Organ transplants: ethical approaches and legal solutions

Torres, Lucas Cruz; Ferreira Filho, Francisco José; Cruz, Jamille Rodrigues Dias; Pinheiro, Pedro Lucas de Oliveira; Figueiredo, Francisco José Gonçalves

doi:10.1590/1983-803420243703EN

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RESEARCH • Rev. Bioét. 32 • 2024 • https://doi.org/10.1590/1983-803420243703EN copy

Organ transplants: ethical approaches and legal solutions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This integrative literature review investigates legal aspects and ethical solutions involved in the illegal organ trade, an activity that sparks debates about ethics and morals. Bibliographical search was conducted on the Virtual Health Library, PubMed and SciELO databases. A total of 14 papers were analyzed, which pointed to low supply associated with high demand for organs as the main etiology of the problem. This market takes advantage of vulnerable populations to coerce them into organ donations. Additionally, the lack of connection between international databases and instabilities in countries with high trafficking rates hinders police action to confront this crime. Organ trafficking should be combated by encouraging legal organ donation, confronting “transplant tourism” and actions aimed at the most vulnerable countries. International entities play a fundamental role in ensuring that different nations work together to repress this type of crime.

Keywords
Organ trafficking; Ethics; Ethics, medical

Portal	Search syntax
VHL	((tráfico de órgãos) OR (organ trafficking) OR (tráfico de órganos) OR (trafic d’organes)) AND ((ética) OR (ethics) OR (éthique)) AND (mj:(“Tráfico de Órgãos” OR “Turismo Médico” OR “Comércio” OR “Consentimento Livre e Esclarecido” OR “Pena de Morte”)) AND (year_cluster:[2013 TO 2023])
SciELO	((tráfico de órgãos) OR (organ trafficking) OR (tráfico de órganos) OR (trafic d’organes))
PubMed	(organ trafficking) AND (ethics)

