Human organs for transplant, whether from a deceased or a living donor, are lifesavers that are in high demand and so much so that it has spurred on a blackmarket trade in organs that has a devastating effect on donors.
The illegal trade in kidneys, for example, has risen to such a level that an estimated 10 000 black market operations involving purchased human organs now take place annually, or more than one an hour, according to the World Health Organisation estimates for 2013.
Professor Magda Slabbert of UNISA, who has researched kidney transplants for the last 11 years, wrote in one of her papers that a recipient paid almost €95 000 (±R1.2m) to an international organ broker for the kidneys transplanted in Netcare hospitals.
She, and others, believe that a radical revamp of the way such organs are sourced and distributed would help to reduce a chronic shortage and prolong the lives of many South Africans.
Read: One in two die waiting for a kidney transplant
They propose that the trade should be legalised, allowing donors to sell their organs to those who need them. Due to the shortage of transplantable kidneys, governments around the world should discuss whether it should be allowed to buy and sell a kidney on a regulated basis to curb the ever-increasing trafficking on the black market.
Image: Lahore, PAKISTAN: Pakistani men at a police station in Lahore reveal scars after their kidneys were removed in May 2007. Police raided a clandestine clinic and busted a gang trading in kidneys, arresting eight people including five doctors and found ten people whose kidneys had been removed. Pakistan is known to have numerous secret groups involved in paying poor people for their kidneys. Arif Ali/AFP/Getty Images.
The way things stand at the moment
South Africa currently uses a system of ‘opting in’ for organ donation. If you are older than 16 and willing to donate your organs for transplant in the event of your death, you inform your next of kin of this decision or carry a signed organ donor card.
A person’s spouse, major child, parent, guardian, major brother or major sister (in that specific order) may also consent to donate their organs after death.
This differs from some other countries, including Austria and Belgium, which have adopted a process of ‘opting out’ instead. Here, everyone is automatically considered to be an organ donor when they pass away unless they specifically indicate otherwise while alive.
Read: FAQ about organ donation in SA
Slabbert points out that in South Africa there are currently no official regulations or rules that govern which patients will receive organs that become available, other than an informal agreement between the state and private medical sectors to consider the urgency of potential recipients and to allocate one organ to the public sector for every organ used in private hospitals.
Living persons may donate organs for transplant if they are a blood relative of the patient or their spouse. Others who want to donate an organ while alive must lodge an application with the Department of Health.
Noting that the system as it presently exists doesn’t secure anywhere near enough organs to satisfy national requirements, Slabbert is critical of the fact that living organ donors are the only participants in the process who do not benefit.
The recipient gets a lifeline, while the nurses, doctors, hospitals, and pharmaceutical companies all get paid. Altruistic donors, by contrast, typically have to cover their own hospital and medical expenses, which are not paid for by their medical aid.
Beyond being reimbursed for the costs they incur, it is illegal for living organ donors to accept a reward (financial or otherwise) for their services.
Read: Is a kidney transplant a good option?
Why legalising organ sales will be a good thing
Proponents of legalisation argue that many more organs could become available for transplant if individuals had the right to sell them, ultimately resulting in substantial savings in time, money and lives.
Living donors allow for better planning and matching with recipients, while their organs can be optimally maintained and monitored until they are needed.
It is an undeniable fact that illegal transplants do happen, fed by a global black market in human organs and potentially endangering the lives of both donors and recipients.
In 2010, for instance, it was discovered that living donors were flown to South Africa from Brazil and Romania to supply wealthy recipients in a KZN hospital with kidneys.
Read: Man found guilty in New York court for illegally brokering kidneys
Legalisation would allow the practice to be officially monitored, regulated and controlled in the interest of public health.
Slabbert believes that it is ethically and morally acceptable to allow people to buy and sell their own organs provided that:
* they make their decision voluntarily, with informed consent and an understanding of exactly what the transaction means for them;
* there is clear evidence that no harm will follow their decision to donate an organ; and
* the trade includes safeguards to protect people, especially vulnerable individuals, against exploitation and abuse.
“We seem to be quite happy to let poor people do life-threatening activities such as working in coalmines or cleaning skyscraper windows,” she says.Watch the trailer from the award-winning documentary: Tales from the Organ Trade
“Should we not change the law to allow each individual the freedom to choose according to his belief and his rational reasoning whether to sell a kidney or not?”
Obstacles and opposition
The most common objection Slabbert hears when she proposes a scheme for trading in human transplant organs is the widely-held conviction that it is unethical to sell body parts.
But there is a legal problem as well: according to the law, you don’t actually own your liver or kidney in the same way that your house or car are your private property which you can sell to others.
According to the World Health Organisation, subjecting the human body and its parts to commercial transactions is “inconsistent with the most basic human values and contravenes the Universal Declaration of Human Rights”.
Opponents charge that it would be wrong to deal with human body parts in the context of a commercial, for-profit market.
When the demand for artificial limbs or pacemakers goes up, it’s a fairly simple matter to increase the production of these commodities to satisfy the market.
If kidneys are in short supply, however, the solution shouldn’t be one of simply bringing greater numbers of willing donors to market like cattle to a livestock auction.
Others argue that commodifying human organs would only exacerbate social inequalities in an already unequal world, enticing desperate poor people to sell off body parts at a potential detriment to their own health and longevity, while contributing to the wellbeing of those who are already in a position of wealth, power and privilege.
While this is a complex and emotive issue, there is little doubt that the system as it exists currently is in dire need of changes to ensure a greater number of people their constitutional right to access to health care.
But does the solution lie in legalising the buying and selling of human organs? What do you think?
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Image: Kidneys, from Shutterstock