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March 15, 2008

Organ Transplant Tourism

Need a kidney? Buy one for $20k in Russia.
Need a liver transplant? Visit the Philippines. Cost $129k.
Need a heart?  South Africa has them for $140k.
(Lisa Ling, Reporter, National Geographic Special on Organ Donation)

Airplane72x721 The shortage of organs available for transplantation continues to rise in the United States and the demand for organs exceeds the supply. Thus, many Americans, rather than staying on waiting lists for 5 to 15 years, are traveling to various countries to obtain necessary organs to remain alive. China recently stopped allowing Americans to travel to that country for organ donations. Executed prisoners often were utilized as organ donors in the land of the Great Wall. To me, this sounds rather barbaric.

The shortage of donated organs and the lack of supervision of hospitals in China have led many to view transplant surgery as a cash cow. Many people have been enticed to profit from this situation by offering their organs for sale. The same seems to now be occurring in Russia, India, and other under-developed countries as well.

I kept thinking about how needless all of this would be if we didn't have such loose organ donation policies in the United States. Do we even have a governmental policy on organ donation? The US government’s site on organ donation and transplantation (http://www.organdonor.gov/ ) offers the following statistic: "Each day, about 74 people receive organ transplants. However, 18 people die each day waiting for transplants that can’t take place because of the shortage of donated organs." That's about 6500 people who die every year in the United States waiting for an organ donation -- two times the number dead in the 911 attacks. Should we be doing something more – education, public service announcements, or online marketing to lower these drastic numbers?

About 2.4 million people die each year in the United States. Only a fraction of these people are organ donors. Why are so many life-saving organs being thrown away? What do we do with the growing number of people requiring organs? Do we let them live out their lives as they are or institute a change in the voluntary "Become an Organ Donor" card, such as somehow making it mandatory in nature? What are other countries doing to solve the problem of organ donation?

Please share your suggestions.

March 15, 2008 in Beka | Permalink


Quite an interesting topic as it is life saving though a lot of ethical issues around it. many people still have some myths about organ donation some simply because of lack of knowledge. Scholars must engage more on research to identify the gaps that are mostly preventing a lot of potential donors not to donate especially amomg the Black South Africans.

Posted by: Nozi | Aug 19, 2011 3:00:57 PM

im willing to donate my heart for someone who need it..philippines

Posted by: secret | Jan 22, 2011 8:33:45 PM

Hi Derek - No brain transplantation for me ! Deep Brain Stimulation was enough ! I cant imagine an Abdominal Transplant either !


Posted by: beka | Apr 14, 2008 2:45:23 PM

I have a friend who says she is "good with" the idea of being an organ donor, but hasn't elected to be one, due to, as she puts it, "dumb paranoia." She harbors some deep-seated fear that checking the box on her license renewal form would make her body parts too valuable, so that heroic efforts would not be made to save her life. I think that fear is not uncommon... I confess to a hint of it myself, despite having the little heart on my driver's license.

The idea of mandatory donation is abhorrent, but we can still do a lot more! My own preference would be for a modified opt-out scheme, like the Belgian system. Under that model, while the onus is on individuals to document their objection to organ donation, it cannot proceed if a spouse or 1st-degree relative objects for ANY reason, or if any relative or friend can document that the patient had expressed opposition to being a donor (despite no official record of such). This satisfies all my ethical requirements of beneficence, non-malfeasance, autonomy, and respect for persons. Sadly, people in this country are too pigheaded to accept laws which benefit the common good and not just their purses. We should rather increase the number of organ donors the truly American way, by repealing helmet laws and the highway speed limit!

Even if we don't change the consent or allocation systems a bit, a major public education blitz could do a lot to increase the donor pool, by combating fears like those of my friend above. But there will always be tension and conflict as long as demand outstrips supply, and there are many complex issues affecting supply and demand, such as definitions of death, policies for being considered for the waiting list, and availability of qualified transplant teams. No system anywhere has managed to generate enough organs to reduce the waiting list to zero. Maybe what we need are more heroes like this one at MGH: http://www.theonion.com/content/video/anonymous_philanthropist_donates

Now, how do you all feel about brain transplantation? I was going to make a fierce objection, but nights like this I think I could use a new one.

