In cases when failing vital organs resist the available types of treatment, the only option for survival may be associated with transplantation. However, there is a significant lack of organ donors who can provide enough resources to patients who need them. Because of the severe shortage, some patients may attempt accessing organs illegally as there is not enough time to join a waitlist due to life being at risk. According to Shimazono (2007) for the World Health Organization, the black market of organs has thousands of sales each year, contributing to the problem of illegal trade that also has risks for the health and well-being of both donors and organ receivers.
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However, there is a solution for the problem – the legalization of organ sales that is already viable in countries such as China, which can significantly reduce the time that patients have to wait to receive a transplant. Furthermore, the legalization may solve the issue of poor post-surgery follow up that leads to the development of complications and morbidities among donors and patients. Thus, the key objectives of the current policy proposal are to identify problems related to organ transplantation and propose solutions for their elimination.
Illegal organ trade grows on a global scale due to the chronic shortage of organs necessary to save patients’ lives. The Kosovo organ transplant scandal, when a Turkish man fainted at the airport shortly after having his kidney removed, showed that people who engage in the illegal sale of organs are at high risk of developing comorbidities and further health complications due to the inadequate medical attention (Houser, 2017). Moreover, the controversy with Kosovo revealed the involvement of higher officials in the illegal organ trade, pointing to the tremendous financial incentives associated with the problem. The issue has three distinct characteristics, which would point to the need to reconsider current approaches to organ care.
The first aspect is that those who sell their organs through the black market usually receive less money than initially negotiated or promised. This occurs due to the lack of integrity on the part of payers as well as their financial incentive to purchase organs for less and sell them for more. The second aspect is significantly limited aftercare due to negligence, which inevitably leads to permanent adverse effects on the health of donors and organ receivers. Low levels of medical support point to the absence of care on the part of those involved in illegal trade, with the key objective of the transaction being the attainment of income.
Moreover, there is a problem of inadequately trained surgeons performing surgeries in unhygienic conditions (Houser, 2017). The third aspect is concerned with the involvement of wealthy patients from developed countries. Such patients contribute to the development of illegal organ trade because they are willing to pay large sums of money to traders and do not consider the adverse implications of the problem for donors. As mentioned by the report by Shimazono (2007), organ recipients may pay up to $200,000 for a kidney in the illegal market while donors can receive as little as $5,000, which points to the unfair distribution of income between brokers and donors. Therefore, it is highly likely than 50% of more of what recipients pay for an organ may not be accessed by those who donate for money.
Need to Solve the Problem
The problem of organ trafficking must be solved as soon as possible because the victims of illegal trade are predominantly vulnerable and poor populations. While the coercion of live donors is more common in the black market, there are cases in which victims were put under anesthetic and woke up to find their organs missing without their consent, more than one organ missing United Nations Office on Drugs and Crime, 2018). Recruiters (brokers) use vulnerable potential donors through building trusting relationships, promising significant reimbursements that would feed families for years, and convincing that a vital organ may not be needed (United Nations Office on Drugs and Crime, 2015). For example, when it comes to transplantation of kidneys, which is the most widespread in the black market, brokers may tell uneducated victims that the organ will grow back, that having it is unnatural, or that kidney removal is entirely harmless.
Therefore, it is imperative to eliminate the issue not only to help individuals in need access organs but also to protect vulnerable populations subjected to becoming victims of unfairness and violations of human rights. Trafficking persons for the aim of removing their organs contributes to the issue as it occurs when donors are treated as products and used in trafficking for organs. Thus, eliminating the illegal trade of organs is necessary for preventing both organ trafficking that occurs with the consent of donors and without their permission. As the recipients of trafficked organs are predominantly wealthy because they can afford the high costs of transplantations, they rarely consider the real effect of the black market on underprivileged individuals.
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On a global scale, the system of donor donations predominantly neglects a large pool of potential, healthy, and consenting donors that may provide organs and reduce the unexpected deaths outside an the units of intensive care (ICU). As mentioned by Wall, Plunkett, and Caplan (2015), it has been projected that reliable protocols for paid organ transplantations could generate more than 20,000 of donation opportunities per year in the United States only, which would reduce long waiting times for organs. Furthermore, if deaths due to trauma are added to the estimation, the likely pool for organ transplantations could increase by more than 60% (Wall et al., 2015). Therefore, the solution to illegal organ donations is two-fold: establishing a system that would allow volunteering donors to provide their organs in exchange for payment and creating a robust framework for organ transplantation following unexpected deaths.
