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Keys Ethical Issues in Organ Transplantation
The global human organ shortage, mainly kidney, has led to illegal and unregulated organ markets. According to World Organization health, about 5 to 10 percent of all kidneys transplanted per year are obtained in Africa, Asia, Eastern Europe, and South America. Therefore, the world faces double tragedy; first, very many patients who die waiting for an organ transplant due to their shortage. Secondly, violation of human rights in which corrupt mediators and brokers deceive indigent organ donors about the nature of operation; ignore their post-surgical effects by cheating them out of payment. Not all countries but both developed and developing countries use a posthumous donation. Unfortunately, most transplant processing establishments, including the World Health Organization and the World Medical Association, never focus on organ trafficking. Instead, in the process of trying to get rid of illegal underground markets, corruption chips in, and the market continues flourishing.
So, let’s look at this scenario in this perspective: illegal and unregulated organ markets are one of the causes of and consequences of individuals driven to seek transplantation therapy across the world. The driving force for one to be alive is a powerful human instinct and overshadows the human bond between people. It leads to humanity violations and requires stringent and robust laws and regulations. Such opportunistic disrespect of human rights and cannibalism should not have a place in world health care. Organ donation after death is the only acceptable and practicable solution for heart, lungs, pancreases, intestine, composite tissue, and most liver recipients. When considering kidneys alone, broader needs for transplantation have been discarded because most solutions are not embracing both the deceased and the living donor.
This is the time to turn the market approach. The main problem is a result of those who do not care about the responsibility for transplant patients or organ donors. Otherwise, the focus should be getting the organs from the deceased but not buying organs from live kidney donors. Payments for live vendors by physicians have placed the transplant community at ethical and professional risk. Besides, there are consequences to be measured by society regardless of the increasing demand for the supply of organs. Some questions arise about whether the economic analysis of cost-effectiveness makes the buying and selling of organs by the society ethically acceptable and whether it would be acceptable health policy for government planners. I believe the answer to these two questions is no.
Neither scientific justification nor cost-effectiveness reasons overcome ethical concerns. Human ethics of organ sales precede any analysis of its economic value or practical value. The discussion cannot take place without ethical considerations. Ending the increased supply of organs cannot justify using any other means available and demonstrations that claim payments works also tend to ignore the importance of ethical consideration. The consequences of adopting the organ transplant market by focusing on cost-effectiveness are profound. The transplant community and the policymakers must consider these consequences before even trying to conduct a pilot project.
Besides, there are social consequences that are as a result of uncontrolled buying and selling of human organs. The government needs to exercise regulatory control of this market. However, it is quite unlikely that legislation responsible for this will soon focus on running such a system. Current efforts are far removed from live donors’ payments and also unable to get consensus. It opens the door to a more widespread market of organs that currently exists (Jeffrey and Francis).
Some of us assume that the government would be able to strictly and tightly regulate the exchange of organs, which is not the case. If the justification of selling and buying of the human organ is to solve the organ shortage, then why should the vendors be limited to a government-regulated market? In other cases, allowing kidney sales are known to be used as a remedy for poor to get themselves out of poverty, at least for some time (The Ethics of Human Organ Trading). Creating deliberately and systematically, a society driven by poverty, then we should expect an increased rate of immorality and violation of human ethics.
My view is that we should get rid of policies that allow the selling and buying or organs as they represent a failure themselves. They can reinforce a policy environment of human disrespect rather than an exception to be prevented. The government itself has the responsibility to provide for the poor and eliminate poverty without violation of human rights (The Ethics of Human Organ Trading).
The organ sale would not solve the poverty of the poor person. Reports from India indicates that selling of human organs makes the majority of the donors worse than they were before, medically socially and even financially. The same system of organ sale in the United States of America would lead to the same kind of exploitation (the United States. Congress. House. Committee on International Relations. Subcommittee on International Operations and Human Rights).
