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 healthcare
Market-driven logic
- deregulation
- privatization
- commodification
Economic approach of globalization =
Neoliberal ideology
- competition
* 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
Global problems and organ trade
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
What can be done:
• Problem of organ shortage: present realistic alternatives to
desperate patients
Increase living donation and establish robust
deceased donor programs
of kidney transplantation from living and deceased donors
USA
Netherlands
Turkey
Global problems and organ trade
What can be done:
• Stop migration of donors, recipients and human body parts
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:
* Global cooperation
Professional responsibility
Istanbul Declaration
DICG (Declaration of Istanbul Custodian Group: implementation
Professional peer control
Long-term follow-up of donors
Thank you for your
attention