My ethics project
llegal organ trade
According to the
World Health Organization (WHO), illegal organ trade occurs when organs are
removed from the body for the purpose of commercial transactions.[22] The WHO
justifies these actions by stating that, “Payment for…organs is likely to take
unfair advantage of the poorest and most vulnerable groups, undermines
altruistic donation and leads to profiteering and human trafficking.”[23]
Despite these ordinances, it was estimated that 5% of all organ recipients
engaged in commercial organ transplant in 2005.[24] Research indicates that
illegal organ trade is on the rise, with a recent report by Global Financial
Integrity estimating that the illegal organ trade generates profits between
$600 mill and $1.2 billion per year with a span over many countries, including
but not limited to
Egypt
India
South Africa
the Philippines
Israel
Colombia
the Balkan Region
Turkey
Eastern Europe
United States of
America
United Kingdom
Macedonia
Canada[23]
Poverty and loopholes
in legislation contribute to the illegal trade of organs.[25] Poverty is seen
in all countries with a large black market for organs. This, however, is not
the only factor affecting illegal organ markets - some of the poorest countries
in the world do not engage in organ trade. Legislation is another contributing
factor in the illegal organ trade, especially legislation with loopholes. For
example, India's Transplantation of Human Organs Act (THOA) requires that an
organ donor must be a relative, spouse, or an individual donating for reasons
of "affection." Oftentimes, claims of "affection" are
unfounded and the organ donor has no connection to the recipient.[26] Monetary
transactions for organs are illegal in India currently, but there are no laws
concerning funds given to a spouse. The spousal inclusion provides a loophole
for illegal trade; in some cases organ donors marry the recipient to avoid
legal penalty.[27]
History
The international
community and national governments have been trying to find stable, ethical
systems to deal with the high demand for organ transplants. In 1968, the United
States implemented the Uniform Anatomical Gift Act of 1968, which gave
individuals the right to donate their organs after their death. Following, the
U.S. enacted the National Organ Transplant Act of 1984, which established a
national online registry for organ donors and prohibited the buying or selling
of organs in the U.S. The most recent efforts of the United States to combat
high organ demand include the revision of the Uniform Anatomical Gift Act in
2006 and the 2007 Charlie W. Norwood Living Organ Donation Act [22]
Numerous other
countries have passed laws aimed at ending illegal organ trade. In 1994, India
passed the Transplantation of Human Organs Act, which banned both the sale of
human organs and organ transplants between non-relatives. South Africa adopted
the Human Tissue Act of 1983, which outlaws the transfer of tissue (including
flesh), bone, organ, or bodily fluid in exchange for payment.[26] In May 2007,
China adopted the Human Transplantation Act banning organ commercialism.[28]
Current state
According to the most
recent Bulletin of the World Health Organization on the state of the
international organ trade, 66,000 kidney transplants, 21,000 liver transplants,
and 6000 heart transplants were performed globally in 2005.[24] Another article
reports that in 2008 the median waiting time for the U.S. transplant list was
greater than 3 years (with projections to increase in the next few years),
while the United Kingdom reported a lack of organs for 8000 patients, with the
rate increasing at 8%.[22] In response to the high demands and long waiting
times, the illegal organ trade has been expanding. Currently, it is estimated
that about 10% of all transplants occur illegally, with the Internet acting as
a facilitator.[37] For 2006, it was estimated that at least 4000 prisoners were
executed to supply approximately 8000 kidneys and 3000 livers for foreign
buyers.[37] In 2007, 2500 kidney transplants were bought in Pakistan, with
foreign recipients making up two-thirds of the purchases.[22] As of 2007, the
Voluntary Health Association of India estimates that approximately 2000 Indians
sell a kidney every year. And in Canada and the United Kingdom, experts
estimate that about 30 to 50 patients illegally purchased organs abroad.[24]
Demographics
Data from the World
Health Organization indicates that the primary group targeted by the illegal
organ trade is impoverished individuals in developing nations. In a study of
organ donors in India, it was found that 71% of all donors fell below the
poverty line.[41] Tales of organ theft usually characterize the victims as
unemployed males between ages 20-40 who are seeking work and are taken out of
the country for operations.[42] This is seen in the case of Makbuba Aripova,
whose husband left Uzbekistan for a job in Canada. His corpse and those of
family members traveling with him were found several days later with missing
organs and bags of money believed to be the proceeds from an organ sale.[5]
While men feature prominently in anecdotes on the organ trade, impoverished
women are also frequent victims.[41] However most data show that women are
rarely the recipients of purchased organs.[15]
Reasons for donating
Considering the poor
status of most donors, one of the primary stated reasons for organ selling is
to pay off debt.[42] Those who are poorest are frequently seen as more reliable
targets for transplant tourists because they are the most in need of money. It
has been argued that by providing compensation to donors, the organ trade is
helping to lift some people out of poverty. However evidence of this claim is
still being debated.[14] In some cases, organs are sold to other family
members, either from parents to offspring, or from adult children to parents.