Moreover, the organ selling program creates an inherent conflict between the physician and the patient hence destroying the professional relationship (Jeffrey and Francis). Consequently, patients become vendors, and the medical decision and willingness to operate may be forced on the physician based on the financial interests rather than the best care for the patient. One could anticipate litigation from the potential vendor as a result of physician refusal to remove the organ. In this case, there can also be a confrontation between the vendor and physician for the denial of payment for the sale of the organ.
Attempts that leads to monetary valuing of human body parts regardless of increasing demand for organ supply lowers human dignity and devalues the very human life that the physician is truly dedicated to saving. This approach puts at risk the core value of the profession of medicine, turning physicians into an illegal entrepreneur of human body parts for consumers and clients. Instead, the profession rules state clearly that they should engage in facilitating overly risky actions in the medical context, no matter how informed and willing the patients may be or the financial gains to be made.
Limits have been put to potential organ donation (New England Journal). Live donors should be considered and promoted, and the proposal that lowers the motivation for monetary enrichment for gift put into action. Hence, the donor will not be financially responsible for doing the good deed of donation. Reimbursement of expenses by the employer is an ethically acceptable approaches; removing a disincentive for living donors. At the same time, live donors should be given insurance against potential disability as a result of the donation procedure.
Medicals systems globally are far from meeting the needs of kidney-transplant patients. However, there is an urgent need for regulation of the process by which organs are donated. World Health Organization has been armed for international standards, which will protect the poor, monitor transplantation processes, and ban commercialization. Thousands of patients from the United States, Israel, Saudi Arabia, and other developed countries get the kidneys they need through the exploitation of some of their donors financially and medically. A survey has been done in Pakistan for-profit market, where many of the transplant operations are done on the foreigners. It showed that almost 70% of the donors were bonded laborers, of which 90% of them were illiterate. Out of the research, another finding was that about 88% of the donors do not benefit financially, and the Health of about 98% ends up declining with chronic pain from large incisions. WHO and its decision-making body have improvised ways to reject commercialization, hence protecting the poor (World Health Organization).
Prevention can be another way of reducing the increasing need for a kidney transplant (Noel). The waiting list can be reduced through more cadaver donations and living donors. In the Philippines, restrictions have been made on kidney transplants, with the operation to the foreigners reduced to 10 percent. However, this is different from reality because the same country has a village named ‘kidney Ville’ due to the existence of the high number of kidney donors living there. To make the matter worse, Philippine health officials came up with a written policy to make human organ sale open and legal in the country.
Unethical practices lead to the exploitation of poor and vulnerable people (Delmanicio). Yes, it is right; there is a considerable waiting list of patients. Still, on the other hand, studies suggest that allowing commercialization of organs will destroy altruism and reduce the number of kidneys gotten from both live and cadavers donors. Nevertheless, the list can shorten as almost half of the patients are not eligible for the transplant. They are too sick for the required surgery. The value of human beings is critical and crucial such that it should have incomparable worth (Kerstein). Therefore, the market for human organs should be wholly prohibited because it devalues human life. Secondly, it treats the poor as tools available for the right price. An example is what happened in Europe in the 18th century, where the poor were being exploited for their teeth, which were then transplanted into the jaws of the wiling rich. Selling organs is done with little respect for human dignity, particularly for the poor.
There can be other ways and alternatives to buying and selling organs. An example is ‘organ draft,’ which is a random set up for the healthy to donate organs. Organ transplant has indeed saved the lives of many in the last 50 years. This is a commendable job for the dedication and creativity of medical professionals as well as to the generosity of the donors. Nonetheless, there is a rising rate for kidney disease, meaning that most patients will not get the transplant they are waiting for. However, buying and selling of organs will be wrong. It will harm the existing voluntary donation programs and fail to be effective in increasing the supply of organs. Many organs have been bought from the destitute globally, tarnishing the reputation of organ transplants and poor medical outcomes (Caplan et.al).
