TRANSPLANT TOURISM
AND ORGAN TRAFFICKING
E2 GUS 2010
Achmad Shidiq
Dilla Aprilia
Dimas Setiaji
Dini Desmona
Monika Hasna
Mutia Ayu
Nadya Iswandari
Noer Olivy
Nur Afifah
Tara Zhafira
Wulan Dwi Sakinah
E2 (22)
“The 20th
century
miracle”
Best
treatment
The only
available
treatment
• Survival rate ↑
• Cost effective
• Quality of life
↑
• For end-stage
failure
Market and Demand
Market and Demand?
About 112,600 solid organs transplanted
worldwide in 2011. There was 5.1% of
increase over 2010. It was only ≤ 10% needs.
Global Activity in Organ Transplantation 2011 Estimate (Global
Observatory on Donation & Transplantation, 2011)
Kidney
Liver
Heart
Lung
Pancreas
Small Bowel
76.118
23.721
5.741
4.278
2.564
209
The Gap is Widen
Data from optn.transplant.hrsa.gov and OPTN/SRTR Annual Report.
** Data include deceased and living donors
I need the
kidney, I have
the money
I have the
kidney, I need
the money
Organ Trafficking
Recruitment, transport, transfer,
harboring or receipt of persons, by
means of the threat or use of force or
other forms of coercion, of abduction,
of fraud, of deception, of the abuse of
power, of a position of vulnerability, of
the giving or receiving of payments or
benefits to achieve the consent of a
person having control over another
person, for the purpose of exploitation
by the removal of organs, tissues or
cells for transplantation (UN Trafficking
Protocol, 2000)
The commercial transaction is a
central aspect of organ
trafficking; the organ becomes a
commodity and financial
considerations become the
priority for the involved parties
instead of the health and wellbeing of the donors and
recipients
Transplant Tourism
Has become
a
connotation
for organ
trafficking
The purchase of a
transplant organ
abroad that includes
access to an organ
while bypassing
laws, rules, or
processes of any or
all countries
involved (UNOS)
However, not all
medical tourism
that entails the
travel of transplant
recipients or
donors across
national borders is
organ trafficking.
Transplant tourism
may be legal and
appropriate.
The Real Victims in Organ Trafficking
Vulnerable populations (such as illiterate and
impoverished persons, undocumented
immigrants, prisoners, woman, children and
political or economic refugees) in resourcepoor countries.
100 nationals from countries such as
5–10%of kidney transplants
performed annually around the
globe are currently via organ
trade.
Saudi Arabia (700 in 2005), Taiwan
(450 in 2005), Malaysia (131 in 2004)
and South Korea (124 in the first 8
months of 2004) went abroad
annually for a commercial kidney
transplant.
At least 20 nationals from other
countries such as the Australia,
Japan, Oman, Morocco, India,
Canada and the United States
traveled as transplant tourists
for trafficked organs.
China (2006-2007)  11000
transplant were performed
from executed prisoners 
8000 kidney, 3000 liver, approx
200 are hearts
The 8000 kidney transplants
alone in China in 2006 would
account for at least 10% of the
total number of annual organ
transplants done in programs of
organ trafficking.
In Indonesia?
• 1st kidney transplant in Ina  RSCM, 1977
• In Indonesia  40.000 people need kidney transplant.
Only 500 had it.
• Kidney donors  alive and only a few. Mostly patients
underwent the transplant in China (many donors and
not so expensive)
• Underwent kidney transplant  elongated age by 29.9
yrs (Transplant Centre Directory, 1992)
• As a medical procedure, organ transplant has a
potential to be misused  need a regulation, ethically
and legally.
International Convention
and National Regulation
The Declaration of Istanbul
on Organ Trafficking and
Transplant Tourism
WHO Guiding Principles on
Human Cell, Tissue, and Organ
Transplantation
UU No 23 Tahun 1992
PP No 18/1981
The Declaration of Istanbul on Organ Trafficking
and Transplant Tourism
“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 and should be prohibited
a. Prohibitions on these practices should include a ban on all types of advertising
(including electronic and print media), soliciting, or brokering for the purpose of
transplant commercialism, organ trafficking, or transplant tourism.
b. Such prohibitions should also include penalties for acts, such as medically screening
donors or organs, or transplanting organs, that aid, encourage, or use the products of,
organ trafficking or transplant tourism.
c. Practices that induce vulnerable individuals or groups (such as illiterate and
impoverished persons, undocumented immigrants, prisoners, and political or economic
refugees) to become living donors are incompatible with the aim of combating organ
trafficking, transplant tourism, and transplant commercialism.”
WHO Guiding Principles on Human Cell, Tissue,
and Organ Transplantation
Guiding Principle 5
Cells, tissues and organs should only be donated freely,
without any monetary payment or other reward of
monetary value. Purchasing, or offering to purchase, cells,
tissues or organs for transplantation, or their sale by living
persons or by the next of kin for deceased persons, should
be banned.