Posted by: Derek, RN | Apr 12, 2008 10:07:41 PM

If we start asking for fees or payments for organ donations from potential organ donors - are we not then indirectly participating in "organ tourism " ????

Who would do the paying ?? The person or family looking for an organ ? Is that really Ethical ???


Posted by: beka | Apr 7, 2008 11:46:08 AM

Why not pay donors or their families for the organ? all other goods and services in nursing and medicine are billable. Everyone else (except the patient) is making $$ on it. Sure you have the good samaritans who will indicate it on their driver's license, but when a price gets tagged on--the numbers of available organs could increase exponentially. Naturally this would only be handled through a certain legitimate process. Hopefully with tissue/organ engineering--the issues of donors may one day become a moot point.

Posted by: Brenda | Apr 2, 2008 10:11:37 AM

Anyone hear of the Spanish Model ?
The Spanish Model is simply a team of specially trained people - separate from the medical/transplant teams - who are responsible for raising the donor rate in the hospitals within the European Union.

Spain has risen from one of the lowest donation rates in the world to one of the highest, going from 14 to 35 donors per million population. This increase followed nationwide implementation of a standard donation process, focusing responsibility for handling the donation process with hospital-based donation teams. Hospitals are held responsible for their performance in donation. Spain continues to achieve donation improvements when the rest of Europe shows flat or declining rates of donation.

Spain’s story of donation and transplantation began in 1965, when the first transplants were done in Madrid and Barcelona. In 1979 legislation was passed that enabled donation and transplantation to expand. Modest growth continued until the mid-eighties, when progress in donation stalled.

In 1989, The Organizacion Nacional de Trasplantes (ONT) was formed to address the problem of declining donation rates. The organization believed that the problem was not lack of suitable donors, but rather a problem of identifying potential donors and obtaining consent.

Rather Intersting ..uhmmm...? Would the Spanish Model work in the States ? Any Foreign Thoughts ?

Posted by: beka | Mar 31, 2008 11:50:14 AM

I also work on a transplant floor in a large city hospital. There are strict guidelines for transplant criteria. Those cases where "drug abusers" received transplants must have more behind story then the writers are telling. I have seen patients (heart and lung transplant candidates) who are noncompliant with the hospital guidelines and then are told they can not be placed on the transplant list. A person in their 20's who doesn't follow the diet restriction, medication plan, or smoking restriction has not been placed on the transplant list. There are guidelines and plenty of information out there for people who believe otherwise.
also - best resources can be just checking out the transplant services at your closest hospitals
Getting back to the primary issue of this article - let's try to support the public's education on organ donation. Is your ID card dotted with a donor sticker?

Posted by: Jen | Mar 21, 2008 12:05:49 PM

There are VERY strict guidelines for organ donations. Out of the hundreds of deaths I've experienced in the hospital, I remember only one that was acceptable as an organ transplant donor.
As far as someone waiting for a transplant, they are placed on the transplant list, but when an organ comes available and it is their turn, there are certain things they must meet in order to receive the available organ, otherwise, it goes to the next person on the list.

Posted by: eJane | Mar 21, 2008 1:45:13 AM

May be a Solution ---

In Transplantation Ethics, Robert Veatch outlines an interesting way of assessing need. He calls it the "over-a-lifetime perspective" (340). This approach takes into consideration a person's entire life when determining who is worst off. A 17-year-old and an 80-year-old both dying of heart failure are equally bad off, but this perspective allows that the person who has had 63 more years of life is better off, so the 17 year old is neediest. Veatch writes, "from this over-a-lifetime perspective, justice requires that we target organs for these younger persons who are so poorly off that they will not make it to old age without being given special priority. The younger the age of the person, the higher the claim" . This methodology furthers the goal of utilizing organs to their maximum potential.

Veatch, Robert M., Transplantation Ethics, (Washington, DC: Georgetown UP, 2000), 277-413.

