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  • Ethical analysis and debate (4)

    Please note that this section of the website is currently under development. Articles and commentary about more countries and ethical issues will be added over time.

    Click on the links below to find more articles and information about ethical issues and debate in the following countries and regions:

    China

    United States

    Organ Markets

     

     

    • United States - Ethical issues and debate (3)

      Allocation of deceased donor organs to non-US citizens

       

      The allocation of organs procured from altruistic deceased donors in the United States to wealthy foreigners who travel to the country specifically for the purpose of organ transplantation raises serious ethical concerns about justice. (See Why is it Legal... below) Nevertheless, access is often provided to foreign patients for admirable reasons, for example to save the lives of children who have no hope of obtaining a transplant in their own country (See Foreigners, desperate...).

      It's important to remember that the number of foreigners who obtain a transplant in this way is very small - only 38 in 2013. Most organs donated by residents of the United States are allocated to fellow residents of the country, not wealthy foreigners.

      The recent change in UNOS policy provides critical transparency that will help to inform professionals and the public. The transparency of data will  support efforts to ensure that organs are shared within societies that help contribute to meeting needs for transplantation through donation. (See Organ Transplantation for nonresidents...)

    • China - Ethical issues and debate (1)

      China relies heavily on organ procurement from executed prisoners, and has been a key destination for transplant tourists.

      The procurement of organs from executed prisoners has been widely condemned by the international medical community, notably by The Transplantation Society, the Declaration of Istanbul Custodian Group and the World Medical Association. As articulated in the policy of the Transplantation Society:

      "It is a fundamental principle for The Transplantation Society that organs and tissues are given freely and without coercion. Because of the restrictions in liberty in a prison environment it is unlikely that prisoners are truly free to make independent decisions and thus an autonomous informed consent for donation cannot be obtained. Further, the financial incentive for recovering organs from executed prisoners may become an incentive to increase the number of such organs available for transplantation. Thus, The Transplantation Society is opposed to the recovery of organs and tissues from executed prisoners and from any other individual where an autonomous consent for the procurement is lacking."

      The World Medical Association declares that,

      "In jurisdictions where the death penalty is practised, executed prisoners must not be considered as organ and/or tissue donors. While there may be individual cases where prisoners are acting voluntarily and free from pressure, it is impossible to put in place adequate safeguards to protect against coercion in all cases."

      A number of public statements by national health authorities and policy changes have been made in China since 2006, indicating that China aims to end the practice of organ procurement from prisoners and develop an allocation system for deceased donor organs. Signs of progress have been welcomed and encouraged by the international community, however serious concerns remain about the ongoing use of organs from executed prisoners.

      Below you will find a number of news reports and journal papers discussing this issue:

      • Procurement of organs from executed prisoners (17)

        China relies heavily on organ procurement from executed prisoners, and has been a key destination for transplant tourists.

        The procurement of organs from executed prisoners has been widely condemned by the international medical community, notably by The Transplantation Society, the Declaration of Istanbul Custodian Group and the World Medical Association. As articulated in the policy of the Transplantation Society:

        "It is a fundamental principle for The Transplantation Society that organs and tissues are given freely and without coercion. Because of the restrictions in liberty in a prison environment it is unlikely that prisoners are truly free to make independent decisions and thus an autonomous informed consent for donation cannot be obtained. Further, the financial incentive for recovering organs from executed prisoners may become an incentive to increase the number of such organs available for transplantation. Thus, The Transplantation Society is opposed to the recovery of organs and tissues from executed prisoners and from any other individual where an autonomous consent for the procurement is lacking."

        The World Medical Association declares that,

        "In jurisdictions where the death penalty is practised, executed prisoners must not be considered as organ and/or tissue donors. While there may be individual cases where prisoners are acting voluntarily and free from pressure, it is impossible to put in place adequate safeguards to protect against coercion in all cases."

        A number of public statements by national health authorities and policy changes have been made in China since 2006, indicating that China aims to end the practice of organ procurement from prisoners and develop an allocation system for deceased donor organs. Signs of progress have been welcomed and encouraged by the international community, however serious concerns remain about the ongoing use of organs from executed prisoners.

        Below you will find a number of news reports and journal papers discussing this issue:

         

    • Organ markets (21)

      The Declaration of Istanbul, consistent with Resolutions 44.25 and 63.22 of the World Health Assembly, strongly condemns the sale of human organs. Principle 5 of the World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation states:

      "Cells, tissues and organs should only be donated freely, without any monetary payment or other reward of monetary value. Purchasing, or offering to purchase, cells, tissues or organs for transplantation, or their sale by living persons or by the next of kin for deceased persons, should be banned.

      The prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income, or paying the costs of recovering, processing, preserving and supplying human cells, tissues or organs for transplantation."

      Commentary in the Guiding Principles justifies this prohibition as follows:

      "Payment for cells, tissues and organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation, and leads to profiteering and human trafficking. Such payment conveys the idea that some persons lack dignity, that they are mere objects to be used by others."

       

      In this section you'll find links to a number of articles discussing the issue of markets in human organs.

  • Empirical studies (10)
  • Reports and reviews (18)
  • The Council of Europe Convention Against Trafficking in Human Organs (6)

    The Council of Europe Convention against Trafficking in Human Organs was adopted by the Committee of Ministers of the Council of Europe on 9 July 2014. The adoption of the Convention represents a historical milestone in the fight against organ trafficking. It is the first legal document that provides an internationally agreed upon definition of trafficking in human organs, identifying the activities that ratifying States must criminalize in their national laws.

    Like other criminal law instruments, the Convention also includes provisions to deter these practices and to protect victims. This instrument complements the existing international legal framework against trafficking in human beings (including for the purpose of the removal of organs), which does not reach some transplant related crimes and many of the actors, such as surgeons, whose involvement lies at the heart of the criminal activity.

    Fourteen countries have already signed the Convention: Albania, Austria, Belgium, Czech Republic, Greece, Italy, Luxembourg, Moldova, Norway, Poland, Portugal, Spain, Turkey and the United Kingdom. This signifies their intention to ratify it, which will bind them legally to incorporate its provisions into their domestic law. The Convention, which was conceived to have a global scope, is open for signature and ratification not only by Council of Europe member or observer countries but by any State in the world, and several have already indicated that they are considering acceding to the Convention, as have additional COE member States. 

    More information about the Convention can be found in the media and journal articles below.

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