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      The state of the international organ trade: a provisional picture based on integration of available information Translated title: Situation du commerce international d'organes: un tableau prévisionnel reposant sur l'intégration des données disponibles Translated title: Situación del comercio internacional de órganos: panorama provisional basado en la integración de la información disponible

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      Bulletin of the World Health Organization
      World Health Organization

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          Abstract

          Organ transplantation is widely practised worldwide. The expansion of organ transplantation has led to a critical shortage of organs and the development of the organ trade. Many patients travel to areas where organs are obtainable through commercial transactions. Although the international organ trade is regarded as an important health policy issue, its current state remains obscure because of scarce data and the lack of efforts to synthesize available data. This paper is an attempt to integrate information about the current international organ trade and create a tentative global picture based on a systematic review of 309 media reports, journal articles and other documents. The international organ trade is described in terms of its forms, the organ-exporting countries, the organ-importing countries and its outcomes and consequences.

          Translated abstract

          La transplantation d'organes est maintenant largement pratiquée de part le monde. La diffusion de cette pratique a conduit à une pénurie critique des organes et au développement d'un commerce international. De nombreux patients se rendent dans des zones où l'on peut obtenir des organes par des transactions commerciales. Bien que le commerce international d'organes soit considéré comme une question importante de politique sanitaire, la situation actuelle de ce commerce demeure obscure en raison de la rareté des données et du manque d'efforts pour faire la synthèse de celles disponibles. Le présent article s'efforce d'intégrer les données sur l'état actuel du commerce international d'organes et fournit un tableau préliminaire de cet état à partir d'une revue systématique de 309 rapports par les médias, articles de revue et autres documents. Le commerce international d'organes est décrit sous l'angle des formes qu'il adopte, des pays qui le pratiquent en exportant ou en important des organes et des résultats et conséquences qu'il entraîne.

          Translated abstract

          El trasplante de órganos es una intervención ampliamente practicada en todo el mundo. La expansión de ese tratamiento ha provocado una grave escasez de órganos y la aparición del fenómeno del comercio de órganos. Muchos pacientes viajan a zonas donde es posible comprar y vender órganos. Aunque el comercio internacional de órganos se considera una importante cuestión de política sanitaria, sigue habiendo grandes incertidumbres sobre la situación actual de esa práctica, debido a la falta de datos y de iniciativas para sintetizar los datos disponibles. En el presente artículo se ha procurado integrar la información disponible sobre el comercio internacional de órganos en la actualidad para ofrecer un panorama mundial provisional, basado finalmente en una revisión sistemática de 309 noticias aparecidas en los medios de comunicación, artículos de revistas y otros documentos. Se describe el comercio internacional de órganos en relación con sus distintas modalidades, los países que exportan órganos, los países que los importan, y los resultados y consecuencias de esa práctica.

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          Most cited references51

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          Economic and health consequences of selling a kidney in India.

          Many countries have a shortage of kidneys available for transplantation. Paying people to donate kidneys is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. However, whether individuals who sell their kidneys actually benefit from the sale is controversial. To determine the economic and health effects of selling a kidney. Cross-sectional survey conducted in February 2001 among 305 individuals who had sold a kidney in Chennai, India, an average of 6 years before the survey. Reasons for selling kidney, amount received from sale, how money was spent, change in economic status, change in health status, advice for others contemplating selling a kidney. Ninety-six percent of participants sold their kidneys to pay off debts. The average amount received was 1070 US dollars. Most of the money received was spent on debts, food, and clothing. Average family income declined by one third after nephrectomy (P<.001), and the number of participants living below the poverty line increased. Three fourths of participants were still in debt at the time of the survey. About 86% of participants reported a deterioration in their health status after nephrectomy. Seventy-nine percent would not recommend that others sell a kidney. Among paid donors in India, selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health. Physicians and policy makers should reexamine the value of using financial incentives to increase the supply of organs for transplantation.
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            Where It Hurts: Indian Material for an Ethics of Organ Transplantation

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              Iranian kidney donors: motivations and relations with recipients.

              The motivations of Iranian kidney donors and donor-recipient relationships are clarified. A 13-page 69-item questionnaire was completed by 100 donors and interviews were videotaped. Of the donors 90% did not knew the recipients preoperatively and only 13% had any information on recipient fate postoperatively. In 87% of cases there was no postoperative relationship. Because of recipient failure to appreciate the donors and refusal to realize preoperative promises 51% of donors hated the recipients and 82% were unsatisfied with their behavior. Motivations for donating were purely financial in 43% of cases and mainly financial with a minor altruistic component in another 40%. Of the donors 76% agreed that kidney sale should be banned and if there was another chance they would prefer to beg (39%) or obtain a loan from usurers (60%) instead of vending a kidney. All 6 related donors were paid. The goals of vending were achieved not at all by 75% of donors. None of the donors studied fulfilled the criteria of compensated donation or donation with an incentive and 97% were vendors. All evidence shows that the donor-recipient relationship in Iran is pathological with no similarity to the emotionally related category of transplantation. Reports by the reformist Iranian press, which have all been banned, show that our sample is a good representative of other Iranian donors. Almost none of the criteria of an acceptable living unrelated renal donor transplant program is met in Iran. The opinion of kidney donors should be regarded as the final arbiter when labeling the act as a sale or donation and it should be considered in discussions of living unrelated donor transplantation.
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                Author and article information

                Contributors
                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                December 2007
                : 85
                : 12
                : 955-962
                Affiliations
                [1 ] University of Oxford United Kingdom
                Article
                S0042-96862007001200017
                10.2471/BLT.06.039370
                2636295
                18278256
                b219cb65-fc3c-411d-9228-e6f0531a8ada

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0042-9686&lng=en
                Categories
                Health Policy & Services

                Public health
                Public health

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