Ethical Principles Of Global Bioethics

Introduction

Internationally, organs transplantation has been legal and ethical on the basis of living related individuals. However, the image of organ transplanting is eventually taking on a different course that has prompted urgent need for international standards. In the recent past, the organs for transplanting have experienced low supply compared to the increased demand of the organs worldwide. As a result, living unrelated organ transplant has been legalized in some nations while others still hold on to the efficiency of living related donors. The living unrelated organ transplant has been perceived differently as commercialization is carried out both legally and illegally resulting to human trafficking. Human organ trafficking violates human rights and ethical principles as most vendors sell their organs for money and not out of respectable autonomous decisions and informed consent. Conversely, as nations try to protect their citizens from exploitation by human organ traffickers, they end up violating the principle of beneficence. The human organ trafficking also encourages the violation of justice as vendors are provided with low quality health services for their organs in exchange for money. The most affected individuals are those from socially disadvantaged backgrounds. Human organ trafficking deals with recruitment, transport, transfer, harboring or receipt of persons, by means of threatening or force or other form of coercion like abduction. In this paper, the discussion focuses on ethical principles responsible for explaining ethical issues in organ sales in the international level. The main ethical principles explaining the ethical issues in organ sales are autonomy, informed consent, and principle of beneficence. In addition, the paper agrees that there is no justification in the modification of principles according to the context so that prohibited actions in some nations are permitted in other nations.

Organ trafficking

Organ trafficking is legal in an issue raising intense concerns in the world today. Human organs have been illegalized in most world nations, but still human organ trafficking is flourishing at an unusually high rate. The commercialization of human organs has resulted to exploitation of the poor, unknowledgeable persons who are willing to sell their parts of their bodies for money. These illicit actions of human organ trafficking are never exposed and rarely are there convictions. The secrecy of human organ is trafficking, and the willingness of the vendors to sell their organs for money are factors resulting to limitless organs supply to the traffickers despite the low supply internationally. On the other hand, the expanding and aging population worldwide is causing increased demand for human organs especially the kidney. The practice of kidney transplantation has been motivated by the ultimate goal of managing end-stage Renal Disease or ESRD (Barsoum, 2008). ESRD is preferred by most stakeholders since it offers prolonged survival and improved life quality to the patient compared to dialysis (Surman et al, 2008). Despite these benefits, kidney transplant programs have been faced with unavailability of enough donors especially the deceased and live-related donors (Surman et al, 2008). In most nations, organ trafficking is prohibited, and people have to wait until they are eligible for a transplant. As a result, organ brokers offer customers who are willing to ignore moral qualms and law to extend their lives. in addition, some organ customers say they would prefer organs from living donors unlike the waiting for an organ donor from deceased persons

Transplant tourism

Commercial transplants come in transplant package designed for foreigners and locals. These packages are exclusively by private centers and take up to seven. The concern about the health services offered to organ vendors arises from the use of middlemen in offering hospital stays, kidney price and immunosuppressive drugs. In addition, the condition of the donated organ is of concern given that donor evaluation is only subject to blood group, hepatitis B screening and renal function. Again, most commercial transplant private centers are lacking in terms of renal biopsy, monitoring of immunosuppressive drugs, tissue matching and imaging.

Given these deficits, both the recipient and the donor experience poor outcomes individually and collectively. For instance, Parkistan kidney recipients and donors demonstrate complications resulting from infections and surgery. For most transplant tourists in Pakistan, low grade graft outcome and complication are as a result of poor donor recipient and insufficient donor evaluation procedures. Such outcomes are frustrating given that the main aim of the commercial center is in the profit and not the transplantation recipient sustenance. For the organ vendor, there is a one year free healthcare plan. However, this plan is not coupled with follow up. As a result, the donor is at the risk of experiencing health deterioration. In most cases, donors through commercial centers are motivated to sell their organs to improve their social economic status. As a result, health concerns are not an issue at the time of donation. Health issues come second since the money obtained from the transplantation is used to pay debts. In addition, the donors are from poor backgrounds while the recipients are from high income backgrounds (Adibul Hasan S. Rizvi, Anwar S.A. Naqvi, p.125-126).

Ethical principles useful in explaining ethical issues in Organ sales internationally

Principle of justice and fairness

With kidney commercialization, the issue of organ vending is open to willing vendors. As a result, there are increased black market kidney sources for global transplant tourism transplantation (Barsoum, 2008). The decision of a person to sell their kidney is motivated by sincere considerations. However, the lack of subjection to proper screening, health status and kidney renal function evaluation result to injustice committed to the innocent recipient. These injustices result to complications in health which increases vendor’s morbidity. Although vendors’ decisions are to be respected, the outcomes of inability to work as hard as before denies a person and his family a better life compared to the period prior to donation. Such consequences are capable of costing a person his or her job at their family’s expense. This can be attributed to the injustices committed to the donor by the commercial centers in terms of denied proper and efficient healthcare before and after the donation.

