Transplant Tourism: Has Money Influenced

The number of patients in the US who are in desperate need of an organ transplant has swelled to an alarming 95,000, with only 25,000 surgeries conducted per year. Patients who require an organ transplant can sign up in the appropriate registry (administered by the Organ Procurement and Transplantation Network) and wait to receive an organ from an anonymous donor, with wait times ranging from months to even years, determined by a variety of factors, including type of organ needed, length of time spent on the list (for kidneys), urgency of need (in the case of liver transplants, this is determined using the Model of End-Stage Liver Disease), and availability of an organ that matches that patient's specific profile. Lucky patients may have the option of a family member or friend who is a good match and is willing to donate. Unfortunately, this is not always possible, tempting desperate people to resort to other means to obtain the needed organ--buying one directly from another person through the thriving international black market for organs, for example. This illicit trade, known as “transplant tourism," relies on an intricate web of middle men and raises all manners of legal, moral, and ethical red flags, especially since it relies so heavily on exploiting economic inequalities.

It turns out organ demand is highest for kidneys. A recent article from Reuters India about organ trafficking noted how the practice often involves donors from poor and underdeveloped countries and recipients from industrialized nations. The piece described how a US citizen paid $60,000 to receive a kidney from a Brazilian donor, who was paid just $6,000.

Some think this should all be viewed as a simple economic transaction—a matter of supply and demand—and question why people should not be permitted to buy and sell organs, as we do with food, oil, and other commodities (noted conservative author Thomas Sowell makes just such a case). Perhaps government officials and medical experts should consider the economic needs (rights?) of the thousands of people worldwide who would be interested in selling their organs, and the suffering of the tens of thousands of patients waiting for a kidney or other organ? At a conference in the Netherlands on European transplantation policy, Arthur Matas, a University of Minnesota transplant surgeon, said, "It is morally wrong to continue to let patients suffer and die on dialysis when we can do something to prevent it." Matas also stated that prohibiting "the poor from selling a kidney still leaves them poor and removes one possible option to improve their lives."

David Holcberg, a media research specialist at the Ayn Rand Institute in Irvine, CA, wrote an article in the American Chronicle outlining how legal organ trading could save lives. "The right to buy an organ is part of your right to life," he said. "The right to life is the right to take all actions a rational being requires to sustain and enhance his life. Your right to life becomes meaningless when the law forbids you to buy an organ that would preserve your life."

Or should we heed the words of health officials and transplant experts who warn against any kind of transaction-based traffic in human organs, for fear of further exacerbating the divide between rich and poor and creating a kind of “medical apartheid?"

These questions will likely take on increased urgency and significance for Americans as the Baby Boomer generation ages; the number of people affected with chronic diseases will increase, and the need for transplant organs will skyrocket, as the transplantation market is projected to reach $20 billion by the end of 2007. The economic shortage is the only number that stands any real chance of losing ground. Perhaps a regulated market is the answer.

ADDITIONAL READING

BioEthics.net: Organ Transplants/Donation

The Case for Selling Human Organs

Economic and Health Consequences of Selling a Kidney in India

A Free Market in Kidneys: Efficient and Equitable

JAMA Consensus Statement on the Live Organ Donor

Journal of Medical Ethics Commentary on an “Ethical Market” in Human Organs

Legal Issues in Payment of Living Donors for Solid Organs

Organ Procurement: What Are the Questions?

Organ Shortage Fuels Illicit Trade in Human Parts

Organ Trade: A Global Black Market; Tracking the Sale of a Kidney on a Path of Poverty and Hope

Overcoming Barriers to the Organ Donation Crisis: Medscape Expert Column Series

Paying for Kidneys: The Case Against Prohibition