Organ donation and transplantation in emerging economies: organ trafficking, mistrust and insufficient treatment

"The impact of commerce, transplant tourism and organ trafficking remains a burning issue in the global community of transplantation. Emerging economies became the centre of transplant commerce and tourism with centers in many countries. The views differ in the selling and buying countries," Dr. S.A. Anwar Naqvi and colleagues (Karachi/Pakistan) report. Experienced physicians provide an overview in the new handbook "Organ Transplantation: Ethical, Legal and Psychosocial Aspects. Global Issues, Local Solutions".

"The impact that commerce and tourism have on transplantation can be judged by the experience of Pakistan which became the largest organ bazaar in the world.

Availability of a vendor has increased family refusal rates in local transplant programmes on social and medical grounds. The economic gains have encouraged the physicians and surgeons to shift transplant activity from public to the private sector hospital.

There came a point in the years 2004 and 2005 where more than 2.000 foreigners travelled to Pakistan each year for transplantation. Several studies have highlighted the plight of vendors both in Pakistan and India. The majority were illiterate, bonded labourers who sold their kidneys for debt repayment. Our clinical study on vendors showed low glomerular filtration rate after donation, proteinuria in 17% and hepatitis C positivity in 24%. Several papers from other countries where recipients bought kidneys from Pakistan show that they experienced serious infectious complications and early rejections.

Transplantation is still a very specialized field in many emerging economies. Paucity of intensive care unit facilities and a negative attitude of physicians towards brain death and organ donation specially in emergency services and intensive care units, has held back deceased donor programmes. Non-availability of transplant services in the government sector and high costs in the private sector render the majority of the population disfranchised from dialysis and transplantation. The population seems to be unwilling to support deceased donation programmes due to several reasons. Firstly they cannot be beneficiary of deceased donation, further there is mistrust of doctors in the ICU situation for the fear of inproper care and finally there is the perceaved fear of sale of organs of the dying ..."

>> W. Weimar, M.A. Bos, J.J.V. Busschbach (Eds.) Organ Transplantation: Ethical, Legal and Psychosocial Aspects, Vol. III. Global Issues, Local Solutions. Pabst, 340 pages, ISBN 978-3-89967-931-1

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