WEEK 6: Transplant Tourism Scenario and Reflection
Moderator: Hello everyone. Thank you for coming today. More than 100,000 people in the US
are currently on waiting lists to received new kidneys.
Due to limited supply of organs for transplant, only around 17,000 kidney transplants took
place in 2014.
It perhaps should not surprise us then, to learn that many Americans look for alternatives
abroad.
But unlike other forms of medical “tourism”, organ transplants present a unique ethical
quandary.
Organs obtained in other countries may come from questionable sources, and poor regulation
and oversight make for muddy waters when looking for transplant solutions.
Moderator: Our speakers on the issue today are Dr. Michael O’Connor and Dr. Gwen Reynolds.
We will begin with Dr. O’Connor.
Dr. O’Connor: “Transplant tourism” is a serious and growing problems. Patients are obtaining
organ transplants abroad to avoid waiting lists and expenses in the US, but it is not always
possible to track the sources of these organs. Many donors are paid to donate, and often
receive very little compensation. They may be plagued with regret and depression after they
participate in the transplantation, not to mention they may potentially develop health
problems of their own. The overall implication is that the lives of poor donors in other countries
are not as valuable as the lives of the American patients who are willing to travel abroad to
procure the transplants they need.
Dr. Reynolds: The ethical quagmire of black market organs is related to transplant tourism, to
be sure. But there are a number of other factors to consider before denouncing the practice
altogether. For one thing, it is important that we do not let a few bad apples spoil the barrel.
There are reputable transplants performed internationally under government regulations that
ensure both patient safely and the ethical procurement of organs. Also, this is an issue of
international politics. If we are going to make a public statement, we will have two problems to
consider. One, we are a group comprised of medical professionals, so we are inherently biased,
and the opposition will point that out. And two, we must remain sensitive to the complex
cultural dynamics of countries that may not share our ethical framework.
Moderator: How common is transplant tourism?
Dr. Reynolds: An estimated 3500-7000 kidney transplants involve paid donors throughout the
world every year. That’s between 5-10% of total transplants.
Moderator: Are overseas transplants safe?
Dr. O’Connor: A recent UCLA study 33 patients who had received transplants overseas found
that they had much worse results than patients who received transplants in this country. Paidorgan donors are not screened as thoroughly as they should be, and problems like hepatitis are
often overlooked. Early organ rejection is twice as common in these patients, and infections are
frequent.
Dr. O’ Connor: It’s our job to make a statement. Those who interpret our statements and
develop policy can determine and address any issues of bias. And we can be culturally sensitive
without altering our ethical compass. Stating publically that we oppose these procedures is not
the same as forcing other countries to end them. It only means that we are presenting a
consensus of professional opinion in the hope of reaching an ethical industry standard on a
global scale. We are pointing out problems that need solutions. Maybe we should keep in mind
the words of Rudolph Virchow “ Medicine as a social science, as the science of human beings,
has the obligation to point out problems and to attempt their theoretical solution”. The
politicians must find the practical solutions.
Dr. Reynolds: I am not arguing what our role is to be Michael. I am merely pointing out the
complexities of an ethics issues that permeates a variety of cultures. If there are ethical outlets
for international transplants, we should not take away those options from patients whose lives
are at stake just because we cant adequately address black market organs. We just need to
identify and address those real problems. And by “we”, I mean human beings in general not just
the US. An organ transplant is not, in and of itself, unethical. Our focus should be on regulation
rather than prohibition. Anytime we remove an option, we limit patient freedom and
potentially limit medical progress.
Moderator: What do we know about the issues facing the paid organ donors? Are they well
paid and take care of?
Dr. O’Connor: It varies widely, of course, but poor people who sell a kidney, sometimes do so
for as little as $800 according to the World Health Organization. They will face future health
problems including the worsening of their own kidney function-provided, of course, that their
surgery goes well, which is never guaranteed. Donors in America can have kidney removed with
very small incisions. But third world donors, can end up with wounds up to 14 inches long.
These wounds can take months to heal, making the patients unable to do the manual labor that
most of them depends on
Moderator: Thank you
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