face was bloated and her entire body was swollen. Her neighbors believed she was a victim of witchcraft and there was no use taking her to a hospital. But Leo loved his mother dearly. With the little cash he was earning as a dockworker, he was giving almost everything to her. But each visit to the hospital was a financial struggle. Although the basic consultation fee was free, Teresita could not afford the foreign-brand medicine prescribed. Each treatment was at most consultative in nature. She could not afford a continuous or comprehensive treatment. On her last confinement, her doctor advised her to be admitted lest it would be too late. Leo made the biggest decision in his life—to “donate” his kidney for his mother’s sake.

Nobody in the family knew about his decision. Not his brothers, not his mother. He did not want to aggravate his mother’s suffering. Only he and Baboy knew about the plan.

10. Leo had already “donated” blood several times before, more than a gallon in all. At a blood bank in Santa Cruz, Manila, he and his fellow stevedores had periodically made trips for “blood donation.” Every time he and his friends were out of cash, they would take a trip to a blood bank somewhere in the city. They were like occasional prostitutes; they would do this once every three months just for kicks. So when Baboy asked what his blood type was, he confidently replied: “O.” An “honorarium” of five hundred pesos (five hundred yen) would be given to him for every five hundred cubic centimeters (cc) of blood extracted from him. He had “donated” his blood ten times. After each session, he would always feel weak and dizzy. He would always eat lots of vegetable tops and balut (salted duck’s embryo) to expedite his recovery.

He was not a newbie to making a “blood donation” but he was shocked to know that a kidney too could be “donated.”

11. He wore his treasured pair of imitation Levi’s that he had custom-tailored in an underground shop in Quiapo, Manila. He topped it with an equally brand-new white T-shirt. He had his hair cut like a skinhead. He looked like a skinny high school kid just starting military training.

Instead of going to school, Baboy took him to St. Luke’s Hospital in Quezon City, Metro Manila to begin his medical philanthropy and missionary work. Agent Baboy delivered an O “donor” to the exclusive hospital. Leo was shocked at the grandness of the facility.

“Napakalaki!” he exclaimed, amazed at the size. “Ang ganda. Aircon lahat ng kuwarto.” He was all praises for the hospital’s air-conditioned rooms and impressive looks.

“Are you sure you really want to ‘donate’ your kidney?” Baboy confirmed one more time as they entered the hospital compound. “There’s no turning back, okay?”

“Lalaki akong kausap mo,” Leo invoked his masculinity as a guarantee of trust. “You are talking to a man.”

They entered through the main entrance of the hospital. Leo was a little a nervous. He had never been in a hospital of the rich and powerful before. Baboy led him to the basement and knocked at a door with a sign that read: Renal Unit. A tall, sensual lady in miniskirt opened it. She was Lady M, the transplant doctor’s secretary. Dr. R, the surgeon—described Leo—was a short, dark, elderly lady with short, black hair; she had a round face and she wore glasses. Upon seeing Leo with Baboy, she fired:“Ano’ng type ka?” She asked Leo’s blood type. “Are you O?”

She did not bother to greet or ask her “donor’s” name. Of course, she was more interested in blood type and kidney. Leo’s name was only incidental. A name, it seemed, was only something you used to distinguish a thing or person from another, a tool to aid the memory or a tool against forgetting.

Even before Leo could respond to the honorable doctor’s interrogation, she had fired another question: “You sometimes sell your blood, don’t you?”

“Opo,” was all he could meekly say to confirm the allegation.

He was surprised to hear the doctor use the word “sell” instead of “donate.” He had wanted to believe, despite the cash he was promised, that what he was doing was an act of altruism and a real help to someone very ill. But the old lady surgeon extinguished that illusion of philanthropy with one swish of her bladed tongue.

“How often do you sell?”

“Every three months, Doctor,” he said honestly.

Baboy must have filled her in about Leo’s visits to blood banks.

On the other hand, as a veteran doctor, she could tell a person’s state of health at a glance.

At the reception, about a dozen patients were waiting. Most of them, Leo thought, were Chinese-Filipinos. Most of them were very pale, their faces deprived of cheerfulness, and there was a lack of luster in their eyes.

