The Market for Human Organs - Coursework Example

THE MARKET FOR HUMAN ORGANS Number November 23, Introduction Over the last few years, the number of victims who have lost their lives due to body organs failure increased tremendously. This raised an alarm in medical centers that perform organ transplants as more people die waiting for replacement of their organs.1 Before the year 2002, AATB reported that human tissue transplant had multiplied to a level of 750,000 between years 1995 to 2000; in the same period, according to CBC, tissue banks were not authorized nor inspected, and it lacked central registry in Canada. Recently, Canada as one of the major organ importing countries experienced a shortage of human organs for transplant just as it is a global problem. 2 The imbalance between supply and demand will continue to see people suffer to death as they wait for organs, unlike in Iran, which has a high donor rate following officially approved monetary compensation for organ donors. Kidneys are always at a higher demand worldwide than lungs, liver, heart and other body tissues. 3 The Canadian data as of 2009 indicate that 3796 patients were on the waitlist for organ transplants. Many patients die without even making it onto a waitlist, and without the hospitals even considering those who are at their latest phases of illness. Below is an illustration of different organ transplant in various provinces of Canada. Table 1 Transplant rate and organ transplant waiting times by province in Canada Source: OTDT and CBS, Ensure Fairness and Transparency in the ODT System. Call to Action: A Strategic Plan to Improve Organ and Tissue Donation and Transplantation Performance for Canadians, 11, < http://www.organsandtissues.ca/s/wp-content/uploads/2012/06/OTDT-INDX-final-C2A.pdf > Regulated Market for Human Organs Since human organ trade is illegal, it becomes difficult to acquire the right information of most of the organs traded and transplanted as they are not registered. The registry, hospital, and medical management can only provide information based on donation consent. This means that the black market can not be fully accounted for. 4 During 1990s, China, United States, and India were regarded to be the largest markets in human organ trafficking; Canada recorded 946 human organ transplantation, 138 human organ trafficking and a shadow market (involving all activities from trafficking, production, distribution and use of illegal goods) of 14.6 %. The regulated market has to depend on organ altruism and deceased donors. In the 2009, the deceased donor rate was still below15% donors PMP of Canada, which was relatively lower than in other developed countries, as illustrated below. Deceased donors in 2009 Fig. 1: OTDT and CBS, Deceased donors PMP (2009). Call to Action: A Strategic Plan to Improve Organ and Tissue Donation and Transplantation Performance for Canadians, 62, < http://www.organsandtissues.ca/s/wp-content/uploads/2012/06/OTDT-INDX-final-C2A.pdf > A regulated market can only be identified in countries with legal structure for compensating donors. Unlike Canada, countries with government funded and regulated programs like Iran indicate an increasing number in the organ market, much faster to curb the waiting list. Fig. 2: Number of renal transplants performed in Iran from 1984 to 2005 annually (Ghods and Shekoufeh, n.d.): One among other organs transplant in Iran, which has increased in the market is renal transplant.5 Before the Iran government approval of compensation on renal transplant from un-related living donors, few donors existed in the Iran market, but after its consent in 1988, donors increased to clear the waiting list by 1999. The regulated markets would facilitate both donations from living-related and unrelated donors to increase reducing the shortage. Through these markets, patients would reduce tourism transplant as the expensive prices charged abroad were reduced within a country’s regulated market. Reasons for Shortage of Human Organs One reason behind the shortage was because countries like India, China, and Pakistan who were major sources of human organs suppliers, despite the trade been illegal, decided to ban organ sales, while the World Health Organization initialized it’s working on a draft to ban global human organs trade. 