Organ trade within the scope of global bioethics

1. Organ trade within the scope of global bioethics Henk ten Have, MD, PhD Director, Center for Healthcare Ethics Duquesne University, Pittsburgh, USA

2. Organ trade/transplant tourism: • WHO estimation (2007): • Each year 5-10% of transplanted kidneys from organ trade: 3500 – 7000 kidneys per year • ‘Hot spots’: • Export countries: Philippines, China, Pakistan, Egypt, Moldova • Import countries: Australia, Canada, Japan, Oman, Saudi Arabia, USA

3. April 2013: Five medical doctors convicted for organ trafficking in Pristine, Kosovo, by a panel of European Union judges. According to the indictment, traffickers in the network promised payments of up to $26,000 to poor people in Turkey, Moldova and Russia to persuade them to travel to Kosovo and donate an organ. They were asked to sign false documents saying they were donating for a relative for humanitarian reasons. Two dozen donors were taken in by the scheme; many were never given any compensation and were released without adequate medical care. The wealthy patients who were to receive the organs flew to Pristina for transplant operations at a clinic called Medicus.

4. March 2014 Police in Mexico’s western state of Michoacan detained an alleged member of the Knights Templar cartel, saying he is suspected of trafficking organs. Michoacan state Public Safety Secretary Carlos Castellanos Becerra alleged that Manuel Plancarte Gaspar was part of a cartel ring that would target people with certain characteristics, especially children, for kidnapping and organ harvesting.

5. December 2013 Chinese doctor admits to stealing seven babies and selling them for profit. She sold the baies to traffickers between November 2011 and July 2013. One of the babies was sold for 21,600 yuan, approximately $3,600, and then resold for 59,800 yuan, approximately $10,000. Chinese authorities uncovered 1,868 child trafficking cases in 2012.

6. Huffingtonpost 17 July 2012 • Ukraine: police discovers minibus with human bones and other tissues • Materials destined for factory in Germany belonging to RTI Biologics, Florida based medical products company • International pipeline of ingredients for medical and dental products to be implanted in people • Global tissue trade • In US: 2 million products derived from human tissue are sold each year • One single body generates cash flows of $80,000 to $200,000

7. Globalisation = movement • medical students • health professionals • patients • medical research • drugs and devices • ethical problems

8. Globalisation = movement • medical students • health professionals • patients • medical research • drugs and devices • ethical problems • movements are not symmetrical

9. Ethical problems of globalization • privatization of healthcare • care as commodity; consumerism • focus on high tech • emphasis on treatment over prevention • decrease of expenditures for public health Growing inequities • gap between private and public services • two-tiered health system • internal brain drain

10. Globalization of healthcare • Market-driven logic • deregulation • privatization • commodification • competition Economic approach of globalization = Neoliberal ideology * promotion of profitability rather than public welfare * prioritizing market actors rather than citizens Growing inequalities Breakdown of social protection Precarious labor Less accessible care and treatment Social disintegration Mainstream bioethics is powerless as long as it is dominated by the perspective of the individual moral agent

11. Global problems require global answers Need for a really global bioethics Broad conception of bioethics Bioethics as connection between individual, social and environmental dimensions; Individual person is related and connected to others (family, community, society, biosphere); Focus on socio-cultural and political context: wider agenda of issues: inequality, poverty, exploitation, marginalization, discrimination, environmental degradation; Combine academic research with social activism and advocacy Individual ethics is no longer sufficient: bioethics is a social ethics

12. Global problems and organ trade • Ethical problem of organ trade • Negative impact on transplantation technology and practice • Exploitation of vulnerable people • Link between human trafficking and trafficking of human organs

13. Global problems and organ trade Declaration of Istanbul, 2008 “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…”

14. Global problems and organ trade • What can be done: • Problem of organ shortage: present realistic alternatives to desperate patients • Increase living donation and establish robust deceased donor programs

15. 2009 rates of kidney transplantation from living and deceased donors USA Netherlands Turkey

16. Global problems and organ trade • What can be done: • Stop migration of donors, recipients and human body parts Domestic legislation Prohibition of making financial gains with the human body and its parts International legal agreement to ban organ trafficking and trade Implementation of international guidelines Blame packaged deals of companies Identify and fight black markets (investigative journalists; anthropologists

17. Global problems and organ trade What can be done: * Global cooperation Professional responsibility Istanbul Declaration DICG (Declaration of Istanbul Custodian Group: implementation Professional peer control Long-term follow-up of donors

18. Thank you for your attention