Lady M took a sample of Leo’s blood. She extracted 5 cc. The sight of the syringe did not scare him at all. “It felt just like an ant’s bite,” he said. After the first test, Leo and Baboy had lunch at the cafeteria. Leo had a soup dish of vegetables and Baboy had pork adobo. Before they left, Lady M pulled Baboy to one side.

“Find me a Type B,” she whispered. “This is urgent.” Baboy nodded several times. Lady M pulled an envelope from her drawer and counted eight hundred pesos on Baboy’s palms. Baboy then gave Leo three hundred pesos.

12. Three days later, Baboy and Leo returned to St. Luke’s Hospital. Leo was subjected to more blood tests. He was examined for Hepatitis A and B. He had chest X-rays, ECGs (electrocardiography), and MRIs (Magnetic Resonance Imaging). After the check-up, Baboy gave him a share of three hundred pesos; again, he pocketed the five hundred pesos. Though his share was a pittance, Leo was content. It was much easier than going to Santa Cruz and “donating” blood. For every test he was subjected to, he would always ask himself: “Can I pass? Can I pass?” He was worried that if he did not pass, his mother would not be able to get medical treatment.

That night, after a battery of tests was administered to him, he wanted to test his strength. He wanted to prove he was healthy and strong. Therefore, he joined a gang of nightshift stevedores. From sunset to sunrise, they unloaded steel bars on the docks. He earned a thousand pesos. At noon, Leo and his fellow stevedores started drinking gin. Baboy joined in the “early celebration.” They drank to their last penny and to the last drop of their glasses until the last seconds of the day. They drank to their hearts’ content.

“If you pass all the tests,” Baboy reminded his recruit, “never forget my ten thousand pesos.”

Leo was promised one hundred thousand pesos. For him it was a fortune. He then promised to give the “first fruit” of his kidney to Baboy.

13. On his third visit to the hospital, Leo went through another series of intensive examinations. His lungs, heart, and kidneys were thoroughly checked.

The fourth time, he was tissue-typed. How compatible his tissues would be with his yet-unknown recipient was examined minutely. All this time, Baboy was always with him and they always went back home together. But after this check-up, he suddenly bade him goodbye.

“I have to go and find more money,” he said, grinning like a politician confident of winning the elections. “This one is already done.” He gave Leo a thumbs-up sign. Leo did not know what the gesture meant at that time. He followed Baboy to another room.

A young man in his mid-twenties was seated in a chair. He was short, fair-skinned, skinny, with his long hair swept back. He was wearing a white short-sleeved shirt. He looked so pale, and very yellow, Leo said. Standing beside him was a tall elderly man who looked just like him. He was the father. But he looked sad and deeply worried. Not far from the father was Lady M, smiling seductively and quite triumphantly.

Baboy gave the father and son a thumbs-up sign and another one to Lady M. Leo was bewildered. What were they thumbs-upping for, he thought. What were they agreeing about? Why couldn’t they say them in words? Why were they talking in gestures?

Lady M spoke in English.

“Kusunori-san, this is Leo, your donor.”

The young man stood up, shook hands with Leo, and gave Leo a friendly thumbs-up. His hand was so smooth and soft, Leo felt. Leo returned his thumbs-up gesture. Only then did he realize he had passed all the tests. He felt a surge of joy and fear. He took comfort in the thought that hundreds of Baseco men had already done the same and they had survived.

He thought he would be giving his kidney to a Filipino patient. Baboy never told him a single word about his would-be recipient. It never occurred to him he would be “donating” his young kidney to an equally young foreign man, to a Japanese.

It was already seven in the evening and Leo wanted to go home.

“Dito ka na lang,” Lady M said asking him to stay in the hospital and not to go home anymore.“Huwag ka nang umuwi.”

Lady M wanted to be absolutely certain Leo would not chicken out at the last minute. Leo could not resist the bewitching seduction of Lady M. He was admitted, to be precise, seduced to be admitted. In the past, some prospective “donors” had escaped at the last minute before the transplantation. But Leo was dead-set. His mother was the raison d’etre of everything and Leo was ready to give away his kidney.