The prohibition on sale or purchase of cells, tissues and
organs does not preclude reimbursing reasonable and
verifiable expenses incurred by the donor, including loss of
income, or paying the costs of recovering, processing,
preserving and supplying human cells, tissues or organs for
transplantation.
UU No 23 Tahun 1992
Pasal 33
(1)
Dalam penyembuhan penyakit dan pemulihan kesehatan dapat dilakukan
transplantasi organ dan atau jaringan tubuh, transfusi darah, implan obat dan atau
alat kesehatan, serta bedah plastik dan rekonstruksi.
(2)
Transplantasi organ dan atau jaringan tubuh serta transfusi darah sebagaimana
dimaksud dalam ayat (1) dilakukan hanya untuk tujuan kemanusiaan dan dilarang
untuk tujuan komersial.
Pasal 34
(1)
Transplantasi organ dan atau jaringan tubuh hanya dapat dilakukan oleh tenaga
kesehatan yang mempunyai keahlian dan kewenangan untuk itu dan dilakukan di
sarana kesehatan tertentu.
(2)
Pengambilan organ dan atau jaringan tubuh dari seorang donor harus
memperhatikan kesehatan donor yang bersangkutan dan ada persetujuan donor dan
ahli waris atau keluarganya.
(3)
Ketentuan mengenai syarat dan tata cara penyelenggaraan transplantasi sebagaimana
dimaksud dalam ayat (1) dan ayat (2) ditetapkan dengan Peraturan Pemerintah.
PP No 18/1981
BAB V
TRANSPLANTASI ALAT DAN ATAU JARINGAN TUBUH MANUSIA
(1)
(2)
(1)
(2)
Pasal 10
Transplantasi alat dan atau jaringan tubuh manusia dilakukan dengan memperhatikan
ketentuan-ketentuan sebagaimana dimaksud dalam Pasal 2 huruf a dan huruf b.
Tatacara transplantasi alat dan atau jaringan tubuh manusia diatur oleh Menteri
Kesehatan.
Pasal 11
Transplantasi alat dan atau jaringan tubuh manusia hanya boleh dilakukan oleh dokter
yang bekerja pada sebuah rumah sakit yang ditunjuk oleh Menteri Kesehatan.
Transplantasi alat dan atau jaringan tubuh manusia tidak boleh dilakukan oleh dokter
yang merawat atau mengobati donor yang bersangkutan.
Pasal 12
Dalam rangka transplantasi penentuan saat mati ditentukan oleh 2 (dua) orang dokter
yang tidak ada sangkut-paut medik dengan dokter yang melakukan transplantasi.
Pasal 13
Persetujuan tertulis sebagaimana dimaksud dalam Pasal 2 huruf a, Pasal 14, dan Pasal 15
dibuat di atas kertas bermaterai dengan 2 (dua) orang saksi.
PP No 18/1981
BAB VIII
PERBUATAN YANG DILARANG
Pasal 17
Dilarang memperjual belikan alat dan atau jaringan tubuh manusia.
Pasal 18
Dilarang mengirim dan menerima alat dan atau jaringan tubuh manusia
dalam semua bentuk ke dan dari luar negeri.
Pasal 19
Larangan sebagaimana dimaksud dalam Pasal 17 dan Pasal Pasal 17
18 tidak berlaku untuk keperluan penelitian ilmiah dan keperluan lain yang
ditetapkan oleh Menteri Kesehatan.
A 25 yo
with no
insurance
A 65 yo
that able
to pay all
cost
To which person will you give the kidney? Why?
Conclusion
• Organ transplant  tindakan yang mulia, tapi
hanya boleh dilakukan dengan consent dari donor
dan memperhatikan risiko donor, efektivitas
pendonoran, kemungkinan keberhasilan pada
penerima, serta ada tidaknya unsur “jual beli”
atau komersialisasi di dalamnya.
• Secara legal, Indonesia bersama negara lain
menentang adanya organ trafficking maupun
transplant tourism.
Thank you! 
“we make a living by what we get, but we make a life by what we
give”
-Winston Churchill
References
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http://organdonor.gov/about/data.html
Delmonico FL. The development of the Declaration of Istanbul on Organ Trafficking
and Transplant Tourism. Nephrol. Dial. Transplant. (2008) 23 (11): 3381-3382.
Budiani-Saberi DA, Delmonico FL. Organ Trafficking and Transplant Tourism: A
Commentary on the Global Realities. American Journal of Transplantation 2008; 8:
925–929.
Tazeen H. Jafar, MD, MPH. Organ Trafficking: Global Solutions for a Global
Problem. American Journal of Kidney Diseases, Vol 54, No 6 (December), 2009: pp
1145-1157
The Declaration of Istanbul on Organ Trafficking and Transplant Tourism.
http://cjasn.asnjournals.org/content/3/5/1227.full
http://www.balitbangham.go.id/PERANGKAT%20UU%20TERKAIT/UU.%2023.pdf
http://hukum.unsrat.ac.id/pp/pp_18_1981.htm