Transplant Tourism – a scourge – yes; but, what are policy makers doing about it?

This is a quote from a fantastic article by Danovitch and Al-Mousawi -available open access: “At least ten percent of the organs transplanted globally each year are obtained through trafficking [Lancet 369, 1901 (2007)] - in some countries nearly all kidneys donated by the local population were for paying foreign recipients”

Recall that the “The Declaration of Istanbulon Organ Trafficking and Transplant Tourism” was adopted at an international meeting held in 2008. The Declaration provided a set of principles and a series of proposals “to improve the ethics and expand the benefits of the international organ transplantation endeavor.”

In a very nice article on transplant tourism from New Zealand the issue of transplant tourism is re-visited. Here is a quote from the article: “Sadly the number of people who need organs is growing. The transplant waitlists are getting longer, five years for a kidney, and that is if you are lucky enough to even get one. The supply of organs from both living and deceased donors is getting shorter. With this in mind, it is understandable why people are turning to illegally purchase organs from overseas. However, there are also many reports of deaths of patients who have gone abroad for commercial transplants.”

The article goes on and cites Rachel Walsh who is researching into this issue: “there were three types of trafficking. The first type was where a trafficker forces or coerces a victim to give up one or more of their organs. The second instance was where a victim’s organ was removed without their knowledge. The final type of trafficking was where victims were not paid the amount agreed upon for the sale of their organs. Organ trafficking victims are usually poor, homeless, or illiterate, therefore vulnerable to traffickers. There are numerous people involved in organ trafficking, including hospitals, doctors, middlemen, organ banks and transporters. Kidneys are most sought after. With trafficking, anything that can be removed can be sold on, regardless of the age or lack of consent of the victim.’’

Here is a quote from the Danovitch article:

“Promotion of such self-sufficiency is at the core of any attempt to resolve the problem of organ donor shortages and to prevent organ trafficking and transplant tourism; however, achieving this goal requires a favorable legislative framework. In this regard, the complementary goals of the Declaration and the WHO Guiding Principles are invaluable. Development of a critical pathway to evaluate the national potential for deceased donation was endorsed by the 3^rd WHO Global Consultation on Organ Donation and Transplantation held in Madrid, Spain, in 2010. The purpose of this pathway is to facilitate deceased donation according to international norms, particularly in countries where deceased donation is currently absent or rudimentary.”

The issue is this: we all agree that organ trafficking is reprehensible and unethical, however, the flip side to this is that policy makers have been rather slow in legislating cadaveric or deceased donors as a source of kidneys. And, this slowness is now a major factor in driving continued organ trafficking.

Take for example, the UAE, it is now starting to write laws in this area. Even among countries where legislation is in place, government’s have been slow in implementing deceased donor programs. In India, a law is in place but only sparsely implemented. Policy makers need to speed up in both enacting and implementing laws banning organ trafficking. Lip service just won't cut it.