Transplant Tourism: The Ethics and Regulation of International Markets for Organs

Abstract

"Medical Tourism" is the travel of residents of one country to another country for treatment. In this article I focus on travel abroad to purchase organs for transplant, what I will call "Transplant Tourism." With the exception of Iran, organ sale is illegal across the globe, but many destination countries have thriving black markets, either due to their willful failure to police the practice or more good faith lack of resources to detect it. I focus on the sale of kidneys, the most common subject of transplant tourism, though much of what I say could be applied to other organs as well. Part I briefly reviews some data on sellers, recipients, and brokers. Part II discusses the bioethical issues posed by the trade, and Part III focuses on potential regulation to deal with these issues.

A Fuller Picture of Organ Markets

“…It is not a true organ market, but a half-market where sale is permitted but not buying and the government is the monopsonistic buyer of organs, distributing on the back end through its own system, with an overlay of gift-giving that may in fact partially reintroduce the other half of the market in it (Cohen 2013;2014). It is one model, but there are many other kinds of regulatory configurations, and I have recently (Cohen in press) undertaken to spell out the various potential options by category (though my list is not exhaustive): price controls (set price, price floor, price ceilings), restrictions on the forms compensation can take (limits to in-kind compensation, giving organ donors and their family priority for organs), restricting who can buy and sell organs (outlawing brokerages, monopsonistic government buyer while outlawing private sale, excluding poor sellers, requiring psychological or medical screening, legal prescreening for competence and understanding of terms), restricting what kinds of organs that can be sold (permitting the sale of only cadaveric organs, permitting the sale of only certain kinds of organs such as renewable ones), and other measures (prohibit advertising, forbid judicial enforcement of contracts, permit damages but not specific performance, make contracts voidable but not void).…”

Curbing transplant tourism: Canadian physicians and the law

“…Various commentators have suggested that requiring the reporting of this information, for example to a central public health authority, would help to combat transplant tourism by providing information about the nature and scope of the phenomenon and would potentially facilitate follow-up by regulators in the relevant jurisdiction. 6,9,10 The potential merits of such a reporting scheme present an opportunity for modest, yet valuable, legal reform in Canada. Existing health information legislation could be amended to create a reporting system that permits or even requires physicians to provide basic information about suspected transplant tourism, including the location and any known details about the organ transplant network.…”

“…6 Data on the experiences of organ recipients who obtained kidneys via illegal commercial transactions similarly reflect a range of adverse results, including surgical complications, diverse and sometimes unconventional infections, increased risk of late allograft loss and poorer outcomes overall, as compared with domestic transplant recipients. 2,3 The implications of transplant tourism for domestic health care systems can also be serious.…”

“…1 If a physician knows or has reason to believe that a patient is considering transplant tourism, he or she should, as part of the informed consent process and the fiduciary obligations to the patient, disclose information about the risks, including a candid assessment of the potential health hazards outlined earlier and other risks such as the lack of continuity in clinical care, inadequate records and risks associated with premature postoperative travel. 3,5 Physicians may also consider discussing the potential harms to organ "donors" in commercial transactions 6 and the illegal nature of the activity. Although such information may fall beyond the usual disclosure process, it seems something a reasonable person in the patient's position would want to know (which is, broadly speaking, the standard for disclosure in Canada).…”

Generating Ambivalence: Media Representations of Canadian Transplant Tourism

“…Social science scholarship on the organ trade has shifted over time from documenting transactions and health outcomes to surveying and comparatively analyzing efforts to stop the organ trade (Bagheri & Delmonico, 2013;Budiani-Saberi & Columb, 2013;Cohen, 2013;Kelly, 2013;Lavee, Ashkenazi, Stoler, Cohen, & Beyar, 2013;Scheper-Hughes, 2000). Although reproductive and medical tourism studies (e.g., Markens, 2012;Snyder, Crooks, Johnston, & Kingsbury, 2013) can provide insight, there is a paucity of empirical research on public understanding of transplant tourism in client countries.…”