When Malaka, an Indian tsunami refugee, agreed to sell her kidney, the organ broker told her she would receive $3,500. But after the operation, he gave her only $700 - for an organ that a wealthy foreigner likely paid $40,000.

"She got what she deserved," the broker told the National Geographic Channel in an "Explorer" episode, "Inside the Body Trade," that airs tonight.

Later, when Malaka's son's kidneys were failing, the doctor told her, "You gave away your kidney. Now your child needs a kidney. Who will give it to him?"

While free-market types have talked up Transplant Tourism as a nifty way for the world's poor to barter their way out of poverty, National Geographic Channel reporter Lisa Ling told me that after visiting organ donors from two villages in India - one known as Kidneyville - "the overwhelming majority of them did not get the money they were promised."

Director of the Center for Bioethics at the University of Pennsylvania Art Caplan told me, "We may feel we can still justify this by saying we're leaving them better off than they were - minus a kidney, but at least they've got some change in their pocket." In a sense, it is "the equivalent of the neighborhood thug comes to town and says, 'You owe me money and I see you have two kidneys.' "

At least Malaka is alive. In China, officials have admitted that they have sold the organs of executed prisoners to foreigners. And China executes convicts, not just for violent crimes, but also for crimes like embezzlement - perhaps even, according to allegations denied by the government, for being an adherent of Falun Gong.

"Nobody really told me about these things that I'm hearing about now ... I had no idea," Eric De Leon of San Mateo told Ling. Diagnosed with terminal liver cancer so advanced that he did not qualify for a transplant in America, De Leon bought a liver in China last year.

China has since announced new restrictions on its organ trade. For his part, De Leon continues to blog on his "Transplant Tales - to China and Back." The "No. 1 crime punishable by death, the most common crime committed, is drug smuggling," De Leon blogged last year. It seems the odds are good that his liver did not come from a dissident.

De Leon told Ling that when he told his doctors he was going to China for a liver, they told him, " 'In your shoes, I'd probably do the same thing,' and they would be happy to treat me when I came back."

"I find that hard to believe in this sense," Caplan noted. "It's difficult to find doctors who will treat you post-transplant if they weren't involved in the transplant." Given the ethical state of the organ trade, Transplant Tourism often involves unhealthy organs and poor surgical procedures. And some doctors won't treat patients like De Leon for ethical reasons.

Stanford University professor Bill Hurlbut, a member of the White House bioethics advisory council, noted that doctors should "not be encouraging at any level" the trade of organs from dubious sources. He fears "the commodification of human body parts."

When I talked to De Leon last year, he told me that if I needed a healthy liver, "Let's see how fast you're in line."

That's not a standard. Maybe during a fire, a man might panic and claw his way past children to get to an exit. But who wants to encourage such behavior?

As Caplan noted, he can conceive of the scenario in which Transplant Tourism might work for both donor and recipient, but by and large, it is immoral.

Every year more than 6,500 people die in America waiting for transplants. Ling closes by noting, "If we all signed up to become organ donors, no one would die waiting for an organ." Organ donations do save lives.

But just as it is wrong for Americans to die waiting for organs, it also is wrong for prisoners to die because an American needs a liver, or for a child to die because his mother sold her kidney. And it is beyond reason that in a country that passes numerous regulations on the feeding and care of livestock, people don't want to judge those who, like vampires, troll for organs in the third world.

And if the donors complain, we'll just sneer and say: They got what they deserved.

E-mail: dsaunders@sfchronicle.com.