Based on who sells the kidney, Moazam, Zaman and Jafarey (2009) reveal that the principle of justice is compromised. The health institutions purchasing human organs are not honest in their dealings and do not keep their promises. The health institution purchasing human organs should offer the vender high quality health care services to ensure that their lives are not compromised after the surgery. However, most of the vendors complain of incision related issues including those that had their nephrectomy performed several years earlier (Surman et al, 2008). For most of the vendors, there is fear of breaking stitches. In addition, most vendors are not informed of the resultant half man syndrome which is experienced on the left half of the body. Most cases of kidney vending in Pakistan involved married men who never consulted with their wives before the transplant (Moazam, Zaman and Jafarey 2009). Men are the head of the family and vend their organs to raise family’s living conditions. However, most wives confess increased expression of anger, inability to work as before especially in manual labor, which is an injustice to the dependents or families

Principle of Beneficence

Barsoum, (2008) argues that, with increased unrelated organ transplants, there are increased poor standards of medical care in commercial transplant programmes, poor pre-transplant patient screening accounting for infections transmission in donated organs or noncompliance of patients. In this case, the principle of beneficence of the recipient and the vendor is compromised. Driven by the monetary gain associated with human organs, medical institutions fail to provide to the vendors the right form of screening and health care services. This leads to low quality immunosuppressive protocols (Barsoum, 2008). The violation of medical values and international standards in commercialized transplant is propagated by the perception that the donor is provided with material benefits characterized by unjust financial agreements covered by altruistic motives. Commercial, live-unrelated donation is untainted trade that is advertised in different media including the internet. In these dealings, recipients are recruited to transplant centers individually or in groups while the donors are recruited by brokers. The entire business is overseen by financial and legal experts. Given the poor living and financial conditions associated with developing nations, most vendors are from developing nations. On the other hand, the unequal income gradient between developed and developing nations propagates kidney trafficking and transplant tourism.

According to Budiani-Saberi and Delmonico (2008), countries are responsible for facilitating organ trafficking. These countries include Pakistan and Philippines. These countries do not release precise data on the number of international patients travelling there for transplants. Governments in world nations have the obligation to bring good in all their actions. This is required in the principle of beneficence (Budiani-Saberi and Delmonico, 2008). Through failure to take positive actions in preventing harm, nations such as Pakistan and Philippines, are not taking the right steps towards prevention of harm. Other data reveal that, about 2000 kidney transplants had been performed to transplant tourists in Pakistan. However, the whereabouts of the organ donors are not provided. In February 2007, newspaper in Philippines accounted for over 3000 kidney sales none of which was provided in the human organ transplant reports for the country. The government in Philippines is one among the many seeking to increase commercial transplanting through transplant tourists, which is intended harm for the organ donors who are not accounted (Budiani-Saberi and Delmonico, 2008).

However, there is a hidden harm as governments try to prevent their citizens from harm through the principle of beneficence. In Egypt, for example, organ donation from deceased donors is prohibited (Budiani-Saberi and Delmonico, 2008). However, there is lacks an entity to govern allocation or transplant standards which gives control of distribution mechanism to the market. As a result, there is increased human organ trafficking coupled with the health condition deterioration. Budiani-Saberi and Delmonico (2008), reveal that the evidence of the poor health conditions during transplant are evident in the deteriorating health conditions of donors owing to conditions such as insufficient donor medical screening, pre-existing compromised health conditions of CLD groups and the engagement of the majority of the CLDs in labor intensive jobs. For most Egyptian donors, the money obtained is used to pay off debts rather than enhance their lives. What the government of Egypt considers as a way of preventing harm on its citizens in organ transplant is what has resulted to increased harm. In addition, most of the Egyptian donors regret their donation and are unwilling to be known publicly as being public vendors. This requires anonymity owing to life threats by those in control of the trade.

Principle of respect vulnerability and human integrity

According to this principle, every human being is rendered to a fixed risk of experiencing wounds both on their physical and mental integrity. This principle also acknowledges that human at one point or the other lack the means to defend themselves, their wellbeing and health. Moazam, Zaman, and Jafarey (2009) reveal that with commercialization of organ transplant, the principle of respect venerability and human integrity is jeopardized. This is because the main targets are individuals from less privileged backgrounds will be provided with reasons of financial gain as a result of organ donation and not the associated health consequences.