Authorship; year	Title	Portal	Main results
Martin and collaborators; 2019 ¹³	“A new edition of the Declaration of Istanbul: updated guidance to combat organ trafficking and transplant tourism worldwide”	VHL	The Istanbul Declaration (lD) denounces the practice of offering financial incentives for organ donation, acknowledging the challenges in combating trafficking, particularly in economically disadvantaged nations. It emphasizes the importance of health professionals and individuals engaged in facilitating voluntary organ donation to educate patients about the risks associated with illicit organ procurement.
Kabbur; 2016 ¹⁴	“Can social media help increase the organ supply while avoiding exploitation and trafficking?”	VHL	Social media has exerted a substantial influence on the organ donation process, yielding both positive and negative outcomes through actions such as online campaigns aimed to bolster donor numbers. Conversely, concerns arise regarding data breaches and the compromise of ethical confidentiality. Furthermore, it warns of the fact that the low supply of voluntary donations indirectly encourages organ trafficking.
Piccoli and collaborators; 2015 ¹⁵	“Doctor, can I buy a new kidney? I’ve heard it isn’t forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?”	VHL	The text underscores kidney sales on the black market, highlighting how globalization has streamlined the trade and tourism of organ transplants. Additionally, rooted in the principles of medical ethics, the text delves into the adverse consequences of organ purchasing and the coercion of vulnerable populations into donating organs.
Ambagtsheer and collaborators; 2015 ¹⁶	“Reporting organ trafficking networks: a survey-based plea to breaching the secrecy oath”	VHL	Combatting organ tourism, particularly the purchase of kidneys in countries like China, Pakistan, and India, presents formidable challenges. These hurdles include the arduous task of substantiating the procurement process, patients’ limited awareness regarding the ethical intricacies at play, and the inherent difficulty in reporting trafficking operations without jeopardizing medical confidentiality through the disclosure of patient data.
Moazam, Jafarey; 2014 ¹⁷	“Pakistan’s experience with kidney transplantation and trade: a call for international solidarity”	VHL	The history of organ transplantation in Pakistan is explored, with a particular focus on the influence of Muslim religious beliefs, which contribute to the reluctance of practitioners to embrace organ transplantation. Additionally, challenges in enforcing laws against organ tourism are underscored, attributed to the influence of criminal enterprises and organizations within the state.
Danovitch; 2014 ¹⁸	“The high cost of organ transplant commercialism”	VHL	The text acknowledges the flow of illegally traded organs from poorer countries to wealthier ones, despite the prevalence of high rates of kidney failure in impoverished nations. The text also emphasizes efforts against trafficking undertaken by entities such as the Istanbul Declaration Custody Group and the Israeli government.
AlSulaiman and collaborators; 2021 ¹⁹	“Organ transplantation in Arabian Gulf countries: ethical and legal practice and beyond”	PubMed	The concern regarding organ trafficking and the exploitation of vulnerable individuals is recognized as an international issue. This practice is prohibited across the Arabian Gulf, prompting a discussion on the situation in these countries and the historical measures implemented to combat both human and organ trafficking.
Spasovski, Busic, Delmonico; 2015 ²⁰	“Improvement in kidney transplantation in the Balkans after the Istanbul Declaration: where do we stand today?”	PubMed	The text underscores the situation and obstacles faced by national transplant systems in the Balkans, drawing upon the principles outlined in the Istanbul Declaration regarding practices to combat the illegal trade in organs.
Dalal; 2015 ²¹	“Philosophy of organ donation: a review of ethical facets”	PubMed	Illegal monetized organ donation often exploits socially vulnerable individuals by offering derisory compensation, thereby subjecting them to various risks. The text examines actions aimed at bolstering the legal demand for organs in different countries, such as the Israeli organ transplant law and financial incentive initiatives in China and Iran. These actions raise ethical questions while also exposing vulnerable individuals to exploitation as mass donors.
Ajayi, Raji, Salako; 2016 ²²	“Ethical and legal issues in renal transplantation in Nigeria”	PubMed	Nigeria grapples with ethical issues concerning organ donation, notably the absence of national regulatory laws, which exacerbates the export of donors. Given its vulnerable environment, the country faces challenges ranging from securing voluntary donations to combatting the violent criminal harvesting of organs.
Hartsock, Helft; 2019 ²³	“International travel for living donor kidney donation: a proposal for focused screening of vulnerable groups”	PubMed	Specific issues concerning the donation of organs from living individuals who are not native to the country of donation are addressed, aiming to curtail the illegal trade in organs. In such donations, illegal remuneration can be disguised since the expenses are typically covered by the recipient. Moreover, it becomes the responsibility of the country to certify the altruistic nature of the donation and ensure safe conditions throughout the process for the donor.
Biasibetti; 2021 ²⁴	“O tráfico de pessoas, órgãos e partes do corpo humano em Moçambique: um olhar a partir de 3 estudos realizados pela CEMIRDE”	SciELO	Organ trafficking in Mozambique is exacerbated by a multitude of socioeconomic and cultural factors. Of note are political tensions, cultural rituals involving the offering of human body parts, and significant migratory patterns resulting from civil conflicts within the country.
Rodrígues; 2018 ²⁵	“Tráfico ilegal de órganos: retos para la seguridade internacional”	SciELO	The primary cause of illegal organ trade stems from the disproportionate relationship between demand and supply in organ donations. Additionally, there is a profound social inequality among nations, contributing to various issues that foster the sale and illicit trafficking of organs and people.
Porxas Roig; 2017 ²⁴	“La Convención sobre la lucha contra el tráfico de órganos, una mirada desde la bioética”	SciELO	The Convention against Organ Trafficking (CTO) served as a platform to harmonize concepts and legal frameworks concerning organ trafficking, including the criminalization of monetized voluntary donations. Discussions at the convention revolved around topics such as the “opt-in” and “opt-out” systems for individuals’ consent to donate their organs, as well as the donation of organs from individuals incapable of providing consent.

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[1] Correspondence
Lucas Cruz Torres – Rua Sebastião Bandeira de Melo, 242, Centro CEP 58900-000. Cajazeiras/PB, Brasil.