6 Another reason, basing on economic explanation has made people avoid free consent on organ donation. According to Beard,7 Kaserman, and Ostercamp, prohibition of legalizing compensation to organ donors revokes the will of those who would like to offer their body organs, to save a life but benefit from the act. Many argue that compensation to the donor would be one step towards legalizing human organs sale. Yet, whether legal or illegal, human organs are traded at a high price that only the rich can afford. In Canada, the Medical and hospital management could have a proper legal strategy, in the case of procuring the organs at a stable price for everyone, to solve the shortage. The policies restricting donor compensation result in higher demand for organs, from willing buyers that supply from the donors; hence, the price is set high, when the organ is available combined with illegal middlemen contribution. In the developing world, donation and transplantation are functions carried out as in an individual country. In these countries, the belief in traditions, culture ties and limited education levels limits legitimate establishment of human organs donation, failing to recognize the power of the procedure in human lives.8 Kelly reveals that lack of political agreement among the countries in those regions inhibit coordination, limiting the networks established to share the donor organs where available. The whole situation affects the communication, coordination, timing, and delivery of human organs in medical centers where transplants take place. Why No Producer Surplus for Donors In the present law worldwide, sale of human organs is illegal; hence, the solution to organ shortage is left for donation. Organ producers are denied any profit, because once allowed, the compensation procedure will express human organs as an article of trade. Very few people are willing to donate their organs, and to some extent, the act of being related can push them to donate without any expected compensation. 9 However, upon hearing the presence of worthy compensation in monetary terms, individuals who were unwilling before, change their mind on their former decision, due to the fact that money is being paid, showing that the decision made was not totally free, nor voluntary. Even in the present law, when it is illegal, the donor’s profit is shared among the involved participants, where the brokers mediate the transaction such that by the time the donor is receiving the compensation, he or she wishes they would have retained their organs. Net Gain to Society From an Exchange of Human Organs for Money In a perfectly competitive market, both the consumer and producer receive a surplus that satisfies them, upon reaching demand and supply equilibriums. Sellers would be contented with monetary gain as the organ buyers manage a better life after organ acquisition and transplant. Eliminating organs market monopolies and brokers, the perfect competitive market would leave the seller (donor), and the buyer (sick patient) to benefit from the procedure. The competitive market for human organs would act as a free (unrestricted) market. Fig. 3: Eco 301: Final Exam, Following the regulated system as illustrated earlier, organs supplied in the market are Q and the price is Pd; in case of exchange of human organ for money, supply changes to Q* since donors are motivated by monetary gain lowering the price to P*. 10 The total net gain in a perfect competitive market becomes the entire area under ABQO, which is larger than in the restricted market, ACQO. Ethical and Distributive Justice Arguments against Sales of Human Organs Ethical argument: By allowing selling of human organs, humanity is demoralized, since the organs are sold as commodities. According to religious believes, human bodies are holy entities and cannot be traded for any amount. Again, turning human body into a commodity would lead to the weak and poor in the society being potential donors. 11 There would be a higher tendency for those individuals in desperate financial situations to sell their organs than those with alternative means of income. Furthermore, the income differences continue to widen between the rich and the poor. It would then follow that the unequal bargaining power would cause the poor to profit less, due to unfair prices. Distributive argument: In the market, human organs, taken as items of trade, would only be available to the few. Organ failures do not recognize whether the individual is a poor or rich human being; sickness can occur to anyone. However, if organs are for sale, the rich will get them at the highest bid, while the poor wait for what they can afford or die. 12 This reason would limit fairness for the poor in society to access health care. Is There an Equity-Efficiency Trade-Off in Prohibiting the Sales of Human Organs? Even in the present law, there is lack effective fairness in human organs exchange. Most sick patients are willing to acquire an organ from a donor at an agreeable price, but the law places a boundary. Some individuals, too, in the society would be willing to take the risk for monetary gain, as a compensation for the pain, organ, and other associated needs. As much as it is prohibited, the black market will for sure never die, but remain to harass the donor, while benefiting the brokers, rich recipients, and the involved medical physicians. Despite all this, it is for a fact important to protect