Contributed by Faith Johnson
There are approximately 114,000 people wait-listed for an organ transplant in the United States. Another person is added to the list every 10 minutes. When one considers an aging population in a co-morbid state, it’s understandable that 20 people die waiting for a suitable organ transplant every day (American Transplant Foundation, 2019). Is everyone in need of an organ transplant treated fairly? Can money or social position move one up the list? There are ethical ways to get closer to the top of the list. In the United States, medical necessity, location, and compatibility can improve one’s position. If a potential recipient feels they aren’t moving up fast enough there are options, some more legal than others.
The World Health Organization (WHO) has identified 91 countries where kidney transplants are performed. In 2005, 66,000 were performed globally (The State of the International Organ Trade, 2019). The selection of who received these organs varies based on their national situation, availability of organs, health care cost, and technical capacity. While most think of organ donation as coming from a deceased (brain dead) person, many come from live donors facilitated by a medical doctor. Some of these live donors sold their organs. Web sites offer transplant packages ranging in price from $70,000 to $160,000 (The State of the International Organ Trade, 2019).
Twenty-five percent of live donors are not biologically related. About 6,000 of these donations occur every year (American Transplant Foundation, 2019). Buying and selling human organs for transplant, known as Transplant Tourism, is illegal in the United and most other countries. However, due to growing demand, an international black market is thriving to provide organs from both live and deceased donors. Up to eight lives can be saved through a deceased donor, and more than 100 lives enhanced through tissue donation (American Transplant Foundation, 2019). So, it is easy to see how profitable it can be for those who work as brokers in a somewhat subversive industry.
The American legal and health care structure is designed to protect donors through articles such as informed consent or a Living Will, where a person can put their final wishes in writing to be carried out by family members or an Executor Outside the protection of the United States, the situation is questionable. Many of these donor transactions are carried out by medical doctors who supposedly have the best interest of the patient in mind. At times, they work with facilitators in the recipient’s country of origin. As cited in The State of the International Organ Trade, the Taiwanese Department of Health revealed that 58% of 118 patients interviewed said their transplant surgery was facilitated by their doctor. There are other notations of donors and recipients from different countries going to a third or neutral country to have the procedure performed. In 2005, approximately 12,000 kidney and liver transplant procedures were performed in China with organs harvested from executed prisoners. There wasn’t any notation of consent being part of the process (The State of the International Organ Trade, 2019).
Transplant tourism is a global issue that will require a global solution. Collaboration and legislation among the participating countries to identify and monitor transplants are needed. Seven countries including the United States have been identified in a report by Organs Watch as organ-importing countries. The other countries identified are Australia, Canada, Israel, Japan, Oman, and Saudi Arabia (The State of the International Organ Trade, 2019). The Human Organ Transplantation Act of 1994 was put in place to ban organ trade. We need international human rights Legislation including monitoring by governments of any country that allows organ importing to be part of the legal defense. Amendments should be made to the Affordable Care Act to allow employers to exempt coverage to employees who have been organ recipients, domestically or internationally, that were non-compliant with benefit plan requirements. Also, Medicare and Medicaid would not provide coverage for these organ recipients so they would not qualify for disability benefits. International deceased or incarcerated donors should have legal protection to ensure that they or their families are aware of their organ contribution. Tighter controls are needed to reign in private transplants of questionable origin.
The world is filled with health dilemmas, including transplants. A shortage of compatible organs has added another layer of complexity to the equation. As the co-morbid state of an aging population continues to grow, so will the deficit of organs needed to bring better health to those in need. A communication campaign to raise awareness of the benefit of organ donorship is long overdue. If more people allowed their organs to be harvested at the time of death, a shift in the supply of viable organs may occur. One might see it as the recently deceased living on for years to come through the gift of their organs. A larger supply of organs available legally, coupled with tighter controls and Legislative compliance, could bring about a positive shift in organ transplantation.
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