Transplant Tourism: Ethics in Organ Procurement

(Review of Broumand & Saidi, 2017 and The Transplantation Society's "Policy & Ethics")

While kidneys are usually thought of as the only organ that can be donated by a living donor, living donors can actually donate portions of the lungs, liver, pancreas, and intestine (The Transplantation Society). A living donor can function with only 1 kidney, the donated portion of the liver regenerates, and donated non-regenerative portions of the liver, pancreas, and intestine are not required for full bodily functioning, although donors may have certain physiological limits in terms of exercise (Health Services and Resources Administration).

Though increased live organ transplantation helps alleviate the long waiting list for cadaver organs, this avenue presents its own host of ethical problems. “Transplant tourism” occurs when individuals from developed countries with long waiting lists for organs travel to underdeveloped countries where there is little regulation prohibiting the sale of organs and where there are economically disadvantaged individuals willing to sell body parts to support themselves (Broumand & Saidi, 2017). This creates the potential for live donor transplantation to become an economically abused enterprise.

The Transplantation Society (an NGO with official relations with the World Health Organization) asserts that living donors must be of sound mind, must not be coerced, must be informed of the potential risks involved, and must be informed of alternative treatments available to the recipient (among others), and states that, “organs and tissues should be freely given without commercial consideration or financial profit” (The Transplantation Society). However, these are policies established by this society at select transplantation conferences and there is no international regulatory body that oversees organ xenotransplantation. Transplant tourism has thus become problematic due to the lack of regulation and the potential for exploitation of donors and recipients (The Transplantation Society).

Justice and autonomy are central to transplant tourism via the involvement of multiple parties. How do these ethical factors play out if a wealthy individual can travel to another country to pay for a liver part from a live donor who has been coerced by their family to donate so that they can pay their bills? What if the individual is perfectly willing to donate an organ (and of sound mind) in order to provide for their family?

            

The Transplantation Society also condemns harvesting organs from executed prisoners. This could constitute an entirely new blog thread, but is a relevant and horrifying ethical dilemma considering recent allegations that the Chinese government is detaining and harvesting the organs of ethnic minorities (Withnall, 2019, September 24). “Where there is demand, there is supply” can have dark implications for all 4 of the biomedical ethical principles when medicine and economics are mixed.

Cited Literature

Broumand, B., & Saidi, R. F. (2017). New Definition of Transplant Tourism. Int J Organ Transplant Med, 8(1), 49-51.

Health Services and Resources Administration. The living donation process.   Retrieved from https://www.organdonor.gov/about/process/living-donation.html

The Transplantation Society. Policy & ethics.   Retrieved from https://www.tts.org/index.php?option=com_content&view=article&id=11&Itemid=223

Withnall, A. (2019, September 24). China is killing religious and ethnic minorities and harvesting their organs, un human rights council told.   Retrieved from https://www.independent.co.uk/news/world/asia/china-religious-ethnic-minorities-uighur-muslim-harvest-organs-un-human-rights-a9117911.html