But more questions come to mind ---

In February 2003, 17-year-old Jesica Santillan received a heart-lung transplant at Duke University Hospital that went badly awry because, by mistake, doctors used donor organs from a patient with a different blood type. The botched operation and subsequent unsuccessful retransplant opened a discussion in the media, in internet chat rooms, and in ethicists' circles regarding how we, in the United States, allocate the scarce commodity of organs for transplant. How do we go about allocating a future for people who will die without a transplant? How do we go about denying it? When so many are waiting for their shot at a life worth living, is it fair to grant multiple organs or multiple transplants to a person whose chance for survival is slim to none? And though we, as compassionate human beings, want to help everyone, how far should our benevolence extend beyond our borders? Are we responsible for seeing that the needy who come to America for help receive their chance, or are we morally responsible to our own citizens only?

The Jessica Case ??? Food for Thought or Debate ???

Posted by: beka | Mar 20, 2008 5:14:23 PM

Visit these two websites for more information :



Any Canadians out there? What are your thoughts about the process, for those of you working/living in a semi-universal healthcare setting?

Posted by: beka | Mar 20, 2008 5:05:52 PM

Over half of the 98,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.

There is a simple way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Posted by: Dave Undis | Mar 20, 2008 3:51:52 PM

Having worked in the realm of End Stage Kidney Disease since 1969 I have seen the progression from -sorry not enough equipment nor personnel so if you have anything else wrong with you besides ESRD you are not a candidate... Yes, we also transplanted patients back then and did 'everything' to keep the kidney while the patient continued to 'go down hill' before removing it and returning to dialysis. Even back then we had criteria. Medicare came in and changed this situation. Today we have multiorgan transplants and new developing ways to assist the patient while waiting. Having also been a procurement (as well as clinical) coordinator we spent a great deal of our time educating both the public and the professional in medicine about the need for organ donation. Our country has chosen to initiate a voluntary donation-you must 'opt in' to be a donor. Some countries in Europe have a 'opt out' policy-you must express your wishes if you do not want to be considered an organ donor at the time of death. We now have the 'expanded criteria'-looking at donors who do not fit the 'perfect' donor criteria as well as non heart beating donors. We are trying but in a voluntary situation it is dependent upon the individual/family to decide. They are looking at possible incentives to increase the donation rate. My own philosophy over the years is in order for someone to think about being an organ donor at death they must usually know the need/or know someone who 'needs'. Until it hits them personally everyone goes about their 'business'-probably saying "oh how sad that that child/adult needs an organ" but is not touched by it personally to do something about it.

Now about the clinical side: all transplant programs have criteria that has the general guidelines for all potential recipients and specific guidelines pertaining to what organ(s) are needed. We have an obligation to that person who donated as well as the family members to give the organ to someone who will 'take care'. Obesity, smoking, drugs etc are all contraindications for recipients. However they are given the option to change these behaviors and when the criteria is reached are placed on the list. Patients once listed are continuted to be screened for the same reasons as stated above about the obligation. Everyone should have the chance-yes, even those who may not have done a very good job in taking care of themselves post operatively and came to realize these expectations are for their benefit and not the benefit of the transplant facility. Each case reviewed individually for outcome.

Posted by: Elaine Vuyosevich | Mar 20, 2008 8:43:53 AM

Mandatory organ donation? How can anyone even consider suggesting such a thing? We are not parts. We are people with many different customs and beliefs even within the predominant Christian faith in the U.S.. I can only imagine how the Native Americans would feel if they were told that anyone from their tribes with viable organs is subject to dissection for the betterment of mankind in the event of brain death. I'm sure that will go over very well with the Orthodox Jews and Muslims too.

This would be a complete slap in the face of Constitutional rights but I suppose that is something that continues to be done on an ever more regular basis in this country. Don't worry folks it's all in the interest of the greater public. It's good for us to have less individual rights because it makes us safer to be less free. Move along folks. Nothing to see here. It's all business as usual.

Wake up America! Something is wrong with this society if people can suggest with a straight face that mandatory organ donation is remotely a viable option. We have truly lost something of who we are and what we are supposed to be about.

I am a registered nurse and I too have cared for patients on LVAD's who were appropriate for bridges to transplant but I have also seen the device used in completely inappropriate cases. Unfortunately the majority of those cases were never transplant candidates. They would be on the equipment for months, explanted and then return rather rapidly to their low ejection fractions and decompensated congestive heart failure. I've seen drug abusers given livers and alcoholics hearts. I've also watched them return to their prior habits after receiving transplants. It's not a great system. Nothing is ever perfect but we hope that the organs are at least given to those with the greatest need and the best possible match.

