Organ donation and trade: hope and caution

Medical science has advanced by leaps and bounds. However, in many cases, medicines and surgeries are not enough. Sometimes, the only solution is organ transplant. Today, many people encourage organ donation. At the same time, there is a vast global network that thrives on an illegal organ trade. In such a situation, all stakeholders have to work together to make the process beneficial and humane.

Organ donation means donating one’s body tissues or organ – either during lifetime or after death, to a person who needs transplantation. Organs are removed and transplanted with the help of surgery, and is followed up by (often prolonged) post-treatment care, both for the recipient and the donor. Eyes, kidneys, cornea, heart and blood are a human body parts that have great demand.

The most preferred form of donation is of course, cadaver donation. A person may will away his body to a hospital or organ donation initiatives. Thousands of people have benefitted from cadaver donations. Only people who die from irreversible cardiopulmonary failure were once thought to be eligible for cadaver donation, but now, tissues and organs of brain-dead people can also be harvested with the consent of his family members.

Donor-recipient dynamic

The relationship between the donor and the recipient is at the heart of the organ economy. Not everyone can donate, and neither can the recipient get a transplant from anyone. Doctors first have to painstakingly determine which donor matches with which recipient. Several factors, like blood type and family health history are analysed. Based on the results, the donor is matched to the recipient and after necessary preparations, the organ is harvested and then transplanted.

In many cases, a family member, preferably a blood relative is the favoured donor. But there are other patients who do not want to have any personal acquaintance with the donor. Also, in the global perspective, there are many patients who source organs from donors living in poorer countries, and prefer that their relationship remains anonymous.

In other instances, many recipients want to know their donors personally, and if the circumstances permit, they spend quality time bonding with each other and may even interact with their families.

Several organizations, like Donate Life America and European Transplant Coordinators Association work towards facilitating transplants. Organ donation is a state regulated issue, and hence, all civil society organizations and charitable institutions have to register with their respective governments in order to carry out their activities.

Legal control

Every country today closely monitors organ donation and transplantation networks. Demand for healthy organs and tissues is evergrowing. People have to often wait more than a decade to get a transplant. Organ Procurement and Transplantation Network, which is under the US department of Health Services, estimates that there are more than 114,820 people on the waiting list. Between January and April, 2012, 8987 transplants have taken place.

The huge gap in supply has led to the rise of a powerful underworld of illegal organ trade. In developing countries, poor people often sell their organs to brokers and shady entities, who pay them a pittance for their trouble. While the organ is then sold, and exported in many cases for much higher returns, the donors often go through a prolonged period of pain and agony. There is little post-harvest care available for them, and in many cases, the donors are reluctant to approach the police.

Instances are also widely reported of poor people being held against will and their organs being forcefully removed. There have been instances where authorities have busted rackets, and have even discovered ‘blood camps’, where individuals are kept in a nearly comatose state while being continuously drained of blood.

Hence, most countries have been proactive in stopping exploitation of donors. In European Union, many states follow the system of presumed consent, or ‘opt out’; wherein it is presumed that a person is willing to donate unless he says otherwise.  Countries like Austria and Spain have very high donor rates, while Germany and UK, where one has to give consent for donation explicitly, donor rates are low.

However, countries like Sri Lanka and India are major global donors. While in India organ selling is legally banned, it is a lucrative trade. Not only are kidneys, corneas, blood and tissues exported from India, the country is also infamous for supplying skeletons and bones. Sri Lanka officially is entitled to supply organs to many countries, and thus, has turned into the biggest global supplier of eyes.

Many dictatorial regimes have been accused to forceful tissue and organ harvesting by human rights groups, which allege that political prisoners become involuntary donors, and often die from the experience.

Bid for transparency

The existence of the black market is often justified for the ends it serves. Going by the huge supply gap, many patients die while on the waiting list. But doctors, activists and other civil society groups have been fighting to evolve a sustainable system that will allow human organs to be used for bettering lives without demeaning human lives and exploiting donors. The most viable solution is to let donors and recipients interact with each other and the method of obtaining organs be made transparent.