Since the first successful kidney transplant in 1954, medicine has progressed. Now, not only can kidneys be transplanted, but so too can hearts, heart valves, livers, lungs, corneas, bones, tendons, and small bowels. In the decades that followed since the first transplant, there has been great societal change towards views of organ transplantation and legal acceptance of who qualifies as an organ donor. Today there is even talk by renowned Italian surgeon Dr. Sergio Canavero of a full body transplant. Organ transplantation is now seen as the best treatment option to improve patient survival and quality of life. However, with an exponential increase in population, cardiovascular, kidney, and other chronic diseases have become more prevalent and with that demand for organ transplantation has also increased.
Three times a week 3600 Canadians across the country undergo dialysis, with the hope that one day their turn for a life changing transplant will come. However, according to the Canadian Transplant Society, in a country where 90% of Canadians support organ and tissue donations, only 20% plan to donate. With 1600 patients being added to organ transplant waitlists every year in Canada alone, there seems to be no end in sight . In 2013 alone, 246 Canadians died while waiting for organ transplants . Canada is not the only nation plagued with this problem, so too are developed nations such as the US and the UK. In the United States 16,905 kidney transplants were carried out in 2004 while 74,000 patients remained on the wait-list. Similarly, the United Kingdom faces a kidney shortfall of 8,000 kidneys per year. Hence, with demand high and supply low, most developed countries are now using the most innovative tools to make the most use out of the body parts at their disposal. However, with wait-lists remaining stubbornly long, many people do not live to reach the front of the list. As a result, many patients embark on “transplant tourism”, which in turn contributes to the black market for organs and organ trafficking in vulnerable developing countries.
According to the Global Finance Report, in 2011 alone 7,000 kidneys are obtained illegally every year. It is estimated that organ trafficking generates between $512 million USD to $1 billion USD per year. On the black market, corneas can sell for $30,000, hearts for $130,000-160,000, a kidney for $62,000, a liver for $150,000, and a pancreas for $98,000- 130,000 (all prices in USD). Depending on the nationality of the donor, prices may range. This, in turn, was correlated to the poverty levels in the country of residence. In many cases, impoverished people living in Brazilian, Indian, and Nepalese slums are duped into giving up their kidneys with cash incentives, left only with long scars along their bodies and a fraction of the money they were promised. In Nepal, the tiny district of Kavre in Kathmandu is the epicenter of the country’s organ trade. According to the Forum for Protection of People’s Rights, in the years between 2010 and 2015, 300 people have reported being victims of kidney trafficking. Many do not come forward due to social stigma. To quell the demand for organs, China, the world’s most populous country, has turned to a highly controversial method. It harvests the organs of its prisoners. The Chinese organ trade alone is worth a staggering $1 billion USD, money needed to fund a healthcare system facing government spending cutbacks. To make matters worse, often times the organs belong to jailed political dissidents, especially the followers of the Falun Gong movement.
How do these operations occur? Illegal transplant surgeries are performed at private for- profit hospitals that lack adequate safety standards. After the surgery, the donors are left on their own. As a result, the transmission of infections is very common, including human immunodeficiency virus (HIV) and hepatitis; and recipients may even die due to improper screening for compatibility. Not only is the physical health of the donor implicated, but so too is their mental health; many donors develop depression and psychosomatic reactions.
In order to curb transplant tourism, the World Health Assembly called upon all WHO members to prohibit transplant tourism . However, this has been met with varying levels of success, since each country must pass and implement organ trafficking laws. Even though conditions have improved slightly, abuse of the poor still goes on. This is in part due to law enforcement turning a blind eye to the flourishing underground trade. Another approach has been taken by Iran, which in 1988 moved to regulate kidney transplantation (Ghods & Savaj 2006) . All potential donors are made to register with the government and undergo careful screening and are offered post-transplant care and are compensated with the fixed amount of $1,700 USD. All recipients are also provided with immunosuppressants at a subsidized cost (Ghods & Savaj 2006) . As a result, kidney transplant waitlists have been eliminated thanks to the increased donor pool and equitable access. However, critics argue that by providing money for kidneys, the poor may be coerced, the nobility of the act is devalued, and the price of the kidney is nowhere near market value. However, the best way to stop transplant tourism is to increase domestic donor pools in developed countries. The Organ Donation Breakthrough Collaborative in the United States, Canada, and Australia has been instrumental in increasing organ donation. Policy changes in some European states and Singapore have also lead to increased donation, where everyone is assumed to be a potential donor unless they opt out. A study by Abadie et al. has shown that this strategy has led to a 25%-30% increase in organ donation rates (Abadie 2006). On a grander scale, cooperation between countries for swapping of organs for compatibility may be helpful for maximizing the use of organs. As well, further promotion of altruistic donation will help.
However, policies and public campaigns can only go so far. The future in alleviating organ shortages lies in regenerative medicine. With time, scientists hope to harness the ability to grow organs ready for transplantation that are genetic matches for recipients, eliminating the need for lifelong immunosuppressant use. In 2013, Dr. Harald Ott of Massachusetts General Hospital was able to bioengineer a rat kidney (Song 2013). Although it was not as efficient as a normal kidney, it still does give us hope that one day, waitlists and organ trafficking rings will become a thing of the past.
By Hussein El-Khechen
References:
Abadie A, Gay S. The impact of presumed consent legislation on cadaveric organ donation: a cross country study. J Health Econ. 2006; 25(4):599-620.
Ghods AJ, Savaj S. Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol.2006;1(6):1136-1145.
Song, Jeremy et. al., “Regeneration and experimental orthotopic transplantation of a bioengineered kidney.” Nature Medicine (2013), 1-8.
Please note that opinions expressed are the author’s own. They do not necessarily reflect the views and values of The Blank Page.
