Men display their scars after kidney removal

A public talk at Cambridge University on Saturday will draw attention to the growing illegal trade in human organs and invite discussion of the complex ethical issues involved.

As a criminologist, my starting point is the mismatch between supply and demand. There are huge waiting lists of people wanting organ transplants – and a scarcity of donated organs.

Dr Frank Madsen

There are desperately poor villages in Asia where few males between the age of 18 and 50 have two kidneys. This is not for some genetic reason; it is because these communities are so impoverished that many men have sold their kidneys in order to raise sums that are unattainable by any other means.

A public talk at Cambridge University on Saturday will draw attention to the extremely difficult and contentious issue of illegal trafficking in human organs – and encourage the audience to think about the complex ethical questions involved. It will also be the inaugural lecture in a research programme focusing on the human organ trade.

The lecture Illicit Trade in Organs will be given by Dr Frank Madsen, a Danish-born criminologist who is Deputy Director of the Von Hügel Institute at St Edmund’s College, Cambridge. With a distinguished career in the investigation of organised crime, he was head of intelligence at Interpol world headquarters, before working for one of the world’s largest pharmaceutical companies as its director of corporate security.

“You can look at the subject of organ trafficking from many points of view – medical, sociological, anthropological, legal and commercial to mention just a few. And it’s an issue that we need to address from all these angles because only through interdisciplinary analysis will we understand what is a very complicated subject,” says Dr Madsen.

“As a criminologist, my starting point is the mismatch between supply and demand. There are huge waiting lists of people wanting organ transplants – and a scarcity of donated organs. In the UK, for example, in 2009-2010 there were almost 8,000 people on the list for transplants and fewer than 2,700 transplants carried out. In the USA, in April there were more than 120,000 people waiting for organs with 17 people on the list dying every day.”

In spite of more donations, the number of people joining waiting lists is likely increasingly to outstrip the supply of organs. This is explained by a rise in conditions such as diabetes mellitus and high blood pressure. “The gap between supply and demand creates a potential market. Experience shows that the creation of so-called denied demand will inevitably create a lucrative supply chain more often than not dominated by elements that can best be described as organised crime,” says Dr Madsen.

Living organ donors selling their organs – mostly kidneys but also parts of the liver - generally come from poor countries, but not all poor countries generate donors. India, Pakistan, Moldova and Turkey are known to be markets for organs. In the most typical scenario, the donor travels to another country to meet up with the receiver and the surgeon, both of whom typically come from a third country.

This strategy allows the people involved to evade legal restraints and obtain access to acceptable operating theatres.  In Sana’a in April 2010 a Jordanian trafficker was arrested as he was preparing to travel to Egypt with seven Yeminis in order to remove their kidneys. The donors were exceedingly poor and had been talked into having their organs removed.

“In many instances, those who donate their organs are promised enticing sums of money that are never delivered. This an obvious corollary of forcing any trade underground. Such exploitation should be part of any ethical consideration of the subject but mostly it is not. Another consideration often ignored is the negative consequences for donors of surgery that is not carried out under adequate conditions and without post-operation follow-up,” says Dr Madsen.

We accept the sale of our time and our skills, our energy and our creativity as part of making a living. How we view the sale of part of our physical selves is a very different matter. If we accept organ donation within families, and procedures such as surrogate motherhood, should we be prepared to change our stance on the concept of the “ownership of our body”?

“There is an instinctive repugnance at the thought of selling human body parts. But we are accustomed to going to the market place for what we desire to purchase – and especially so in developed countries. This is called the Lipmann Dichotomy – from Walter Lipmann’s quip that “Americans wish so many things that they at the same time wish to prohibit”,” says Dr Madsen.

Coercion is involved in many cases – and in some instances people have been killed so that their organs can be harvested. In South America homeless people were lured into a hospital with promises of alcohol and their lives were terminated so that their organs could be removed and sold. Those who bought or received these organs may never have known the truth about their source.

Outrage at the human organ trade – and especially its most exploitative aspects - is understandable.  However, Dr Madsen urges us to reflect on the issue with honesty: “Our instinct is to condemn illegal trafficking in human organs. But you have to think: if your adored teenage daughter was dying of kidney failure and you had the chance to buy one from someone, who, for example, was very poor and therefore induced to sell a kidney, would you be tempted?"

This week’s talk is an inaugural lecture in a programme to study the human organ trade at the Von Hügel Institute, commencing in October 2011 and led by an international team of researchers. A first step will be an attempt to establish why 41% of families in the UK and 45% in the USA refuse permission for the donation of a deceased relative’s organs.  “To change this attitude would not eliminate the human organ trade but it would reduce it considerably,” says Dr Madsen.

Illicit Trade in Organs will take place at Gonville and Caius College, Bateman Auditorium, on Saturday, 14 May 2011, at 4.30 pm.  All welcome, no charge.

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