Ana Lita, Director of the IHEU-Appignani Center for Bioethics, reports on the panel discussion held in New York City by the Center.
Progress in medical science and technology has contributed to the growth of organ transplantation, particularly kidney transplantations around the world. Organ transplantations have become a routine practice. In Europe, the average waiting list for patients looking for an organ transplant averages to about three years. The list is expected to reach about 10 years by the year 2010. With 120,000 patients on chronic dialysis and 40,000 patients waiting in line for a kidney in Western Europe alone, around 15-30% of these patients die because of the shortages of available organs. To avoid death, many patients seek organ trafficking as a solution. Motivated by demand, International Criminal Organizations have taken the shortage of organs as an easy opportunity to pressure people from countries living in poverty into selling their organs. These people, mostly young people, sell one of their kidneys for about $2,500-3,000, while recipients pay anywhere from $100,000-200,000 for the kidney.
To discuss this challenge, the IHEU-Appignani Center for Bieothics co-sponsored by the UN Office of the Special Adviser on Gender Issues and Advancement of Women (OSAGI) and the Council of Europe organized a panel, “Intersecting Human Rights Crises: Organ Transplantation and Organ Trafficking.” Due to these situations, ethical, social and legal questions are raised, including whether the poor should provide for the health of the rich, if the price to get out of poverty should be to sacrifice one’s health, if poverty should compromise human dignity and health, etc.
The hours of committed work that IHEU-Appignani Center for Bioethics and others had put in to organising the important panel discussion on organ trafficking and transplantation was evident by the calibre of the panelists, the sizable crowd of (approximately 100 people) that made effort to attend, and the sustained level of engagement that continued through public interaction (dialogue). The impressive panel, which included representatives from the UN, the Council of Europe, the University of Pennsylvania’s Bioethics Centre, New York University’s Department of Transplant Surgery, and Westchester Medical Department of Surgery and Transplantation, reflected the ethical, socio-political, cultural and medical aspects of organ trafficking and transplantation, which many of the panelists discussed within a human rights framework.
Those who attended were students, journalists, professors, physicians, humanists, among others as well as a pathologist from China, who echoed the concern of one of the panelists about the use of organs from executed prisoners, a human rights issue of fascinating complexity that was new to many in the audience.
One of the main factors offered for the fuelling of organ trafficking and the trafficking of persons for organs was the unfulfilled demand for organs.The logic that was presented was, where there is unmet demand, there is a market of supply that germinates in response. While Professor Art Caplan, from the University of Pennsylvania’s Bioethics Centre considered this market to be unethical and inefficient, this viewpoint was challenged by individual audience members. The disparity between supply and demand suggests why traffickers would rise to meet a need, but it does not adequately explain why some would reluctantly, but knowingly, offer themselves or a part of themselves up in exchange for some promised compensation. By no means, there is no consensus on organ markets though, there are some authors who have argued quite eloquently in favor of legalized markets for organs, and various economists have estimated significant reductions in the supply-demand organ gap if a legalized market were to exist.
The realities of global poverty as Rachel Mayanja, the UN Special Advisor on Gender Issues and Advancement of Women stated in her introductory remarks, and the extent to which those living in poverty actually have no choice, were also subject to debate by the panel. Poverty was seen as such a hurdle to the realisation of human rights in this area that panelists would agree that if we want to solve the problem of trafficking, we simply need to take steps to diminish (seems impossible to eradicate) global poverty and illiteracy.
Mrs.Maud de Boer-Buquicchio, the first woman to be elected Deputy Secretary General of the Council of Europe by the Organisation’s Parliamentary Assembly, with responsibilities for human rights, legal affairs, and the environment mentioned that in order to fight the crimes of organ trafficking, the responsibility should not only be carried by European countries, but the whole world. Although the principle according to which the human body and its parts shall not, as such, give rise to financial gain is already party of the legal acquis of the Council of Europe, many people, in countries living in poverty find loop holes around laws like this. The principle was enacted by the Council’s Convention on Human Rights and Biomedicine, and was reiterated in an additional protocol opened for signature in 2002 but there is no protocol against organ trafficking for the European Convention or the UN Convention against Transnational Organized Crime.
Professor Khalid Butt of the Westchester Medical Department of Surgery and Transplantation touched on the role of poverty in donors participating in organ transplantation. He began with the history of transplantation, noting the first kidney transplant in 1954, with twin brothers, leading to discussion of the seminal reason for organ transplantation procedures, i.e., saving lives. He presented three reasons for organ transplants: emotional, altruistic, and mercantile (which is where the ethical question of legalized organ markets enter). He suggested that in order to improve organ donations it is necessary to improve donor’s primary health care and follow-up medical care.
Professor Thomas Diflo of the New York University’s Department of Transplant Surgery discussed the ever-growing and complex problem of “transplant tourism.” The most recent data from the United Network for Organ Sharing (UNOS) in the U.S. lists approximately 98,000 individuals waiting for an organ, compared to the 30,000 or so organs donated last year. It is this ongoing gap between supply and demand that creates the underground market for transplantable organs. Diflo then noted that most healthcare-related professional organizations in the U.S. formally oppose organ markets or financial incentives for donation, and that data from the organ trade in India suggests that paid donors are left no better off financially. He also noted that marketed organs are often of poorer quality and confer increased risks of rejection upon their recipients. Diflo then talked about his own experience as a transplant surgeon, when an Asian patient of his returned from China after receiving an organ transplant from an executed prisoner, thereby raising important ethical questions in his own mind. In what way, if any, should his relationship with this patient change? Should continuing to take care of his patient, now back in the U.S., be considered implicit endorsement of transplant tourism?
Conclusion
During the very first discussion of this kind organized by the IHEU-Appignani Center for Bioethics in NYC, some of the ideas that they have originated include signing and ratifying different types of Conventions, inviting “donor countries” to improve primary health care, identify illegal donors and provide follow-up medical care, inviting countries to deny medical insurance for patients who have received a transplant from abroad, and many more. The panelists believed that criminal responsibility should include everyone involved in the trafficking, transplant, and post-treatment of organs and patients. People involved in trafficking include brokers, intermediaries and the donor itself. Otherwise, the transplant tourism industry will continue to thrive. With all the recommendations that some of the panelists have made, should all be followed, it will determine. The future of organ trafficking and transplantation throughout the world lies in the enactment of these recommendations made by the panelists.