14. Leo was given a room. It had a TV set with access to SkyCable, a refrigerator, a phone, a stereo set, and air conditioning. It had everything— the dream of a Filipino family. It was a dream room. However, it was a room with its walls painted in blinding white and did not have a single window for you to even get a glimpse of the gray sky. It felt like a prison, Leo said, a fancy prison. It was the first time ever in his life to stay in such a different and so alien a world and to taste such luxury.

He watched pro-wrestling all night on cable television. The stereo was also at full volume. There was so much food: fried chicken, fried fish, vegetables, bananas, sweets, and bread. Room service was also available.

On the third day, his younger brother and a cousin came to see him. Baboy had asked them to keep him company while he was being confined. These two men were also recruits of Baboy but Leo dissuaded both of them. “One among us is enough,” he said. Leo asked his younger brother especially not to proceed with his plans. At night, they would sneak out of the hospital and buy a few bottles of beer. “It was like staying in a hotel,” he said. “And everything was free. I was like a congressman!” But this sweet life lasted only four days.

Because on the fifth day, at six in the morning, a male doctor came to his room and ordered him to take a white tablet. He took it without asking whether it was poison or a miracle drug. He immediately felt sleepy. He got scared. He felt dizzy and his vision became hazy. He was laid on an operating table and his hands and feet were restrained as though he was going to be electrocuted. “I couldn’t move. I couldn’t shout. I couldn’t protest,” he said.

“Swallow your saliva,” the doctor ordered him and he made him turn on one side.

Leo saw a three-inch long syringe—the longest needle he had ever seen. The shot felt as though he was being nailed to the cross, he said. After the injection, complete darkness descended on him. He lost his entire consciousness.

“I died at that moment,” he said. He went under the knives, scalpels, forceps, scissors, and needles. A foot-long cut was carved on his right side. A huge window was surgically opened and his young bean-shaped organ was plucked or “harvested,” as transplant surgeons would say.

When they wheeled him to the operating room, Leo was already unconscious. He could not know if Kusunori, his recipient, was in the same “operating theater” as he was or if he was in a separate room. The operation took six hours.

Leo regained consciousness at noon the next day. Lights, blinding as the naked sun, surrounded him. He opened his eyes. He felt a distinct and excruciating pain in his back. He touched it—it was wrapped in bandage. He felt as though his body had been halved. He was surrounded by men and women in green robes wearing masks and caps.

“Akala mo pinaligiran ako ng mga aliens. Nakatingin sila lahat sa akin,” he said. It was a surreal scene, he said. It felt as though aliens had surrounded him and were staring at him in wonder.

“Para akong binangungot,” he said. It seemed he woke up from a nightmare.

Writhing in pain and minus a kidney, he was wheeled back to his room like a losing rooster in a cockfight. He was not applauded or congratulated for successfully “donating” an organ. Nobody said anything to him. Nobody said “thank you.” His value was already used up.

In his room, he started to contemplate what had become of his body. He could not turn his back to one side for the sheer agony of it.

“Wala na ang isang bato ko.” He rued his absent kidney. “Ano kaya ang mangyayari sa akin?” What might happen to me, he wondered.

He was very sleepy the whole day. He was amazed at the potency of the liquid injected in him.“Hayop sa tapang,” he said.

The following day, Lady M brought a new lady into his room. The equally voluptuous woman introduced herself as Joy and said she was a friend of Kusunori. She was tall, “very white,” adorned with rings, a watch, a gold bracelet, a thick gold chain around her neck, and she was wearing very, very tight-fit Levis jeans.

“Salamat,” she thanked him. “Binigyan mo ng buhay ang kaibigan ko.” She expressed gratitude for “giving life to her friend.”

From her shiny black bag, she took out a manila envelope. Before Leo’s unbelieving eyes, she took out its contents: two bundles of five hundred-peso notes. She handed them to him as though she was a First Lady distributing dole outs to her indigent constituents. Leo received them with joy.