Our health care system is for all practical purposes a broken machine. It has become top heavy and cumbersome. It is rife with cronyism and conflicts of interest from the very top to bottom. Sometimes I feel I'm working within a cleaner, sleeker version of a 3rd world banana republic government. Until the health care system no longer functions as a corporate money making machine we will be faced with expensive and slow to change health care. The system is designed to keep the status quo so that all those entities that feed off the business of illness can continue to grow profits. It is a self limiting system that eventually will make itself obsolete. It may take years for it's demise but like Rome it too will fall. Hopefully what follows will be better. Only time will tell.

Posted by: Kristina | Mar 20, 2008 12:01:33 AM

Should there be specific criteria for organ donor transplantation - should mentally deficient, drug abusers being receiving repeat transplants ?? Prescreening of those listd ?? Or would that suffice to inequality ???Health disparity ???

Control - a private sector org if not the gov, something like the CDC ????

Posted by: beka | Mar 19, 2008 8:32:48 PM

Mandatory (gov. control) organ donation is a BAD idea. It is against some religions to donate &/or receive a transplant. My university gives organs to non-compliant folks, mentally deficient and patients that are drinking or using drugs before and after their transplants.

Posted by: Donna | Mar 19, 2008 6:33:05 PM

I just assumed the role of Organ Procurement Coordintaor at a large city hospital, that does organ transplant, last August. I am a nurse and prior to that I was doing something completely different. I have learned so much about organ donation and know it is truly life-saving. I think the best we can do is make people aware. We need more correct information on TV in the newspapers and at public events. I think many who would consider becoming a donor don't because of misunderstanding. A celebrity who is well respected and received an organ transplant could be a good ambassador for the cause.

Posted by: Karen Scalici | Mar 19, 2008 9:45:00 AM

In regards to the organ donations and whether or not it should be made mandatory would be very dangerous for society. It is always a mistake for govermental authorities to have the power to force its agenda on its people, even if it is for good intentions. Also, people need to realize that there are consequences to the actions that you take such as with your life habits. There will always be innocents that suffer but the guilty far outweigh them.

Posted by: Dixie Stratton | Mar 19, 2008 9:01:49 AM

Most insurers have age limitations for solid organ transplantation. They usually have criteria for the organ recipient, such as having not smoked for 6 months to a year and alcohol free for a certain length of time. I could never imagine asking the government to control organ donation.

Posted by: Jane | Mar 19, 2008 8:57:23 AM

One of the reason for the shortage of organs for transplant is better use of seat belts. Organ donors come from people that die from brain injury (excluding living donors). If someone has a system to increase donation awareness please let Donate Life site know about it. I have personally talked to as many as 1,000 students a year about it at the schools. I am really glad I don't have to decide who can and can't have an organ. As a transplant I don't know any practicing alcoholic that received a liver or even a practicing smoker that received a heart or lung transplant. Yes there is a great need out there and the rate of the list grows daily with out the number of donors increasing much. People need to go to the unos.org site to see how the organs are allotted and not just spout off what they learn from TV sitcoms.

Posted by: Donna Kempton | Mar 18, 2008 8:56:06 PM

Rereading my own blog - I question whether , in fact , we would have a greater supply if the current available organs were to be made available to the " right " candidates ?

How many times have we heard of the 72 year alcoholic with end stage liver cirrhosis receive 2 liver transplants but continues his drinking habits after transplantation ?

Should liver cancer patients be given the offer for liver transplantation ?

A few months ago , I saw an LVAD placed in an 85 year old lady, as a bridge to transplantation ? Is this truly a viable candidate despite intractable CHF ???

What about the young mother who abuses drugs , does not stop or go to rehab, but is placed on the heart transplant list anyway ? Right or Wrong ?? Desreving or Not ?

What about the happily married mother of twins who does receive a heart transplant ? But waits for 3 years for an donor organ ???

Posted by: beka | Mar 18, 2008 7:49:57 PM

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