the life, and welfare of less fortunate and vulnerable people, who would be harassed to sell their organs involuntarily. Causes of Thriving Global Black Market Human organ black markets are illegal and unregistered, which the governments do not support or approve of.13 Experts from World Health Organization revealed that unlicensed trade of kidneys, which currently occurs annually, increased to “an estimated 10,000 black market operations involving purchased human organs.” In some nations, there is active participation of medical and hospitals management in collaboration with the unethical brokers, who exploit people to trade their organs for promises that are never fulfilled. According to Moniruzzaman14, medical officials and involved corporations like drug companies ignore to report the illicit act since they benefit along with the recipients and brokers. In other cases, where human organ donation may be allowed between relatives, participators forge documents to claim that the donor and the recipient are related, which makes organ trade less complicated. The aspect of trade being illegal has raised the price of the organs where available; therefore, illegal sellers have to look for a trusted recipient, who can manage to purchase the organ at their ‘rocketing price.’ Partly, the brokers are not entirely to blame, since recipients are also willing to risk their lives and money. Human organs sellers have to ask for higher prices, due to the implications expected if caught, while most donors would rather part way with their organs for unworthy monetary gain. How the Black Market Leads to a Host of Abuses With regard to the high prices of the body tissues, many donors would only picture the monetary gain but forget their health implications afterwards. Most of the time, they will be paid half or less than the agreed price, and their post surgical needs neglected. According to Aronowitz15, patients who had donated their organs received inefficient postoperative care from the hospitals, which pushed them out a week later threatening to sue them for participating in illegal organ transplants if they took legal action. Some patients also suffer psychologically, while others develop health problems afterwards. This may be accompanied by lack of financial stability if the agreement on payment was just a promise. The less fortunate, vulnerable, and poor in the society are abused, since they are the most common targets of organ donation. The poor are paid little amount as their illegal compensation, while the rich participants get the biggest share.16 Petechuk mentions that the black market that involves transplant tourism has wealthy patients who seek live donors, especially in underdeveloped countries or locales. Because of their poor financial status, the less fortunate would be lured to sell their organs for the little benefit it brings them. 17 Kidney Village is one of the living examples in India, whose many residents sold their kidneys for transplantation at a price that is relatively small, compared to its worth in the current economy. Human trafficking also arises with an aim of harvesting human organs. Cases of abduction of young children around the globe is not a new issue any longer, and when the dead bodies are identified, results of missing body parts becomes the story of the day. Others are accidents, especially in nations that approve of cadaveric donation; this raises doubts in sincerity of the cause.18 Due to the resurgence of trafficking, the World Health Organization has recently suggested that humanity is being demoralized by the vast profits involved, as well as the division between the poor, who remove body organs for cash, and the wealthy sick, who sustain the existence of body parts trade. Non Monetary Incentives Public awareness: while legalizing organ replacement is not an option due to society and crime implications, the governments could use the opportunity to educate people clarifying the existing myths on organ transportation, to encourage people to donate. However, the administration needs to be committed towards this strategy, so as to change the mindset of the society towards the donation.19 Such public awareness campaigns would serve to provide individuals with relevant information and enable informed choices while increasing support and participation in the whole process of acquiring organs and transplanting. The majority in the public lack full information, and would need an assurance of their governments’ stand. Cadaveric donation: Most countries do not have a legal system in place to facilitate extraction of body organs from people when they die. Implementation of such systems will provide human organs that would save the existing society and reduce waiting list of patients who need donation. Although the relatives of the deceased are usually against this, it will always be a sure method that could be sanctioned to save another human life. Despite the fact that some countries and some religions are hesitant, the first step would be by the governments sponsoring public education through, media, religious hubs, and educational institutions. For this to work, presumed consent would support the procedure as well as increase the donor rate in most countries. 