Care for commercial living donors: the experience of an NGO’s outreach in Egypt

Abstract

Summary Follow‐up care for living organ donors is inadequate in countries with advanced transplantation systems based on altruistic donation. In cases where financial incentives drive an organ donation, care for the live ‘donor’ is largely absent. Care must be provided not only to living altruistic organ donors but especially to victims of organ trafficking who are often not suitable candidates for a donation and subject to poor surgical practices and conditions. Such follow‐up is essential not only as a basic right, but also as an important reconciliatory step to regain public trust in transplants where they have been characterized by commercialism. Yet, the question, who will provide care for the commercial living donor? persists. In the absence of public or private commitments to this care, the Coalition for Organ‐Failure Solutions (COFS) conducts outreach programmes that include identifying victims of organ trafficking, assessing their consequences and arranging support services. This paper presents studies on consequences for commercial living donors (CLDs), describes the case of organ trafficking and COFS’ care provision in Egypt and discusses why follow‐up care for CLDs is not an appropriate ingredient for advancing regulation proposals but should be considered an essential component of the movement to end organ trafficking.

Re-conceptualizing the organ trade: separating “trafficking” from “trade” and the implications for law and policy

“…While a number of studies reveal the financial difficulties that lead vulnerable people into selling their organs and the negative consequences that follow [28,32,33], there is little or no information to suggest that these cases involve (all elements of) human trafficking [34,35]. Rather, these studies show that the experiences and outcomes of organs sellers/selling can vary extensively [34][35][36].…”

Epistemic Communities, Human Rights, and the Global Diffusion of Legislation against the Organ Trade

“…Overall, the new millennium witnessed efforts against the organ trade consolidate past progress and expand to involve actors from around the world [169]. The organ trade was recognized as an international issue of utmost medical and human rights concern-receiving coverage in several prominent global agreements-and, notably, the global community was active within many of the organ trade's global "hotspots."…”

“…Over the years, COFS mobilized with local civil society organizations and NGOs, engaged with the highly influential religious community (the ulemma), and worked with policymakers in efforts to "establish or improve national legal frameworks on transplantation" [54,169]. As well, COFS developed a partnership with the WHO, which had become focused on engendering change in Egypt.…”

“…Within this context, and in addition to its research work offering a greater understanding of local and regional dynamics of the organ trade, COFS provided awareness, outreach, advocacy, and victim support programs in Egypt-all of which had been "inadequate or wholly nonexistent" [54,169].…”

The Rationale for Incentives for Living Donors: An International Perspective?

“…Finally, some countries have maximized (or nearly maximized) both living and deceased donation -and still have a significant shortage. A consequence of the organ shortage is that unregulated, underground markets for donation have developed in many countries (over many continents) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”