Human Organ Trafficking
As she lay dying, not dead, but on life support they came with the paperwork. This guy in a suit, who clearly was not a doctor, asked for her organs. He made it sound noble, and 'what she would have wanted'.
At the time, we wanted to believe that. We wanted to believe she would somehow continue to live through the lives the donations would effect. Today, I wonder how the existence of the organ trade effects the administration of medicine. She was young, she looked otherwise healthy. I never thought they did enough to save her life. Why?
Why are there so many people missing and where do they go?
Why does it seem that some are able to get organ transplants while others linger on waiting lists? Is there some 'black market' to be tapped into?
Remember the movie 'Coma'? Could it be true?
Organ trade is the trade involving inner human organs (heart, liver, kidneys, etc.) for organ transplantation. There is a worldwide shortage of organs available for transplantation,[1] yet commercial trade in human organs is illegal in all countries except Iran.
The problem of illegal organ trafficking is widespread, although data on the exact scale of the organ market is difficult to obtain. Whether or not to legalize the organ trade, and the appropriate way to combat illegal trafficking, is a subject of much debate.
The Legal Organ Market
In the 1970s pharmaceuticals that prevent organ rejection were introduced. This along with a lack of medical regulation helped foster the organ market. Living donor procedures include kidney, liver, cornea and lung transplants. Most organ trade involves kidney or liver transplants.
Despite numerous past failures in organ trades due to lack of contractual and/or safety regulation, Robert Truog of Harvard Medical School Department of Social Medicine addresses the lowered safety risks in transplant procedures with available modern medical technology, along with increased regulation in contracting of organ transplantation for individuals with more government interventions.[2]
Attempts to legalize China:
In China, organs are often procured from executed prisoners. Nicholas Bequelin, a researcher for Human Rights Watch, estimated that 90 percent of organs from China are from deceased prisoners.[3]
Despite the legality of the process in the country, there is evidence that the government attempted to downplay the scope of organ harvesting through confidentiality agreements[4] and laws such as the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Prisoners.[5]
Even with this lax regulation, China still suffered a shortage of organs for transplant.
The Chinese government, after receiving severe scrutiny from the rest of the world,[6] has passed legislation ending the legal sale of organs. No legislation currently prohibits the collection of organs from deceased inmates who sign agreements before execution. Recently, China has introduced new legislation in order to standardize its organ collection process. This legislation includes regulations stating which hospitals can perform operations and what the legal definition of brain-death is. Foreign transplant patients are no longer accepted. Since China has ceased the legal sale of organs, global prices are estimated to have risen 40%.[7]
India:
Before the passage of the Transplantation of Human Organs Act in 1994, India had a successful legal market in organ trading. Low cost and availability brought in business from around the globe and transformed India into one of the largest kidney transplant centers in the world.[8]
Several problems began surfacing during the period of legal organ trade in India. In some cases patients were unaware a kidney transplant procedure even took place.[9]
Other problems included patients being promised an amount much higher than what was actually paid out.[10]
Ethical issues surrounding contribution donating pushed the Indian government to pass legislation banning the sale of organs.[11]
Despite these steps, loopholes still exist in current laws that allow non-related donors to give organs if they are emotionally close to the recipient. In many cases, the donor may not be from the same country as the patient, or even speak the same language.[5]
Iran:
In Iran the practice of selling one's kidney for profit is legal. Iran currently has no wait lists for kidney transplantation.[12]
Kidney sales are legal and regulated. The Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) control the trade of organs with the support of the government. The organizations match donors to recipients, setting up tests to ensure compatibility. The amounts paid to the donor vary in Iran but the average figures are $1200 for kidney donation.[13]
Employment opportunities are also offered in some cases. It has been argued that the Iranian system is in some ways coercive, as over 70% of donors are considered poor by Iranian standards.[14]
There is also evidence of highly negative outcomes both in health and emotional wellbeing for Iranian donors.[15]
Philippines:
The sale of organs was legal in the Philippines until a ban took effect in March 2008.[16]
Prior to this, the Philippines was a popular destination for transplant tourists. The Philippine Information Agency, a branch of the government, promoted "all-inclusive" kidney transplant packages that retailed for roughly $25,000.[17]
Since instating the ban on organ selling, transplants have dropped from 1,046 in 2007, to 511 in 2010.[18]
Current Restrictions:
At present, Iran is the only nation that allows the legal buying and selling of organs. The market is contained within the country, that is foreigners are not allowed to buy organs of Iranian citizens. In an attempt to further limit transplant tourism, organs can only be transplanted between people of the same nationality, that is to say an Iranian cannot purchase a kidney from a refugee from another country.[13]
The system is largely charity and volunteer-based, and those tasked with matching donors and patients are not paid for their work.[14]
The Iranian system has been put up as an example of an effective and safe organ trading model by proponents of legalized donation.
