Organ Trafficking

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From the course by University of Cape Town

Organ Donation: From Death to Life

55 оценки

University of Cape Town

Organ Donation: From Death to Life

55 оценки

Considering someone for organ and tissue donation at the end of life is complicated. The boundary between life and death is more complex than ever before and it falls to medical professionals to help clarify a situation at an often confusing and emotionally stressful time. In this course you will learn about the science behind death determination and when it is possible for deceased organ donation take place. The lectures will cover medical standards at the end of life - from brain death testing, to requesting informed consent from a grieving family. By improving knowledge of good ethical practices, cultural and religious considerations and the logistics of the organ donation process this course will empower the interactions and discussions of medical professionals and the general public at an often confusing time. This course will help you to ensure that the option of organ donation is compassionately explored in all appropriate situations at the end of life in the best way possible. Watch the course trailer here https://www.youtube.com/watch?v=Ak-kVtmZGRs The course is certified for continuing professional development (CPD) points in South Africa. Send your completion certificate to organdonation@uct.ac.za together with your HPCSA number for 25 general and 5 ethics points. For another interesting course on organ donation and transplantation, see Clinical Kidney, Pancreas and Islet Transplantation from Leiden University https://www.coursera.org/learn/clinical-kidney-transplantation

From the lesson

Ethical Issues in Transplantation

Congratulations! You've reached the final week of the course Organ Donation: From Death to Life. Many factors influence organ donation rates across the world - from religion and culture to where you live and what resources are available. In our final week we will take a look at the role of money and travel in organ transplantation and show you the steps being taken to stamp out organ trafficking and transplant tourism. Dr Boitumelo Nkgudi a colleague of mine from Department of Surgery will speak to us on the influence that different religions and cultures have on organ donation. Organ donation comes with a lot of stigma and religious and cultural competence is essential to connecting with potential donor families before asking for consent for organ donation. We will end off our last week by looking at how to assess the true potential of deceased organ donation, what deceased organ donation models exist, and possible strategies to improve them including improving public awareness. Nobody can do everything when it comes to transplantation - but everybody can do something… Enjoy the last week of the course.

Introduction to Week 41:16

Money and Transplantation7:30

Travel and Transplantation3:22

Organ Trafficking7:20

Meet the Instructors

David Thomson
Dr
Critical Care Specialist and Transplant Surgeon

[MUSIC]

When faced with needing an organ transplant,

patients do not only explore legal avenues but sometimes illegal ones.

Organ trafficking is a very real concern.

It may feel remote, but it does happen.

Although primarily a problem with living, unrelated kidney donation,

the negative effects tarnish our entire profession and all of transplantation.

How real is the problem?

It was estimated by the WHO that up to 10% of all transplants in

the world in 2006 were as a result of organ trafficking or transplant tourism.

South Africa was unfortunately a site for such activity for

a period of time from 2000 to 2003, before it was stopped and

our systems improved to prevent it from happening again.

What occurred was that renal transplants were arranged between reportedly related

donors and recipients.

This was not the case, the donor and

recipient were not related and there was money changing hands.

Now some may argue that both parties had consented to their operation and

understood the risk.

And that with informed consent it is ethically permissible to proceed.

This is not the case.

There were obviously attempts to deceive the systems in place.

And by adding money into the process with people profiting along the way,

there was undoubtedly exploitation of the weak and vulnerable.

This is something we must actively guard against by ensuring the correct systems

and practices are in place.

Living donors must consent freely, be screened properly, and have long-term

follow up and support for complications related to the donor operation.

To offer anything less than that is automatically exploitation, and

meets the definition of organ trafficking.

Deceased organ donation can also be abused.

If organs are not allocated transparently and freely,

then a national resource being misused.

If the dead donor rule informed consent principles are respected,

then organ donations must not take place.

In 2004, the World Health Organization called on member states to take measures

to protect the poorest and most vulnerable groups from transplant tourism and

the sale of tissues and organs.

The Declaration of Istanbul, formulated by the Transplantation Society and

the International Society of Nephrology in 2008,

was published to help countries do just that.

It has been endorsed by over 100 countries and 150 professional associations, and

has led to law changes in China, the Philippines, Israel, and Pakistan.

Ultimately, the document boils stand to the fact that all countries need a legal

and professional framework to govern organ donation and transplantation activities.

As well as a transparent regulatory oversight system that ensures donor and

recipient's safety and the enforcement of standards and

prohibitions on unethical practices.

Countries must take active measures to put in place legislation

that will support ethical transplantation practices and equitable allocation.

The declaration goes on to state that in order to eliminate organ trafficking,

interventions need to be on multiple levels.

And it provides a framework for countries on how to achieve this.

Firstly, it states that national governments should develop comprehensive

programs for screening, prevention, and treatment of organ failure.

Secondly, that each country should have legislation to govern

the recovery of organs from both deceased and

living donors consistent with international standards.

There should be a national registry of deceased and living donors.

And oversight and accountability by health authorities is required

to ensure transparency and safety.

Finally, that organs must be allocated within countries to suitable recipients

without regard to gender, ethnicity, religion, social, or financial status.

One of the countries to change their laws after the Declaration of

Istanbul was China.

China had a law enabling executed prisoners to be used as a source of

donated organs from 1984 until January 2015.

The law stated that the bodies of executed prisoners could be used for

transplantation if the body was uncollected or

is donated by the prisoner or their family.

This unconscionable practice has officially been stopped

due to widespread international pressure.

The condemnation of such a practice is absolute.

Prisoners are vulnerable persons.

And the ethical concerns are insurmountable. In consultation

with international professional bodies, China has given up this practice.

Changing the law to outlaw organ procurement from executed prisoners and

putting in place a voluntary deceased organ donation program.

If you read on the internet about transplantation in China,

it is difficult to verify that executed prisoners are not still being used.

There are many contradictory reports based on very limited evidence.

One of the major reasons that are ongoing concerns about China is that there is

limited transparency of their transplant system by Western standards.

It is important that all transplant systems make information available

in order to show that the system is accountable.

Recipients of trafficked organs have worse outcomes compared to

regulated transplants.

The chance of being transplanted an organ with a pre-existing malignancy or

infection is much higher.

Because donor workup is often inadequate.

We know this because patients return to their home country after traveling for

their operation, no longer needing an organ transplant, but

requiring ongoing immunosuppression.

There is a concerted effort by countries to stamp out such practices.

Some countries have made traveling abroad for an unsanctioned transplant

illegal with financial penalties and prison sentences for recipients.

Other countries have directed their focus towards the prosecution of brokers and

ethically corrupt transplant teams.

It is a reality that organ trafficking is driven by the need outstripping the supply

and by gross inequalities in wealth.

If all countries had organ transplantation services which light fair access to and

good oversight of transplantation,

then organ trafficking will become far less pervasive.

Improving deceased donation helps to achieve this, and

this is mentioned specifically in the Declaration of Istanbul.

The therapeutic potential of deceased organ donation should be maximized.

Efforts to initiate or enhance deceased donor transplantation

are essential to minimize the burden on living donors.

Educational programs are useful in addressing the barriers,

misconception, and mistrust that currently impede the development of sufficient

deceased donor transplantation and successful transplant infrastructure.

To recap, organ trafficking does take place.

It is driven by a demand for organs that outstrips supply and

by major wealth inequality.

Measures have been put in place to stamp out this practice across the world.

These include legislative changes to facilitate aggressive

prosecution of guilty parties.

Improving deceased donation and access to transplantation across the world is

an effective way to decrease the demand for trafficked organs.

[MUSIC]

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