“Gagaling na Nanay ko,” he whispered to himself. With this money, he thought, his mother would get well soon. He asked his brother to keep the brown envelope.

Joy came to see Leo not only once but almost every day during his post-surgical confinement. She was grateful and her gratitude was a little touching.

“Lagi siyang nagpapasalamat. Pasalamat nang pasalamat. Ako na nga ang nahihiya,” he said. She was always saying thank you. It was making him feel embarrassed.

A day after the transplant, Baboy came to visit. Entering the room he went straight to the refrigerator. He ransacked all the leftover food: oranges, apples, chicken, bread, ice cream, and beer.

“So,” Baboy finally asked him after satisfying his hunger, “how are you?”

“I am now one kidney less,” Leo replied. “Why are you here?”

“I just brought a Type B,” he replied matter-of-factly. “Give me my ten now.”

Over his still heavily sedated body, Leo’s brother counted twenty yellow Ninoy Aquino notes. Baboy collected them as though he was collecting takings from a poker game at a wake in Baseco. He then left abruptly.

Leo stayed seven days in the hospital after the operation. Each day, nurses and doctors took turns coming to check his condition. And each day seemed as long as a year. He was dying to escape from his air-conditioned room so he could immediately take his mother to the Philippine General Hospital for treatment.

On the third day after the operation, he asked his older brother and cousin to go out and buy some gin. Of course, he was forbidden to drink while his wound was still raw and fresh. But as with life in Baseco, everyday was an exercise of ingenuity and wit. Every day created by God was a struggle to outwit and outsmart the powerful and the privileged. So, each time his brother and cousin went out and came back to the hospital, the guard would always query and check what they were bringing in. And they would always show two bottles of clear mineral water. Two bottles of gin in bottles of eau de mineral—the poor shotgun-armed guard would never have imagined that touch of genius, not in his wildest dream.

Years later, each time Leo and his fellow “donors” would gather for a drink, this particular episode would be a great source of laughter, and endless variations would be created by each operado on the same theme. To live despite oppression, exploitation, and agony and still come out with a good story, it seemed, made life more bearable for many of the operados in Baseco.

Leo was a man of very few words. Unless spoken to, he would not initiate a conversation or approach and talk to you. Every time his group would gather and have a drink, he would always act as the tanggero—the toaster, the giver of drinks. He would offer each person seated in the circle a swig and would quietly keep the flow of gin and lime going on smoothly. He was also the youngest.

15. Three days after the transplantation, he was dying of thirst for gin. He, his brother, and a cousin decided to have an early celebration. They filled their glasses to the brim. They toasted the very “cooperative” security guard.

Although still very weak and in pain, he had pretended to his doctors that he was already well. Wearing only an undershirt and a pair of short pants and looking thin as a tingting (mid-ribs of coconut leaves), he requested a discharge. Though reluctant, the attending physicians granted his request. Together with his brother and a cousin, they took a taxi—a very rare thing for him. The cab driver was a little suspicious—they did not look like they could afford treatment at the most expensive hospital in the archipelago. Moreover, when they mentioned “Baseco” as their destination, the driver got scared. He said he could not take them there because he was headed the opposite way, bound for the garage. Leo’s brother then offered a bribe: five hundred pesos—four times the average fare. The once-terrified taxi driver became more courageous at the thought of becoming a few hundred pesos richer, so he stepped on the accelerator. He drove his “suspicious-looking” passengers to the shores of Manila Bay, just beside the derelict and stinking shipyard. From there, the three hired an outrigger ingeniously powered by a septuagenarian generator that had been salvaged from a junk shop.

16. They reached the end of the breakwater. Leo walked slowly on the narrow path like a survivor of a shipwreck. He appeared like a newly circumcised schoolboy treading carefully, avoiding contact with his own clothes and passersby lest they hit his fresh wound.

He arrived at their precarious hut. His mother was lying in bed. Her body was still swollen all over. Her face, arms, and legs were bloated and pale. His mother asked him where he had been. He said: “St. Luke’s.” The name was sufficient for her to know where her son had been and what had happened to him. In Baseco, the name is synonymous with “kidney donation.”

