Progress in medical science and technology has contributed to the growth of kidney and other organ transplantations around the world. Nevertheless, the gap between the supply and demand for transplantable organs continues to widen.
In Europe, for example, the average waiting time for transplantation averages about three years and is expected to lengthen to ten years by 2010.
With 120,000 patients on chronic dialysis and 40,000 patients waiting in line for a kidney in Western Europe alone, about 15-30% of these patients will die annually because of organ shortages.
Many patients engage in organ trafficking as a solution. Various criminals and other individuals have recognized organ shortages as an easy opportunity to pressure people from countries living in poverty into selling their organs. The potential for large profits underpins their interest: sellers of kidneys are paid approximately $2,500-3,000, while recipients pay anywhere from $100,000-200,000.
On December 11, 2007, the IHEU-Appignani Center for Bioethics—co-sponsored by the U.N. Office of the Special Adviser on Gender Issues and Advancement of Women (OSAGI) and the Council of Europe—convened an expert panel discussion, "Intersecting Human Rights Crises: Organ Transplantation and Organ Trafficking." During the discussion, various ethical, medical, social and legal questions were raised.
Speakers included representatives from the U.N., the Council of Europe, the Bioethics Center at the University of Pennsylvania, the Department of Transplant Surgery at New York University, as well as the Westchester Medical Department of Surgery and Transplantation. Those in attendance included students, journalists, professors, physicians, and interested others.
Organ trafficking and organ markets were discussed at length. Professor Art Caplan of the University of Pennsylvania made the point that Falun Gong group has long worried that its practitioners in prisons or labor camps in China have been being used as organ sources for rich transplant patients, domestic or foreign.
An audience member talked about an independent investigation report from two Canadians, a former member of Canadian Parliament David Kilgour and a human rights attorney David Matas, on their findings on the allegation of Falun Gong practitioners being killed for their organs.
These organs have been offered for transplantation to people who have been desperately seeking suitable organs and ready to buy. In the report, the two Canadians present the 33 kinds of evidence they have gathered so far, including various documents, witness testimonies and hospital phone calls in which Chinese hospitals admittedly acknowledged organs from Falun Gong practitioners were available. More information of this specific issue can be found on www.organharvestinvestigation.net or www.david-kilgour.com.
Rachel Mayanja, U.N. Special Advisor on Gender Issues and Advancement of Women, highlighted the critical importance of poverty to organ trafficking in her introductory remarks. The extent to which those living in poverty actually have no choice, were also subject to debate by the panel. Maud de Boer-Buquicchio, the first woman to be elected Deputy Secretary General of the Council of Europe by the Organization's Parliamentary Assembly, emphasized the need for coordinated, multilateral government efforts to combat organ trafficking.
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, leading to discussion of the seminal reason for organ transplantation procedures—saving lives.
Professor Butt presented three reasons for organ transplants: emotional, altruistic, and economic, and suggested that in order to improve organ donations it is necessary to improve the 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.
Dr. Diflo then noted that most healthcare-related professional organizations in the U.S. 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 in the long run (e.g., in terms of average yearly income). He also remarked that marketed organs are often of poorer quality and confer increased risks of rejection upon their recipients.
He then talked about his own experience as a transplant surgeon, when a Chinese American patient of who returned from China after receiving an organ transplant from an executed prisoner, thereby raising important ethical questions in his own mind. He presented his own investigation in China with a reporter, which was published an article in the Village Voice in 1999 when two executed Chinese prisoners' organs were retrieved without their families' permission.
Dr. Diflo estimated that 6000 kidney transplants performed in 2006 and the price of $80,000 per kidney. Thus it is about a half of a billion dollars a year cash business.
Potential solutions emerging from this novel panel included erecting a more extensive legal framework against organ trafficking, initiating measures to improve health in "donor countries," identifying illegal donors, and denying medical insurance for patients who have received a transplant from abroad. Criminal responsibility should include everyone involved in the trafficking transplantation process, including brokers, intermediaries and the donor himself.
Ana Lita, Ph.D. is Director of the IHEU-Appignani Center for Bioethics, a non-partisan, non-governmental organization (NGO) providing thoughtful, timely research and analyses of bioethical challenges facing the global community. To find out more, click www.humanistbioethics.org