This week ABC news published a story on the “Alarming rise in illegal human organ trade.”  The story is brief and mentions exploitation of the poor in China, India and Pakistan. Citing Professor Jeremy Chapman, past President of the Transplantation Society, the story describes the pressure patients feel to find organs and the risks of donors dying from illegal operations.

India Donor Scar
Source: Cain, 2009; Campbell, 2008; Interlandi, 2009

Stories such as these oversimplify the issues and also contribute to alarmism regarding organ trafficking.

Without a doubt, worldwide demand for organs and kidneys in particular, has led to organ trafficking and transplant tourism. 

These practices were declared unethical in a World Health Organization summit held in 2008 in Istanbul.  The summit defined organ trafficking as the illicit sale of human organs, transplant commercialism as treating organs as commodities, and transplant tourism as giving organs to patients from outside a country  (which undermines the country’s ability to provide organs for its own population). The summit resulted in a document called “The Declaration of Istanbul” which states that these unethical practices are the consequence of the global shortage of organs for transplantation.

Pakistan Donor Scar
Source: Cain, 2009; Campbell, 2008; Interlandi, 2009

In 2008, it was estimated that organ trafficking accounts for 10% of 63,000 transplants performed annually worldwide. (Surman, O.S., Saidi, R., Burke, T.F. (2008). Regulating the sale of human organs: a discussion in context with the global market.  Current Opinion in Organ Transplantation, 13(2), 196-201.)

Examples of transplant tourism include 2,000 kidney transplants annually in Pakistan to foreigners and prior to 2008, 3,000 kidney transplants to foreigners in the Philippines. (Budiani-Saberi, D.A. and Delmonico, F.L. (2008). Organ Trafficking and Transplant Tourism:  A Commentary on the Global Realities. American Journal of Transplantation, 8, 925-929.)

It is not just rich Americans traveling to receive organs from donors in other countries. (Shimazono Y. (2007) The state of the international organ trade: a provisional picture based on integration of available information. Bull World Health Organization, 85(12), 955-962.) The major “organ-importing” countries (countries of origin of patients traveling overseas to purchase organs) are Australia, Canada, Israel, Japan, Oman, Saudi Arabia and the U.S.

Overseas Transplants
Source: Shimazono Y. (2007).

All a person has to do is a Google search for “kidney transplant overseas” and find sites such as http://www.kidneytransplantoverseas.com/ and http://surgeryoverseas.com/kidney-transplant and http://www.aarexindia.com/kidney.asp.

Transplant Tourism Websites
Source: Shimazono, 2007, p. 956

Go ahead and try a Google search yourself, take a look.

It is impossible to discuss supply solutions for the extreme need for transplant organs without consideration of a regulated organ market and organ trafficking. There is a serious supply and demand problem.  The kind of gap illustrated in the following chart creates desperation. 

Donor_Transplant_Waiting Trends
Source: Save Lives Now New York

The issue of organ trafficking is more than a simple discussion.  Issues that have to be considered are:

• the bioethical debate,
• economic issues and
• legal issues.

Brazil Donor Scar
Source: Cain, 2009; Campbell, 2008; Interlandi, 2009

Over the next several weeks, I will post information on each of these considerations and finally end with my viewpoint and some suggestions.

Lives are at stake.