Organ trade within the scope of global bioethics Henk ten Have, MD, PhD Director, Center for Healthcare Ethics Duquesne University, Pittsburgh, USA.

Organ trade within the scope of global bioethics

Henk ten Have, MD, PhD

Director, Center for Healthcare Ethics

Duquesne University, Pittsburgh, USA

Organ trade/transplant tourism:

WHO estimation (2007):

Each year 5-10% of transplanted kidneys from organ trade: 3500 – 7000 kidneys per year

‘Hot spots’:

- Export countries: Philippines, China, Pakistan, Egypt, Moldova

- Import countries: Australia, Canada, Japan, Oman, Saudi Arabia, USA

April 2013:

Five medical doctors convicted for organ trafficking in Pristine, Kosovo, by a panel of European Union judges.

According to the indictment, traffickers in the network promised payments of up to $26,000 to poor people in Turkey, Moldova and Russia to persuade them to travel to Kosovo and donate an organ. They were asked to sign false documents saying they were donating for a relative for humanitarian reasons.

Two dozen donors were taken in by the scheme; many were never given any compensation and were released without adequate medical care.

The wealthy patients who were to receive the organs flew to Pristina for transplant operations at a clinic called Medicus.

March 2014

Police in Mexico’s western state of Michoacan detained an alleged member of the Knights Templar cartel, saying he is suspected of trafficking organs.

Michoacan state Public Safety Secretary Carlos Castellanos Becerra alleged that Manuel Plancarte Gaspar was part of a cartel ring that would target people with certain characteristics, especially children, for kidnapping and organ harvesting.

December 2013

Chinese doctor admits to stealing seven babies and selling them for profit. She sold the baies to traffickers between November 2011 and July 2013.

One of the babies was sold for 21,600 yuan, approximately $3,600, and then resold for 59,800 yuan, approximately $10,000.

Chinese authorities uncovered 1,868 child trafficking cases in 2012.

Huffingtonpost 17 July 2012

Ukraine: police discovers minibus with human bones and other tissues

- Materials destined for factory in Germany belonging to RTI Biologics, Florida based medical products company

- International pipeline of ingredients for medical and dental products to be implanted in people

Global tissue trade

- In US: 2 million products derived from human tissue are sold each year

- One single body generates cash flows of $80,000 to $200,000

Globalisation = movement• medical students

• health professionals

• patients

• medical research

• drugs and devices

• ethical problems

Globalisation = movement• medical students

• health professionals

• patients

• medical research

• drugs and devices

• ethical problems

movements are not symmetrical

Ethical problems of globalization- privatization of healthcare

- care as commodity; consumerism

- focus on high tech

- emphasis on treatment over prevention

- decrease of expenditures for public health

Growing inequities • gap between private and public services

• two-tiered health system

• internal brain drain

Globalization of healthcareMarket-driven logic

- deregulation

- privatization

- commodification

- competition

Economic approach of globalization = Neoliberal ideology

* promotion of profitability rather than public welfare

* prioritizing market actors rather than citizens

Growing inequalities

Breakdown of social protection

Precarious labor

Less accessible care and treatment

Social disintegration

Mainstream bioethics is powerless as long as it is dominated by the perspective of the individual moral agent

Global problems require global answers

Need for a really global bioethics

Broad conception of bioethics

Bioethics as connection between individual, social and environmental dimensions;

Individual person is related and connected to others (family, community, society, biosphere);

Focus on socio-cultural and political context: wider agenda of issues: inequality, poverty, exploitation, marginalization, discrimination, environmental degradation;

Combine academic research with social activism and advocacy

Individual ethics is no longer sufficient: bioethics is a social ethics

Global problems and organ trade

Ethical problem of organ trade

- Negative impact on transplantation technology and practice

- Exploitation of vulnerable people

- Link between human trafficking and trafficking of human organs

Declaration of Istanbul, 2008

“Organ trafficking and transplant tourism violate the principles of equity, justice and respect for human dignity and should be prohibited. Because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice…”

Global problems and organ trade

Global problems and organ trade

What can be done:

• Problem of organ shortage: present realistic alternatives to desperate patients

Increase living donation and establish robust deceased donor programs

2009 rates of kidney transplantation from living and deceased donors

Turkey

NetherlandsUSA

Domestic legislation

Prohibition of making financial gains with the human body and its parts

International legal agreement to ban organ trafficking and trade

Implementation of international guidelines

Blame packaged deals of companies

Identify and fight black markets (investigative journalists; anthropologists

Global problems and organ trade

What can be done:

• Stop migration of donors, recipients and human body parts

Professional responsibility

Istanbul Declaration

DICG (Declaration of Istanbul Custodian Group: implementation

Professional peer control

Long-term follow-up of donors

Global problems and organ trade

What can be done:

* Global cooperation

Thank you for your attention