Transplant Tourism, Bioethics and Red Tape

Aidan Maconachy
 


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Rather than focus exclusively on information about the organ trade that is available via news reports on the subject, I'd like in addition to take a look at the conditions that have given rise to this phenomena and what if anything can be done about it.

Medical opinion is increasingly on-side with transplantation as the best possible option for patient's facing organ failure. Advances in organ transplant procedures have increased the odds that the surgery will offer a new lease of life. Consequently there has been increasing pressure to find a ready supply of human organs to meet the needs of patients, some of whom are willing to travel abroad and pay top dollar for a life saving organ transplant. This development isn't surprising given that patients have been faced with waiting periods of a year and more, before acquiring a suitable organ from traditional donor sources.

The phenomena that's become known as “transplant tourism" has a predatory aspect that raises serious ethical concerns. In many cases affluent Westerners seek out sellers in developing countries via the services of a middle man. When the seller is found, the fee promised for a kidney, bone marrow or other organ is rarely what he or she ends up receiving once all the medical costs and broker's fees are tallied up. There is little doubt that many who are targeted as potential sellers, are exploited with little concern for their well being and in many cases ripped off.

Transplant procedures usually take place in the country where the organ has been made available. This has become more feasible as a result of improved medical technology and standards of care. In some of these countries law enforcement is lax, especially when it comes to policing unorthodox medical practices.

Organ retrieval run by brokers for the benefit of paying customers has become a problem. In the Philippines there is a small army of middle men who are engaged in procuring organs. In the Manila area alone, the trade has become so prevalent President Gloria Arroyo has taken steps to crack down on it.

What is emerging in a number of developing nations are ghost networks of procurers, practitioners and care providers who make a living off the trade. In India for example, police raids have netted prominent doctors connected to respectable hospitals and clinics who offer their services in a moonlighting capacity.

Driving the rising popularity of transplant tourism, is the hellish situation many people find themselves in given the long wait for donor organs. At one point in the US in 2006, there were 70,000 people waiting to receive a new kidney. Considering that in 2005 roughly 16,000 patients received kidneys, the situation is clearly dire.

People seeking a transplant who have financial resources have many options, including access to clinics overseas that cater to clients who are willing to pay. Patients often have no direct knowledge whether the transplanted organ comes from a destitute single mother, an executed prisoner or even from a criminal source. The clinical side of the arrangement can persuade paying clients that what they are receiving is more or less a professional service, since few choose to look behind the scenes.

The exposure of organ harvesting practices in China involving prisoners, opened up a nightmare scenario from the far reaches of the horror genre. The reports that surfaced about organ retrieval in China resulted in investigations such as the report undertaken by Canadian MP David Kilgour, and the findings confirmed a lot of people's worst fears.

The international community can't allow an organ donor crisis in Western nations to result in the victimization of the poor and those held in detention facilities abroad. Many of the people who sell organs don't do so willingly, but are driven to the measure as a result of extreme poverty. Rigorous regulatory regimes in the US and Canada have closed down many options that are a lot more palatable than what is currently transpiring in countries like India and Philippines.

The National Organ Transplant Act (NOTA) in the US, states in section 301 that the buying and selling of organs is prohibited. The problem is, NOTA provisions have also been used to block the establishment of a registry to pair organ donors. It's hard to see how paired donations infringe the letter of 301. I would go even further, and suggest that there should be a medical protocol established that would allow for the sale of organs under carefully established guidelines and with proper medical supervision. The point is- something has to give. It is unacceptable that thousands of people are dying on waiting lists while options such as these sit on the shelf.

When you consider the appalling toll of human suffering created by the black market in organs, there is simply no defense that can justify continued obstructionism. We badly need new medical protocols that will address the increasing problem of those in need of organ transplantation.

Aidan Maconachy resides in Ontario, Canada. He has a BA Hons and a BEd. He taught in the UK and Canada, and has been a contributor to a variety of magazines and newspapers over the years. You can visit his blog at http://aidanmaconachyblog.blogspot.com/

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