All other nations have some form of legislation meant to prevent the illegal trading of organs, whether by an outright ban or through legislation that limits how and by whom donations can be made. Many countries, including Brazil, Belgium, and France, use a system of presumed consent to increase the amount of legal organs available for transplant.[19]
In the United States, federal law prohibits the sale of organs, however the government has created initiatives to encourage organ gifting and to compensate those who freely donate their organs. In 2004, the state of Wisconsin began providing tax deductions to living donors.[20]
Worldwide, the trend has been to move towards increased regulation of organ trading. This is seen in the tightening of policies after countries like China and India came under scrutiny for human rights violations related to their organ procurement process.
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[1] "Experts warn against organ trade". BBC News. 2007-01-08. Retrieved 2008-02-18.
[2] Truog, Robert D. (2005). "The Ethics of Organ Donation by Living Donors". New England Journal of Medicine 353: 444–446. doi:10.1056/NEJMp058155.
[3] "China issues human organ transplant rules in attempt to clean up industry". International Herald Tribune. April 7, 2007. Retrieved 2008-05-01.[dead link]
[4] Hemphill, Joan E. (2007). "China's Practice of Procuring Organs From Executed Prisoners: Human Rights Groups Must Narrowly Tailor Their Criticism and Endorse the Chinese Constitution to End Abuses". Pacific Rim Law & Policy Journal Association 16 (2): 431–457.
[5] Glaser, Sheri R. (2007). "Formula to Stop the Illegal Organ Trade: Presumed Consent Laws and Mandatory Reporting Requirements for Doctors". Human Rights Brief.
[6] David Matas, Esq. and Hon. David Kilgour, Esq. (31 January 2007). "Bloody Harvest: Revised Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China".
[7] Watts, Jonathan (2007). "China Introduces New Rules to Deter Human Organ Trade". The Lancet 369 (9577): 1917–1918. doi:10.1016/S0140-6736(07)60897-6.
[8] "Organ Shortage Fuels Illicit Trade in Human Parts". Retrieved 2008-05-01.
[9] "India Kidney Trade". Retrieved 2008-05-01.
[10] "Hub For Global Organ Trade". Retrieved 2008-05-01.
[11] "Indian Journal of Medical Ethics: Asia’s Organ Farms". Retrieved 2008-05-01.
[12] Ghods AJ, Savaj S (November 2006). "Iranian model of paid and regulated living-unrelated kidney donation". Clin J Am Soc Nephrol 1 (6): 1136–45. doi:10.2215/CJN.00700206. PMID 17699338.
[13] Griffin, Anne (March 2007). "Iranian Organ Donation: Kidneys on Demand". British Medical Journal 334 (7592): 502–505. doi:10.1136/bmj.39141.493148.94. PMC 1819484. PMID 17347232.
[14] Hippen, Benjamin E. "Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran". Cato Institute: Policy Analysis.
[15] Scheper-Hughes, Nancy (2008). The Last Commodity: Post-Human Ethics, Global (In)Justice, and the Traffic in Organs. Penang: Multiversity & Citizens International. ISBN 9789833302093.
[17] Turner, Leigh (2009). "Commercial Organ Transplantation in the Philippines". Cambridge Quarterly of Healthcare Ethics 18 (2): 192–196. doi:10.1017/S0963180109090318.
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