The market undermines efforts to build active programs of voluntary unpaid donations from both living and deceased donors. Financial incentives have smothered voluntary contributions, and patients have no reason to ask for support from the relatives and the government. Governments also see no need to build infrastructure and public support for the deceased donation. Iran is the only country that has a government program for paying donors. Still, even after doing so, it has not eliminated the extensive waiting list of patients requiring an organ transplant. Instead, the record has also become more substantial as compared to the one in the United States. The Health of kidney sellers has been reported to worsen, and many of them regretting of selling their kidneys. On the other hand, there is a high rate of kidney transplants in some countries such as Spain and Croatia, which exercises the program of unpaid donation. The on-commercialization of human organs is well discussed in professional statements, such as in the Declaration of Istanbul.
Developed nations have come up with a program that ensures live organ donors do not bear high financial burdens. For example, the 5th principle of the World Health Organization clearly states prohibition on sale or purchase of cells, body tissues, and organs. Covering donors’ expenses is essential because it increases the number of living donors. However, these benefits are not inherent in the gift of the organ itself. It just makes sure that donors are not financially worse than they were after their reward, but not making them productive. WHO and all departments of Health and services should focus on this program and ensure that procurement organizations become more efficient and effective (Cherry 650). They can also introduce practices which will collectively pay respect for, and gratitude to, voluntary living donors and the family of deceased donors for their generosity and solidarity with the patients in need.
Countries should adopt anti-sales laws, and more so for the developing countries should try and resist the pressure to repeal their regulations to have the most significant number of needy individuals. That would doom their medical donation programs and bringing medical ingenuity through exploitation and injustice. The market for human organs is destroying our lives. Asking someone whether he/she is willing to sell his or her organ gets you into a moral, social, ethical, and political filth zone. Selling of body organs has destroyed many families and communities in some countries such as India, Syria, Moldova, Brazil, Egypt, Turkey, among others. Despite having compensation for kidneys, sellers suffer a lot from the operation, which impacts negatively on their bodies, minds, and lives.
Medical journals have failed to report on long-term medical, psychological, and social consequences that come as a result of selling kidneys. They include chronic pain, depression and suicide, self-hatred, distorted body image, a sense of bodily emptiness, anger, regret, and isolation, among many other effects. Most sellers, as stated earlier, they become economically worse than they were more previously. It’s because most of them are poor, uneducated, unskilled laborers who use most of their strength from their bodies while working. The majority are forced to leave their jobs because their bodies no longer sustain the massive tasks that we’re undertaking.
Over many years buyers and sellers of human organs have been exploited by these illegal underground markets run by brokers due to their desperation. It has gone to the extent of these ‘kidney hunters’ to collaborate with surgeons and hospitals and ply their trade based on deceit and exploitation. Some governments have also started practicing exploitation in the name of helping refugees by granting visas and promising them jobs in exchange for kidneys. A few months ago, Turkish authority arrested an international kidney broker by the name Boris Wolfman, who was said to have been recruiting innocent and desperate Syrians from refugee camp to give their kidneys in exchange for legal protection.
Imagine how difficult it could be to run a complex regulatory system on the selling of body parts. Who would be in charge and carry all the responsibilities by ensuring a smooth run and rigorous business? Transplant surgeons? Nonprofit groups? Or independent donor advocates who are burdened with uncovering the hidden real motive behind organ transplants? Instead, these advocates have failed to identify cases in which force and fraud were used for individuals to forfeit an organ. An example is an incident that happened in the United States, where kidney brokers were caught trafficking poor kidney sellers from Israel, which were provided to foreigners and American Citizens.
All in all, it’s inhuman to sell human organs for money. It is total hostility towards kidneys sellers. If someone is willing to buy an organ from someone to save his or her life, I would advise him/her to buy from someone he or she loves from his/her family so that he/she will be responsible for the health long term effects of that person. Price cannot be put on life, but money can be exchanged with a promise of mutual trust, love, and care.
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