One of Britain's leading transplant surgeons calls today for the illicit international market in donor organs to be legalised and brought under the control of governments.
Professor Maqsood Noorani, who has witnessed the harm done by transplant tourism, said there was a worldwide shortage of organs which was being exploited by unscrupulous operators, who were putting donors and recipients at risk.
Living donors in poor countries such as Pakistan, where he has worked, needed compensation for their organs and it should be the responsibility of the government to provide it rather than leaving it to the market, Professor Noorani said.
His remarks will reignite the debate about the ethics of paying for organs and the need for regulation of the burgeoning market. An estimated 40,000 patients are waiting for a transplant in western Europe, more than 6,000 of them in the UK. Fifteen to 30 per cent will die on the waiting list.
Writing in today's British Medical Journal, which includes a debate on the ethics of paying donors, Professor Noorani, a former transplant surgeon at the Barts and London NHS Trust, says his first-hand experience of trying to save the lives of British patients who suffered complications after travelling to Pakistan and buying a kidney from a live donor had convinced him of the need for government action.
"In the past few years, transplant tourism has become a lucrative business in Lahore, Rawalpindi and Islamabad. Private hospitals shamelessly advertise their services in newspapers and on the internet. Taxi drivers and touts know the addresses of all the transplant hospitals and brokers busily scavenge for desperate, poor people to meet the constantly increasing demand for kidneys by foreigners," he says.
Banning the trade is not an option, he adds, and switching to a system of cadaveric donation (after death) might encourage a black market with donors being killed for their organs. Instead, he says, Pakistan should establish an authority, jointly with the private sector, to encourage live donations. "This would provide adequate compensation and incentives to donors and would avoid the exploitation of [them]," he writes.
Speaking to The Independent, Professor Noorani said: "Everyone benefits from transplant surgery except the donor. The donor is never appreciated. Live donors are heroes – they deserve a medal. One cannot pay compensation to donors in the UK – that would tarnish the whole process. But in Pakistan there is exploitation because people are poor. Money is the driving force behind transplant tourism and the Government should come forward to control it."
He said he favoured rewarding donors in kind, with offers of accommodation or education for their children rather than cash. Other countries, including Iran and Saudi Arabia, also compensated organ donors, he said.
The trade in organs is growing around the world, with international crime syndicates cashing in on the shortage and the high profits to be made. Patients from the UK who have bought organs have mostly travelled to India and Pakistan to buy replacement kidneys. A national survey by surgeons at Queen Elizabeth Hospital in Birmingham in 2002 discovered 29 patients who had bought kidneys, half of which failed. A third of the patients died.
Demands for the trade to be legalised have been made before. Professor Nadey Hakim, a transplant surgeon at St Mary's Hospital, London, said in 2005 that the black market in organs could no longer be ignored and the risks of not acting now outweighed the dangers of legalising it.
Should we pay donors to increase the supply of organs?
Arthur Matas, professor of surgery, University of Minnesota
"Today’s biggest problem in kidney transplantation is the shortage of organs. Each year more patients are placed on the waiting list for a deceased donor transplant than there are available organs. Each year the waiting list gets longer.
A regulated system would provide strict control and limit harm. It would include payment made by the government, allocation of kidneys [by predefined criteria] so that every candidate has an opportunity for a transplant, full donor evaluation, long-term follow-up and treatment of the donor with dignity and appreciation for providing a life-saving gift. Compensation for living donors will increase the number of transplants and decrease death and suffering on dialysis. No other alternative to compensation will provide a sufficient numbers of kidneys.
I believe we should advocate a change in the law to allow a trial of regulated compensation for living donors to increase the supply of organs and protect the health and dignity of waiting patients."
Jeremy Chapman, professor of transplant research, University of Sydney
"Transplantation is threatened by the daily global carnage brought about by paying for organs. Sale of organs is advocated by the rich as a human freedom, but this right is exclusively exercised by the poor.
Selling organs does not help people lift themselves from destitution. In the bazaars of India and Pakistan, people sell kidneys to pay off debts, but then average family incomes decline by more than a third, more live below the poverty line and 86 per cent report deterioration in their health.
Organ sales distort the vendor country. Sales of kidneys and livers boomed in China. Executions also boomed and were measured with precision since each execution meant one liver transplant.
Organ sales also destroy donation. In countries where paid organ transplants occur, there is little or no donation. In countries where many transplant recipients go overseas, domestic programmes are underfunded and failing.
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