Vendors from less privileged families are already vulnerable since owing to their family backgrounds. With organ vending, these socioeconomically disadvantaged persons are taken advantage at the expense financial gains from the organ purchasing health organizations. This accounts for the increased instances of deteriorating health conditions of organ vendors as private health care institutions guided by monetary gains seek economically deprived individuals for their organs. This is the case in Asian countries where private health care institutions go to the extent of advertising transplant packages. For the uninformed vendors driven by their need for money, this is an opportunity to sell their organs even without the information on the impact such a practice would have on their health.

In addition to the disadvantaged vendors are also subjected to disrespect of personal integrity through the poor medical attention that is provided to donors before and after donation. As a result, the victims are subjected to deteriorating health conditions after the donation (Budiani-Saberi and Delmonico, 2008). For the donors, such situations result to compromised ability of to achieve previous levels of income. This has subjected many organ donating families to long term financial disadvantages. There is also a feeling of social rejection and regret about commercial donation for most donors.It is not justified to modify the principles according to the context so that what is prohibited in one nation is allowed in another

Ethical principles should not be modified

In the different world regions, ethical principles on human organ transplant are subjected to a composite mix of religion, culture, and compromised public education (Barsoum, 2008). This means that modification of ethical principles to fit into a given context would result to fragmentation that suit only a given groups of people sharing a culture, religion or other aspect. This would result to inefficiency in principles’ application resulting to a chaotic world were people decide what to do under no guidance of the ethics (Barsoum, 2008). This would result to ethical principles that are emotionally driven and not rationally driven.

In addition, modified ethical principles will subject people to personal bias and chaotic practice. What countries should do is to achieve the universal ethical principles on the basis of country specific factors. Under country specific factors, nations will not modify the ethical principles, but will work towards achieving these ethical principles while being just.Ethical principles should remain standard while transplant tourism should be regulated (Kamash and Gaston, 2008). In most cases, there is no light shed on the donor or vendor on the outcomes. These results to deterioration in health condition while resulting to compromise or worsened financial conditions. For the importing nations, patients returning ill from abroad are likely to consume healthcare resources disproportionally.

As a result, nations have to ensure that the education of patients and families on organ trade is mandatory for physicians and other medical professionals. In addition, government should ensure that there are regulations requiring that no patient enters the transplant process without informed consent. The vendors must also be allowed to enter into the interaction fully without any form of coercion or force. The care of the vendor must be aligned for consistency with international standards defined for donor nephrectomy. Effective reduction in organ trade should allow for intervention by health authorities and other government agencies.International ethical principles should remain universal to all people and nations. Budiani-Saberi and Delmonico (2008) argue that the international community should seek to fulfill the goals of the Amsterdam Forum in providing ethical protocols in the selection of the donor and the longitudinal care for the live kidney donor.

Although it is possible to regulate organ trade cash payment, the need for brokers is significant. These brokers should be governments which should be involved to formulae laws on transplants and the health ministry’s to oversee transplant practices. Through such government involvement and laws, it is not necessary to modify the principle of beneficence which requires governments to protect its citizens from harm. Through the permission of a market regulated kidney transplant sector, people from the prohibited nations will be trafficked to non regulated nations for illegal organ donation. This would mean that nations with prohibitions on organ transplant would risk losing their citizens to illegal organ donation in non prohibited nations. This implies that, with a loose market like is the case in Egypt, Pakistan, and the Philippines, the transplant tourists drive the demand which come from prohibited nations. Instead of commercialized organ donations, nations should seek to establish deceased organ donation as opposed to commercialized and transplant tourists who include brokerage and medical professionals that seek monitory profit.

This is because monetary profits result to vendor sale or coerced donation. In organ transplant, the autonomy of the donor is remarkably vital. With reductions in commercialized sales, donors are less likely to be required to agree autonomously to the process. Moazam, Zaman, and Jafarey (2009) argue that the idea of organ sale results to the exploitation of the most vulnerable people in the society at the benefit of the privileged.The modification of ethical principles in some nations and the transplant tourist demand would result to increased expressed concerns on altruistic donations and the integrity of the medical professional (Moazam, Zaman and Jafarey, 2009). As a result, there would be weakened efforts on the initiation and sustenance of deceased donor programs.

The modifications of ethical principles to fit into a given context would mean that the permitted nations would encourage private advertisement of transplant package resulting to reduction in organ transplant accountability and transparency. In order to make vast amounts of profits, private and public health care institutions would be tempted to account partially for the total number of transplants done for reasons of increased profitability. In addition, the private institutions may be tempted to take advantage of organ vendors only to purchase them at terrifically low prices, which end up only paying the debts of the victims and not enhancing their lives as would be expected. This exploitation increases vendor vulnerability as there are no government-set prices on what should be the buying or selling prices of human organs.

