The practice sees desperate people — from countries where waiting lists are longer than their life expectancy or costs are exorbitant — travel overseas to buy an organ and have lifesaving surgery. Within one week, he received a new kidney. He said he would have died before he reached the top of the waiting list for a new kidney in Canada, where he lives with his family.
I came back alive. In the years that followed, several doctors were arrested for allegedly carrying out illegal organ transplants at private clinics, according to local authorities and state media. Acting on a tip-off, police in Bazhou city in the northern province of Hebei arrested three doctors as they prepared to remove a kidney from a man, a local Communist Party official and police told AFP in Value judgments can also influence the process of matching cadaver organs with patients on the waiting lists. At present, its driving considerations are matching a donor and a recipient by blood type, tissue type, and organ size.
There has been some push in recent years to steer organs toward those who are less seriously ill in order to maximize the chances for successful transplantation. UNOS used to have to allocate organs locally, but recently it has moved to a more regional distribution, as organ preservation techniques have improved.
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Or should it be efficacy? In recent years, there has been a shift toward efficacy. Under current UNOS rules patients can increase their chances of getting a transplant by enrolling at more than one transplant center—a practice known as multiple listing. Critics of multiple listing say that it is unjust because it gives an advantage to people with the resources to pay for more than one evaluation and listing. Each evaluation can cost tens of thousands of dollars.
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A number of steps have been taken over the years to try to increase the supply of organs see box. There has also been a recent push to increase donor registration through state-operated online registries, which now account for close to half of all registered donors, but total numbers have not gone up significantly as a result. None of these policies has significantly increased the supply of organs.
Therefore, some people now argue for a shift away from a reliance on voluntary altruism in organ donation toward either a paid market or presumed consent. Two basic strategies have been proposed to provide incentives for people to sell their organs upon their death. Then, individuals would be free to broker contracts with persons interested in selling at prices mutually agreed upon by both parties.
Markets already exist on the internet between potential live sellers and people in need of organs, but these transactions are illegal. The other strategy is a regulated market in which the government would act as the purchaser of organs—setting a fixed price and enforcing conditions of sale.
Both proposals have drawn heated ethical criticism. One criticism is that only the poor and desperate will want to sell their body parts. If you need money, you might sell your kidney to try and feed your family or to pay back a debt.
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This scenario has manifested in Iran, where the sale of organs is legal. In that country there is virtually no waiting list, yet it appears some individuals compete to sell their organs at low prices to feed their families. Choice requires information, options, and some degree of freedom, as well as the ability to reason. It is hard to imagine many people in wealthy countries eager to sell their organs upon their death.
In fact, even if compensation is relatively high, few will agree to sell.
That has been the experience with markets in human eggs for research purposes and with paid surrogacy in the U. Some maintain that selling organs, even in a tightly regulated market, violates the ethics of medicine. The doctor must harm the patient for no end other than a sale to another party.
The creation of a market puts medicine in the position of removing body parts from people solely to abet their interest in securing compensation. A market in human organs has a model in the existing market for human eggs for assisted reproduction and research purposes, but that practice is highly controversial.
Is this a role that the health professions can ethically countenance? In a market—even a regulated one—doctors and nurses still would be using their skills to help people harm themselves solely for money. The resulting distrust and loss of professional standards may be too high a price to pay to gamble on the hope that a market may secure more organs for those in need. There is another option for increasing the organ supply that has not been tried in the U. Based on the European experience, there is a good chance many regions in America could get a significant jump in the supply of organs by shifting to a default-to-donation policy.
Default to donation proposals have been submitted in several states over recent decades, but they have yet to be adopted anywhere in the U.
As of , Wales became the first nation in the U. If Welsh families know that the deceased did not want to donate, despite lack of documentation, their expression to this effect will prevent procurement.
Scotland and Iceland are instituting presumed consent as well. If these policies are successful, they may provide momentum for trying default to donation elsewhere in the U.
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There are important issues to consider before moving to default to donation. For millions of people who are used to actively deciding for or against donation when registering at the DMV or online, a shift to presumed consent could be unsettling. Waiting times for transplantation offered by hospitals in China were extraordinarily low, the tribunal noted, often only a couple of weeks.
Investigators calling hospitals in China inquiring about transplants for patients, the tribunal said, have in the past been told that the source of some organs were from Falun Gong followers. Both former Falun Gong and Uighur inmates gave testimony of undergoing repeated medical testing in Chinese jails. Jennifer Zeng, a Falun Gong activist who was imprisoned for a year in a female labour camp, gave evidence to the China Tribunal about what she said were repeated medical check-ups and blood tests to which inmates were subjected.
We were interrogated about what diseases we had and I told them I had hepatitis. That was for a more thorough physical check-up.
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We were given X-rays. On the third occasion in the camp, they were drawing blood from us. We were all told to line up in the corridor and the test were given. Zeng, who fled China in , did not see any direct evidence of forced organ removal but since reading other accounts, she has questioned whether the tests were part of a medical selection process.