“You shouldn’t have done it,” she said with a tone of anger and sadness. “I won’t be here long.”

Putting on a brave face to avoid showing any hint of sadness, Leo asked an aunt to take his mother to PGH the next day. Teresita, for the first time after her long lingering illness, was given a thorough medical check-up. She was also able to buy all the medicine prescribed to her. She spent about two thousand pesos. But a week later, her situation did not improve. She went back to the government hospital again, was examined again, and some drug was prescribed again. She spent another two thousand pesos. She went for the third and fourth time. Nevertheless, her condition was fast deteriorating. The fifth time, Teresita refused to seek any further medical help. She refused to get up from bed. “My time is coming,” she said.

On a stormy roaring night, Teresita bade goodbye to Baseco and to her children. She was only thirty-eight years old. For her funeral, Leo spent twenty-five thousand pesos. The rest of his money he had used up to buy a television set, a karaoke set, battery for power generation, six pairs of Levi’s style tailor-made jeans, and four T-shirts. He had also bought materials for house repair. With the remaining twenty thousand pesos, he started a business—buying and selling fish. Stevedore that he was and not a vendor or fisherman, his maiden business venture ended up like driftwood on the shore after a typhoon. Furious winds blew away the newly roofed and walled hut. Raging fire the following summer finished off the remnants of it.

17. The slum village of Baseco faces west. On a clear day, the sunset in Manila Bay is one of the finest in the world. It seems the setting sun here is twice the size in diameter—its glow the most passionate on earth, its hue the most intense—the sky burning, the city of Manila the luckiest, and Baseco the most beautiful place on earth.

I’m having a drink with a group of operados. We are right along Baseco Beach—a long stretch of rubbish-strewn, industrial dregs-contaminated, dog and human waste-scattered along the shore. I’m watching Leo mix the last tall and fat pair of gin and lime that I had bought as a present for them. After taking the lids off, he let the Gilbey’s stand on a flat surface and secured it. In a fraction of a second, he fastens the lip of the lime to the lip of the Gilbey’s. The two bottles are welded together in a tight and amorous kiss. After several minutes, gin and lime—like natural lovers—blend and dissolve into one harmonious and potent drink. Leo hands me the first shot in a glass of Nescafe. It’s an honor to have the first swig. Careful not to disappoint them, I drink it bottoms up.

Fifteen years after he had “donated” his young kidney to a Japanese young man named Kusunori, Leo is still alive despite having only one kidney. But he now has long hair, eyes that are always red, a missing set of dentures, and a tattoo of a rose on his left arm (with black leaves and stalks and red petals). His ubiquitous trademark—a foot-long incision on his left side—is a lifetime reminder of that excruciating but memorable day. He remains single and always passes the night on a wooden bench in front of a sari-sari store.

“Kumusta na kaya ang bato ko?” he says as he hands me another shot when my turn comes. He wonders what became of the “stone” he had “donated.” Is it still functioning? And how is Kusunori? Is he still alive?

I have read, I say, that five years is the longest lifespan of a transplanted organ.

“So probably,” he says, “my kidney’s twin is gone.”

“Maybe. Maybe not.”

The sky is smoldering in orange and red. The Manila Bay sunset from Baseco beach is at its best. We all stand up as if it is a countdown.

Leo is standing beside me. His naked torso has become golden. Emboldened by the spirit of gin and lime, he waxes lyrical: “This is my life—always waiting for the sunset here every day. I pass the time watching the ships, fishermen, and stevedores. As for my living, I can’t be a dockworker anymore. I get tired easily. I must take care of my one remaining kidney. The setting sun is always pretty but it makes me lonely. My life is sunrise and sunset. It’s the same every day.”

Brave man, you are, I say. Good man.

This article is adapted from Rey Ventura, Cherry Blossoms in the Time of Earthquakes and Tsunami, published earlier this year by Ateneo de Manila Press. Recommended citation: Rey Ventura, “A Suitable Donor: Harvesting Kidneys in the Philippines”, The Asia-Pacific Journal, Vol. 12, Issue 50, No. 1, December 15, 2014.