The example of Iran, which established regulated compensated kidney transplantation, provides a unique solution to the problem of organ trafficking. Legally adopted in 1988, the system allows to register potential donors who undergo a rigorous process of medical evaluation and informed consent (Jafar, 2009). The government-run program does not involve brokers, and the amount paid for a kidney is fixed and transparent (Jafar, 2009). Such a model is proposed due to its effectiveness in establishing a clear understanding of what is occurring in the sphere of organ transplantation, its sustainability, and accessibility to those willing to participate and contribute to those in need. Furthermore, the policy eliminates any opportunities for transplant tourism as the reimbursement for donations are only available for Iranian citizens while surgeries are performed with only native patients. While there is an ethical concern for the potential exploitation of the poor due to the financial incentive, a proposed model could eliminate the limitation through performing consistent and rigorous evaluations of voluntary donors. These may include their socioeconomic background, health, psychological well-being, and family status to ensure that there is no abuse in power within the system of paid-for organ donations.
In terms of managing organ donations associated with unexpected deaths, it is proposed to create a system that would encourage prior consent authorization. Individuals who give their consent for organs being transplanted after their unexpected death must be educated about the benefits and limitations of their action to make informed decisions about donating an organ. Furthermore, the solution expects to address family concerns on the matter because close relatives are usually hesitant to authorize organ donations after witnessing the unexpected death of a loved one. When there is a system that pays attention to such limitations of organ transplantation, it is expected to increase the number of cases in which voluntary donations take place at no expense for vulnerable individuals and their families (Wall et al., 2015). A pre-determined decision of a donor regarding the use of his or her organs will reduce the wait time for those who need a vital organ to survive.
Therefore, creating an environment of transparency and the increased awareness of the problem and its implications for the sphere of health care will facilitate a greater understanding of the public regarding the issue of organ donations and transplantation. Moreover, the attention to the ethical issues concerned with transplantation should be an imperative aspect of policy. Addressing the concerns of potential donors and their relatives beforehand is a strategy that will facilitate an increase in voluntary donations that could save the lives of patients in need.
Justification and Recommendations
The proposed solution is two-fold, and, therefore, considers two critical problems that concern the public regarding organ transplantation. First, the answer will eliminate the abuse of vulnerable populations who sell their organs on the black market for minor financial incentives. Establishing an environment of transparency regarding transparent pricing and rigorous evaluations of potential donors will eliminate the presence of brokers and create connections between the public and organ transplantation system (Wall et al., 2015). Second, the solution will address the ethical concerns associated with transplant surgeries. Through raising awareness of the benefits of voluntary and informed decisions of organ transplantation, it will be possible to open a dialogue about what constitutes authorized donations and how they should be implemented in cases of donors’ unexpected deaths. As there is legislation intended to battle with illegal organ trafficking, the proposed solution will act as a supporting framework for eliminating the abuse of power and the subsequent negative implications for donors and organ receivers.
The growth of organ trafficking points to the fact that the US, as well as many other countries, do not understand the potential for expanding the pool of voluntary donors. The solutions presented in this policy paper show that a cohesive framework that considers both ethical and practical concerns of organ transplantation can help reduce wait times among patients. With appropriate legal and moral systems targeted at obtaining permissions for organ donations, it will become possible to speed up the process of decision-making in cases when patients require urgent surgeries to replace vital organs. Overall, the solution intends to widen the potential pool of donors by respecting freedom of choice, autonomy, and population vulnerability.
Houser, K. (2017). Black market bodies: How legalizing the sale of human organs could save lives. Web.
Jafar, T. (2009). Organ trafficking: Global solutions for a global problem. American Journal of Kidney Diseases, 54(6), 1145-1157.
Shimazono, Y (2007). The state of the international organ trade: A provisional picture based on integration of available information. Bulletin of the World Health Organization, 85(12), 901-980.
United Nations Office on Drugs and Crime. (2015). Assessment toolkit: Trafficking in persons for the purpose of organ removal. Web.
United Nations Office on Drugs and Crime. (2018). Global report on trafficking in persons. Web.
Wall, S., Plunkett, C., & Caplan, A. (2015). A potential solution to the shortage of solid organs for transplantations. JAMA, 313(23), 2321-2322.