STUDENT VOICES | 2015 CHYNN PRIZE HONORABLE MENTION

By: Christina Sailer

One of the great miracles of modern medicine is the ability to save a dying patient through organ transplantation. However, there still remains a worldwide shortage of organs and an excess of disadvantaged individuals who believe their salvation is not to receive, but sell one.

Today’s global economic imbalance has become a feeding ground for black market systems, a structure that will continue to thrive so long as the dichotomy between poor and wealthy nations persists. The socioeconomic stratification that the black market trade provides offers only a short-term benefit to its donors. These donors, or vendors, have thus become victims of a system that is unregulated, and marked with exploitation.

With capital as their driving force, these impoverished individuals do not have the ability to provide informed, rational consent to the transplant procedures. Instead, new educational programs and policies could help not only caution potential recipients about the corruption in black market organs, but also raise awareness about the issue and inspire more to become legal donors.

Three years ago I was fortunate enough to meet 47-year-old Eleni, a Greek immigrant who had undergone an unconventional transplant operation. After nearly 6 years on dialysis, and even more waiting on the United Network for Organ Sharing (UNOS) donor list for a new kidney, Eleni finally found a living donor.

Like many with organ failure, Eleni had exhausted all options for saving her life, including turning to the black market system. For-profit organ markets, or proposals for government-regulated incentives, can provide hope for individuals in need of a transplant. It is these very acts of desperation that force us to reexamine the broken system in use today. While I wholly advocate utilizing the technological advances at our disposal, I don’t believe they should come at the expense of another’s best interests. While the right to life may be basic liberty, the act of utilizing medicine and technology while jeopardizing another individual is not.

Thanks to modern medical advancements, organ donation has become largely routine. Still, roughly 21 people die each day because of a shortage of available organs (“United Network for Organ Sharing Online – UNOS”). Despite the rise in demand for organ transplants, the number of donated organs has stayed fairly constant over the last decade (Cheney, 2006, p. 13). Treatment options such as dialysis, medications, and homeopathic therapies can indeed provide relief to the ailing patient.

Even with all the technological advances the medical field has witnessed, patients who undergo dialysis have a significantly increased chance of mortality, a statistic that sadly never seems to wane (Greenberg). This shortage of viable organs for donation has thus created a platform to discuss the ethics of donation. In speaking with Eleni, and seeing the physical effects that dialysis had on her body, I find it difficult not to sympathize with her decision. Both she and her donor received a benefit: her donor with an opportunity to lateralize out of poverty, and Eleni with a chance of a normal, healthy life. Nevertheless, with the ramifications the organ trade offers, the donor involved should only be permitted to participate through informed consent.

Conversations surrounding the moral complexities of transplant tourism often begin at the end; it is an unjust, and ethically inexcusable practice. Fueled by desperation, transplant candidates are seeking treatment in unregulated, developing countries where they are offered quicker, albeit riskier, surgeries.

Often referred to as “transplant” or “medical tourism,” Eleni made her way back to her home country in order to bypass the lengthy US donor list and exploit lax legal regulation (Ramana). Acceptance for such practices likely stem from the widespread custom of doctors doing everything in their power to save the life of their patients. A system where “donors” (though in the case of for-profit exchanges, they act more as merchants) of one nation are able to provide valuable organs to recipients in another state surely cannot be a morally, or even politically justifiable organization.

Commoditizing one’s organs promotes a new class, one in which the financial disadvantaged obtain few, if any, lasting gains. Through black markets and the medical tourism it inspires, both ‘donors’ and recipients’ health can be put even further at risk. One solution for reducing risk factors in black market trades could be to allow governments to regulate trade sales. Indeed, though government control, and even incentivized plans, the demand for organs would likely dramatically decrease. Moreover, those looking to escape institutionalized poverty have an opportunity to leave. However, such approaches do little to combat the fundamental concern of true autonomy.

Financial incentives can make legitimate consent problematic, as it may coerce individuals into participating against their best interests. Incentives and financial gain, especially if such gains have the capacity to transform an individual’s life dramatically, can strip donors of their agency. By many clinical standards, in order to achieve the full consent of a participant, one must be rational, informed, and acting purely voluntarily, without duress (Cheney, p. 51). Indeed, there is no clear evidence that in every case a donor’s motives are always less than altruistic. Nevertheless, donors, along with their physicians, must be prohibited.

Since antiquity, the medical sector has been founded on the principle of “do no harm.” However, with living donors, this moral tenant is, in effect, eliminated. The ethical implications of the donor-recipient relationship transcend beyond that of merely those under the knife, but rather the role of physicians must too play a factor. Propelled by media frenzy, Eleni’s doctor, an Israeli renal specialist arrested last year for organ trafficking (Haaretz), bore much of the blame during the trade.

Indeed most news outlets seem fixated on condemning the physician for their involvement in the crime. With doctors continually viewed as the sole rational agents in the trade, acting purely out of greed and not emotion, international courts have been focused on combating the black market through its surgeons.

While, indeed, responsibility for the trade should not rest solely on the physician, doctors do not have an obligation to abuse their medical expertise. Indeed, quite the contrary. With living donors, healthy individuals only become patients via the transplant process. Doctors thus have an responsibility to both patients, that of the donor, as well as the recipient. In keeping with one of medicine’s most rudimentary values, the safety of one life cannot outweigh another, at least not without proper consent.

To help alleviate black market sales, it is important that individuals around the world are fully aware of the ramifications of this practice. Transplant tourism only exists because of material disparities. Worse, it continues to produce further social, and economic inequalities. Oftentimes individuals looking to pay for a kidney from black market sales, particular in South East Asia, can pay upwards of $120,000 USD.

However, the donor will often see only a fraction of that price, roughly $10,000 USD, with most of the funds going to pay off doctors, law enforcement officials, and cover any travel costs (“The Declaration of Istanbul on Organ Trafficking and Transplant Tourism”). By adding discussions about the harsh realities in local school health courses, as well as bringing these facts into the public sphere, could hopefully help deter individuals from engaging in the practice.

While black market sales will undoubtedly continue to exist, raising awareness about a rarely talked about issue could help diminish future trades. Education reforms have the potential to encourage more individuals to become donors, thus helping reduce the organ scarcity that exists today, and in turn reduce transplant tourism. Given the adverse consequences the organ trade provides for its participants, coupled with the inherent monetization of individual life, the custom should be prohibited.

Christina Sailer, FCRH ’15 was a Middle Eastern Studies major, and was awarded an honorable mention in the Fordham University Center for Ethics Education 2015 Dr. K. York and M. Noelle Chynn Undergraduate Essay Prize in Ethics and Morality.

Bibliography

Cheney, Annie. Body Brokers: Inside America’s Underground Trade in Human Remains. New York: Broadway Books, 2006.

Greenberg, Ofra. “The Global Organ Trade.” Cambridge Quarterly of Healthcare Ethics: 238-45.

Haaretz. “NYT Finds ‘disproportionate Role’ of Israelis in World Organ Trafficking – National.” Haaretz.com. Accessed March 24, 2015.

Ramana, Balasubramaniam. “Organ Trade: The Iran Model.” Nature India, 2008.

“The Declaration of Istanbul on Organ Trafficking and Transplant Tourism” Transplantation: 1013-018

“United Network for Organ Sharing Online – UNOS.” Accessed March 24, 2015.