Decision Making Factors of Commercial Donors and Recipients in Live Unrelated Kidney Transplantation in the Philippines

Abstract

Introduction Since the harmonization of the Philippine living kidney donor regulations with the Declaration of Istanbul in 2008, transplant tourism became illegal in the Philippines, except in cases of proven altruistic purpose. Foreign transplant tourists ceased purchasing kidneys from Filipino donors, however domestic transplant tourism continued unabated. This resulted in concealed commercial kidney transplants among Filipinos. No previous study had been conducted to investigate the decision-making dynamics of both kidney sellers and recipient buyers in the Philippines, thus, this research attempts to answer the question: How do kidney sellers and recipient buyers shape their interpretation of kidney trading in the Filipino social context? Results of this research will strengthen the campaign to prevent the exploitation of vulnerable groups of Filipinos who are involved in the clandestine kidney trade. Materials and Methods Qualitative methodology was used through interviews with 12 kidney sellers and 34 kidney recipients of financially compensated donations throughout the period of 2008-2016. Focus group discussions were performed with kidney sellers and their families. Thematic analysis was used for analysing data until it reached theoretical saturation. Results and Discussion The resaerch has identified three themes in the Filipino social context that are associated with decision making of kidney sellers and recipient buyers: 1) values, 2) beliefs, 3) behaviours., and includes the methods families employ in order to sustain their economic existence and the power distance in which Filipino culture accepts hierarchical order, especially between rich and poor. These are all factors which can lead to the decision to both buy and sell an organ. The findings of the reserch indicate that kidney sellers believe that while it is acceptable to sell and organ to a fellow Philipino, it is objectionable to sell to a foreigner. The respondents additionally indicated that kiidney selling occurs as a consequence of unemployment and often it is the matriarch of the family who connects to an organ broker in the local community. Social media is now the principal communication tool used to conduct these transactions. These findings may help us understand why domestic transplant tourism still continues despite the existence of regulatory control. There are several impediments to effectively screen for commercial transactions disguised as altruistic donations in the Filipino social context. Conclusion This study has identified the association of the decision-making considerations of Filipino kidney sellers and recipient buyers based on the Filipino social context and the challenges faced by the Philippine regulatory system in identifying clandestine organ sales. This research additionally identifies the need to strengthen the screening process in order to prevent the exploitation of vulnerable kidney sellers in the Philippines.