Commercialization of Organ Transplants

Summary

Since the first successful kidney transplant in the United States by Dr. Joseph Murray in 1954

and the discovery of the immunosuppressive drugs beginning in the 1970s, organ transplantation,

particularly live renal donation, has been successfully adopted by physicians in many countries

around the world. Borders of developing countries such as Pakistan have been remarkably

porous to medical science and technology. Scientific journals of the last two decades are replete

with reports of successful renal transplants (which still constitute a majority of all transplants),

and graft and recipient survival rates in developing nations compare favorably with results

reported from established medical centers in the developed world. In comparison, there is a

paucity of studies on the sociological and cultural dimensions of organ transplantation on donors,

recipients, and their families in non-Western societies, on persons who, while participating in the

medical benefits of what is now a global procedure, are nevertheless products of cultures that

have vastly different social and historical evolutions and distinctive moral worlds. A few

publications have appeared, largely in medical journals, in which authors attempt to highlight

some of the “non-medical” issues of organ transplantation in cultures that are non-Western in

their orientation. A majority of these involve quantitative, empirical research, including surveys

by indigenous physicians and transplant surgeons, that focuses on concern at the reluctance of

people to donate both live and cadaver organs. Writers identify religion, culture, and local beliefs

as possible causative factors for this reluctance, but what is largely missing in these studies are

the voices of patients and their families. What is also striking is that even while acknowledging

the different cultural and societal norms of “non-Western” countries, the language used and the

arguments proposed by the authors to increase organ donation are generally grounded in

“Western” metaphors and solutions. These include recommendations for full-time dedicated

transplant coordinators, public education and publicity campaigns about “gifting” organs,

government legislation, and even organ donor cards, in effect many of the measures that have

yielded only equivocal success in increasing organ donation sufficient to meet the needs of

industrialized countries. n the last four decades social scientists, philosophers and theologians

have studied and written extensively on the ethical, legal, sociological, psychological, and indeed

political dimensions of organ transplantation in Western Europe and North America. These have

included discourse on the relationship of a human being to his body and “body parts” and

whether organs of the body can be considered and handled as a form of property.

In Asia, especially in India and Pakistan, healthcare professionals, chiefly physicians rather than

theologians, philosophers, lawyers, and others, will shape and set the trajectory for clinical ethics

in years to come. For the thousands of distressed patients and their families, physicians who

minister to them daily in the flesh will continue to embody moral authority for them. Related to

this is a growing desire within the medical community to learn more about indigenous value

systems, especially those that can be traced to Muslim history or be discovered within

contemporary discourse of either the Hindu pundits or the Muslim scholars or ulema. Members

of healthcare professions in these two countries with combined population which is higher than

China, products of their culture and familiar with local realities, are well positioned to contribute

to and enrich the often philosophical, always secular, dialogue within contemporary bioethics.

This is only possible, however, if, unlike the sometimes unquestioning way in which science and

biotechnology have been transplanted into the country, they begin to reflect on the moral

complexities, the good and the bad, of their own culture. There is a similar need for American

bioethicists to begin to reflect on some of their own historical and social imprinting of their

understanding of what constitutes moral interactions between society and its healers.

In order to truly “internationalize” bioethics, the diversity of human voices and experiences must

be brought into the fold. It is necessary to comprehend the many ways in which people

experientially fashion and interpret concepts of dignity and respect for people, interpret caring

for one another, and decide what constitutes ethical conduct between laypeople and those who

assume responsibility for their health. It will serve us all well to move beyond the overdone and

polarizing debates on the dichotomy of universalism and relativism, the individual and the

community, the secular and the religious, West and East, and search for a better understanding of

real lives of real people in actual societies.

There is a well-known parable by Jelaluddin Rumi, a Muslim Sufi or saint, in which he describes

people in a dark room attempting to explain what an elephant looks like. Each touches one part

and visualizes the animal accordingly. To Rumi it is only by combining the experience of all

those present in the room that the true picture of the entire elephant can be formulated. Human

morality is a bit like the elephant. Understanding it requires enlarging intelligible discourse

between people who are quite different from one another in their history, culture, language,

outlook on life, and moral values. Such dialogue is crucial, for as Geertz says, 'we are all

contained in a world in which it is increasingly difficult to get out of each other’s way.'

In India, according to Dr. A.K. Tharien, of the Christian Fellowship Hospital in the Indian

province of Tamil Nadu, the commercialization of organs in India has been taking place through

an organized network involving hospitals. Legal regulation of organ donation that permits it only

within kinship relations has been circumvented through dubious arrangements such as ‘kidney

marriage’. In such instances, a rich person can marry a girl for her kidney; divorce her soon after

surgery, hence ridding him of the responsibility of care (Tharien, 1996: 168-9).

Conclusion

No religion formally forbids donation or receipt of organs or is against transplantation from

living or deceased donors. The society and healthcare professionals must consider living organ

donation as “praiseworthy but optional, even if living donors view their acts as obligatory.” It is

an act that must remain altruistic, an act that transcends duties normally expected and imposed

on any human for the benefit of another, even if close kin. This study shows that the

This study also tries to address one of the less examined aspects of live organ donation

worldwide. Although much has been written about tissue and organ donation, there is a dearth of

ethnographic field research that focuses on the “non-medical” aspects of live donation of kidneys

to genetically related kin. Only a handful of studies exist in the United States that deal primarily

with live, related kidney donors, their families, and the involved healthcare professionals. In a

world of 'organ trafficking' where organs mafias are working internationally in a close network,

it is often very hard to flatly say yes or no to the question of organ transplantation.

At the same time, increasing numbers of publications originating from developing countries

revolve around medical and scientific aspects of organ transplantation including graft and patient

survival rates. Many of these works also note a paucity of available cadaveric organs in their

societies and allude to indigenous religious beliefs and value systems as major deterrents to

procuring such organs. What is also becoming clear is that despite attempts to increase the

supply of cadaveric organs, living donation of solid organs is on the rise in many countries

around the world. Living donors, related and unrelated, continue to remain the primary source of

organs, especially kidneys, for transplantations undertaken in a majority of developing countries.

It is also focused on how shared values inform and mediate interactions, relationships, and

decision-making processes of protagonists when they were faced with a situation in which the

survival of a family member was possible only through the donation of a kidney by kin.

Donation of a solid organ, both live and cadaveric often carries with it almost a religious, biblical

imagery with a Judeo-Christian tradition of self-sacrifice for the love of another human being

whether kin, friend, or stranger. In the United States in particular, such self sacrifice to save the

life of a stranger assumes a prominent motif for the procurement of cadaveric organs. It is

mentioned in the holy books of Judaism, Christianity and Islam, the four major religions of the

world, that 'Man is the image and glory of God', therefore to act that noble and glorious way it is

best to give life to those whose only chance is an organ donation. But just as there is a principle

and a set of rules in nature, so let there be a principle and a set of rules for organ donations.

References:

Cherry M J. Kidney for sale by owner: human organs, transplantation, and the market. Washington: Georgetown University Press; 2005.

Nanji, Azim A. “Medical Ethics and the Islamic Tradition.” Journal of Medicine and Philosophy13 (1988): 257–275.