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.