20 Countries like Canada follow opt-in system, which requires individuals to express their consent, or the family approves of it later. Though the citizens are active campaigners of free consent to donation, they shy away when it comes to reality, which lowers their organ donor rate. Transplantation registry: this would serve to ensure transparency and accountability between the donor and the recipient, within registered hospitals and medical centers. Through this, organ trafficking would be reduced as verification of the relationship between the participants takes place. Live donors registry and an extension of live donors paired with exchange registry would become crucial to sufficient supply of human organs, with a free assent of a living individual, and not necessarily for monetary benefit. With this, donors are assured of their rights on post-operative care, hence spurring them to donate as the society reduces chances of organ trafficking. Age limits: Through increasing the age limits of donors, the number of willing donors increases without been limited by their age. According to Petechuk21, acceptable donor pool widens fast, encouraging and solving the organ donation problem. Most of the people who donate are the juniors, while the number of seniors who donate is less and unstable. Appendices Definitions Donor - An individual, either alive or dead, who can provide organs, cells or other tissues for transplantation Deceased donor - Someone whose solid organs can be obtained for the purpose of transplantation once affirmed to suffer cardiac death. Acronyms AATB: American Association of Tissue Bank CBC: Canadian Broadcasting Corporation WHO: World Health Organization OTDT: Organ and Tissue Donation and Transplantation CBS: Canada Blood Service ODT: Organ Donation and Transplantation PMP: Per Million Populations Bibliography Aronowitz, Alexis A. Human trafficking, Human Misery: The Global Trade in Human Beings. Westport: Greenwood publishing group, 2009. Beard, T., Kaserman, David, and Rigmar Ostercamp. The Global Organ Shortage: Economic Causes, Human Consequences, Policy Response. California, CA: Stanford University Press, 2013. Campbell, Denis., and Davidson Nicola. “Illegal Kidney Trade Booms as New Organ is Sold Every Hour.” Guardian.co.uk. Last modified May 31, 2012. http://www.guardian.co.uk/world/2012/may/27/kidney-trade-illegal-operations-who. Cho, Hyuksoo, Man Zhang, and Tansuhaj Patriya, “An Empirical Study on International Human Organ Trafficking: Effects of Globalization,” Innovative Marketing, Volume 5, Issue 3, (2009): 70. Accessed November 23, 2012. http://businessperspectives.org/journals_free/im/2009/im_en_2009_3_Cho.pdf. Dworkin, Gerald. “Markets and Morals: The Case for Organ Sales,” 156- 161. Accessed on November 23, 2012, http://spot.colorado.edu/~heathwoo/phil1200,SP08/dworkin.pdf. “Eco 301: Final Exam.” Last modified December 14, 2005. http://webs.wofford.edu/mcarthurjr/eco_301/Test/e301f5t3aa.pdf. Ghods, Ahad J., and Savaj Shekoufeh. “Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation.”Asnjournals.org. Accessed November 23, 2012. http://cjasn.asnjournals.org/content/1/6/1136.full. Harvey, J. “Paying Organ Donor.” Journal of medical ethics 16, (1990):117-119. Accessed November 23, 2012. http://jme.bmj.com/content/16/3/117.full.pdf. Kelly, Deirdre A., ed. Diseases of Liver and Binary System in Children. 3rd ed. New Jersey: John Wiley and Son, 2008. Laurier, Joanne. “Human Organs: The Next Future Market?” Wsws.org. Last modified April 26, 2002. http://www.wsws.org/articles/2002/apr2002/body-a26.shtml. Monirizzaman, Monir. “Growing Market for Human Organs Exploits Poor.” Msu.edu, Last modified March 12, 2012, http://news.msu.edu/story/growing-market-for-human-organs-exploits-poor/. Norris, Sonya. “Organ Donation and Transplantation in Canada.” Parl.gc.ca. June 25, 2009, http://www.parl.gc.ca/Content/LOP/researchpublications/prb0824-e.htm. OTDT and CBS. “Call to Action: A Strategic Plan to Improve Organ and Tissue Donation and Transplantation Performance for Canadians.” 1- 175. Last modified April 2011, http://www.organsandtissues.ca/s/wp-content/uploads/2012/06/OTDT-INDX-final-C2A.pdf. Petechuk, David. Organ Transplantation. Westport: Greenwood publishing group, 2006. Shimazono, Yosuke. “The State of The International Organ Trade: A Provisional Picture Based on Integration of Available Information.” Who.int, Last modified December 2012. http://www.who.int/bulletin/volumes/85/12/06-039370/en/ Read More