This is more frequent in nations where waitlists are less formal and among
families that cannot afford to leave the country for transplants. The trend of
younger people donating to their more aged relatives is relatively new, and has
been criticized for placing greater value on kidneys from live donors.[4
Outcomes
Reports by the World
Health Organization show decreased health and economic wellbeing for those who
donate organs through transplant tourism. In Iran 58% of donors reported
negative consequences for their health status. In Egypt, the number rose as
high as 78%, and 96% of donors stated that they regretted doing so.[41]These
findings are relatively consistent across all countries; those who sell their
organs on the market tend to have lower overall health. Substandard conditions
at the time of transplant can also lead to transmission of diseases like
hepatitis B and C and HIV. The poor health of donors is further exacerbated by
depression and other mental illnesses brought on by the stress of donating and
insufficient care after surgery.[42] [44]
Impoverished donors'
economic outcomes are no better than their health outcomes. In a study of
Indian donors, it was found that 96% of donors sold a kidney to pay off debts,
however 75% of all donors still had this debt after a period of time.[41] Organ
brokers frequently do not pay the full amount promised to the donor. Cash that
is received for the donation is often quickly spent on post-surgery care that
is not provided by the buyer.[17] In a study of Iran, the only nation that has
legalized payment for organs, it was found that 66% of donors reported lower
financial status. While the Iranian model does provide better compensation for
donors and has subsidized the cost of immunosuppressant drugs, it has been
argued that the non-negotiable price of a kidney drastically devalues the donor
at the expense of the patient.[42] Donors in all countries often report
weakness after surgery that leads to decreased employment opportunities,
especially for those who make a living through physical labor.[1
Proposed solutions
Several solutions
have been put forward to both increase the amount of legally available organs
and staunch the flow of illegal trafficking around the globe. Policies of
presumed consent have been successful in various countries such as Brazil, the
United States, and several nations of Europe. These policies can be either
opt-in or opt-out. In a nation with an opt-out policy, consent for organ
donation is presumed upon death, although one can choose not to donate by
submitting documentation. Research shows a 25-30% increase in the amount of
available organs in opt-out countries.[42] In nations with an opt-in policy,
like the United States or France, a person may choose to donate their organs
during their lifetime. In opt-in countries, families have on occasion succeeded
in overturning the decision of the deceased to donate.
Presumed consent
programs cut down on organ trafficking in many ways. These laws help increase
the amount of available organs, decreasing the reliance of patients on the
black market. At the same time, the increased amount of organs cuts the
financial cost of a transplant, decreasing the need for medical tourism.[5]
Another method that
has been recommended is to enact laws that would hold doctors accountable for
not reporting suspected organ trafficking. Medical anthropologist Nancy
Scheper-Hughes has written extensively on the issue of doctors knowingly
performing illegal operations with illicit organs.[15] While it can be argued
that expecting doctors to come forward violates doctor-patient privilege, their
legal obligation to the patient is superseded by public interest in ending
medical violations of human rights. If accountability measures were imposed,
doctors would be liable as accomplices if they knowingly performed operations
with black market organs.[5]
Many in the United
States believe that adopting a system for regulating organ trading similar to
Iran's will help to decrease national the shortage of kidneys. By promoting
accountability, ensuring safety in surgical practices, employing vendor
registries, and providing donors with lifetime care, it has been stipulated the
the US could adopt similar policies. Arguments have been made that private
insurance agencies would be invested in providing such care for donors, as the
procedure would become relatively standard given the long waitlist for organs.
Alternatively, laws could be enacted that make long-term care an intrinsic part
of any donation agreement.[14] By legalizing and incorporating organ trade into
the domain of government, poverty could be eliminated and the necessity of a
black market for organs would be mitigated.