Regulated compensated donation cannot alone stop human organ trafficking

In Pakistan and Iran, paid living unrelated kidney donor transplantation has flourished. In both cases, regulated compensated donation programs did not achieve a high transplant rate to meet the demands from patients. Through the regulated compensated donation, kidneys for transplant were obtained from related and deceased donors in attempts to stop human trafficking. Given the prevailing market conditions, these programs were characterized by exploitation and coercion of the disadvantaged and poor (Rizvi, Naqvi, Zafar, and Ahmed, 2009). This led to exclusive dependence on paid living donors and delay and forestalling of deceased donor programs. In Spain, the results are different as there is a well coordinated deceased donor program that is supplemented by non-compensated living related altruistic donor program. In order to achieve regulated compensated donations, Iran and Pakistan should consider using government funded fully-integrated dialysis and transplantation programs in public hospitals. This would increase dialysis and transplantation availability to all in need (Rizvi, Naqvi, Zafar, and Ahmed, 2009).

Alternatives for organ sale

With increasing demand for human kidneys, the modification of ethical principles would encourage human organ trafficking. However, human organ trafficking should be discouraged through the application of various healthcare practices. However, nations should focus on implementing healthcare measures aimed at reducing kidney transplant demand like early diagnosis and treatment. In addition, governments should seek to ensure that basic renal replacement therapy is available, effective and affordable by all. In nations characterized with high rates of kidney sales should have programs in place to educate patients and families on the effects of organ trade and any patient unaware of the associated moral and clinical risks should not be allowed to seek therapy (Khamash and Gaston, p. 398). In developed nations, health authorities like payers should not support commercialized transplant and should be liable for any such actions. Nations wiling to offer transplantation for citizens should require government oversight on the process.

According to Budiani-Saberi and Delmonico (2008, p.928), international community needs to satisfy the Amsterdam Forum goals requiring the observation of donors that have been ethically selected as well as proper and satisfactory medical care for the donor. In nations where organ transplant is loosely practiced like in Egypt, Parkistan and others, such governments should be involved in developing transplant laws that are oversight by their health ministries. In general, nations must establish frameworks for organ donation and transplantation, encourage transparency in transplantation practice, prevent organ tourists to other nations, and payers stop supporting illegal organ transplant practices.

Conclusion

The main ethical principles explaining the ethical issues in organ sales are autonomy, informed consent, and principle of beneficence. In addition, the paper agreed that there is no justification in the modification of principles according to the context so that prohibited actions in some nations are permitted in other nations. For a long time, organ transplant, with the kidney transplant being the most common, organ donation has been a legal and ethically acceptable practice. Kidney transplant is preferred for its efficiency over dialysis (Surman et al, 2008). Traditional kidney transplant had been limited to organ transplant across different related family members or donation from deceased family persons willing to have their organs donated. However, this trend has resulted to the scarcity of kidneys in a world where there is unusually high kidney transplant demand. As a result, the sale of organs has taken root and is increasing at a unusually high rate especially in the developing nations.

Human organ trafficking is illegal in most world nations leaving only a few nations open to the trade. As a result, human organ trafficking has been established as tourists travel from one nation to the other in search of kidneys through transplant tourism. Human organ trafficking has caused violations to ethical principles of human organ transplanting which include informed consent, justice and fairness and beneficence. With justice and fairness, vendors have sincere considerations to donate their organs. However, the patient is subjected to poor screening, poor and poor evaluation of the patient’s health status and kidney renal function. This has resulted to complicated life for the patients after the operation. in addition, the medical institutions responsible for organ transplant are only interested in monetary gains resulting from the bought human organs. As a result, the vendors are subjected to low quality immunosuppressive protocols that violate medical values and international standards (Budiani-Saberi and Delmonico, 2008).

Instead of benefiting the organ vendors, such transactions only benefit the purchasing institutions. Despite subjection to low quality immunosuppressive medical services, vendors are not informed of the consequences their organ donation procedures. As a result, the health of vendors deteriorates after organ donation and most of the money from the donated organs ends up being used in medical services. This leaves the vendor unable to return to his normal ability to participate in manual work.The world is not silent over the issue of organ trade. The main debate is whether or not the ethical principles of organ trafficking principles should be modified. In my opinion, such modifications would mean fragmentation of the principles to suit different groups of people around the world. This is because the decision on what is right or wrong is emotionally and irrationally made by the people and not subject to international criticism.

References

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