Sunday, July 5, 2015

Journal of Human Trafficking, Issue 1, 2015, on kidneys

Issue 1 of the Journal of Human Trafficking contains this article by Alexander Capron and Frank Delmonico. I've highlighted in the abstract two points worth noting--the first involves some untested, but testable empirical claims about what would happen if countries in the first world allowed compensation for donors. (It would be nice to have some empirical evidence...)  The second point is that it is now agreed by everyone that financial disincentives for donating should be removed. (Let's get organized on that, shall we?)

Alexander M. Caprona & Francis L. Delmonico
pages 56-64

Published online: 28 Apr 2015

Most countries now have national legislation that outlaws both human trafficking and organ trafficking. However, international conventions and domestic laws alone have not been enough to stop the trade in organs. As of 2007, a conservative estimate was that 5% of the approximately 100,000 organs transplanted annually were derived from exploiting the poorest and most vulnerable people in society; anti-trafficking efforts have since reduced, though not eliminated, this practice. The Declaration of Istanbul (DoI) was created in 2008 to engage medical professional societies to collaborate with governments and others in combating organ sales, transplant tourism, and trafficking in human organs. In 2010, the Declaration of Istanbul Custodian Group (DICG) was formed to actively promote and to monitor the implementation of the DoI principles. The removal of prohibitions on organ purchases, which is now being promoted in some wealthy nations, is unlikely to shorten transplant waitlists (because organ sales crowd out voluntary, unpaid donation) and would be based on the false view that such sales do not exploit the sellers. To combat such exploitation, the DICG advocates for ratification and enforcement of the new “Council of Europe Convention against Trafficking in Human Organs,” as a complement the Palermo Protocol to the United Nations organized crime convention that prohibits human trafficking for organ removal. To increase ethical organ donation by living related donors, the DICG encourages countries to adopt means to cover donors’ financial costs, which now discourage donation. It also works with the World Health Organization to encourage ministries of health to develop deceased donation to its maximum potential toward the goal of achieving national self-sufficiency in organ transplantation so that patients do not need to travel to foreign destinations to undergo organ transplantation using kidneys and partial livers purchased from poor and vulnerable people. Success in combating human trafficking for organ removal and organ trafficking will be greatly enhanced through organizations like the DICG forging strong relationships with human rights organizations.

1 comment:

Anonymous said...

re: "The removal of prohibitions on organ purchases, which is now being promoted in some wealthy nations, is unlikely to shorten transplant waitlists (because organ sales crowd out voluntary, unpaid donation)"

That is not only one of the "untested, but testable empirical claims" but it is also worded in a tricky fashion since it refers to crowding out "voluntary, unpaid donation". I suspect that many who voluntarily donate kidneys now would also do so in this case, but would consider it fair to be paid (if the payment were say coming from an insurer as opposed to the recipient) at least something if others are paid.

The impression that it would reduce the number of available kidneys is an idea many feel strains credulity to say the least. It may cause money to need to be allocated to paying some donors that currently are unpaid, however overall it seems likely to increase the number of available kidneys given the level of poverty in much of the world. Unfortunately some people seem to feel they have a right to prevent those poor people from making their own decision regarding how much they value money compared to their kidney. There are people who may need funds to help provide medical care to save the life of a relative who are condemned to death due to what I would consider the unethical elitist position of people like those authors who think they know what is best for others.

re: "and would be based on the false view that such sales do not exploit the sellers."

That sort of absolute statement seems to be implying that *all* such sales by definition exploit the seller.
Often such authors seem to misguidedly project their own personal situation onto others and can't empathize with the different life circumstances of people with fewer monetary prospects and with different value systems who can make what in their minds is a rational choice to sell a kidney. I suspect that there are people in this world who would sell their kidney who could convince even the authors of that paper that they were making a fully informed choice that it was better for them to receive money in exchange for their kidney than not to do so. (unless of course it is merely the sort of rabidly anti-capitalist rant that some high paid professionals oddly make while taking home comfortable salaries).

When something is outlawed that there is a demand for then a black market will usually arise to fill that need. Such underground markets are far more likely to involve poorly informed or coerced participants and the use of violence in the operation of the non-legal market than would exist in a legal market. (ala the difference between legal alcohol in the US now vs. during prohibition, or compared to illegal drugs in the US). Worst case if they demand government protection to reduce the potential for "exploitation" there could be required guidelines for the information provided to those who sell their organs to ensure the participants are making fully informed decisions.