Transplant Tourism Research Articles

Impact and Implications of Solid Organ Transplant of Undocumented Immigrants versus Transplant Tourists on the Transplant Center and OPTN National Policy Development

Impact and Implications of Solid Organ Transplant of Undocumented Immigrants versus Transplant Tourists on the Transplant Center and OPTN National Policy Development

Criminal Legal Regulation of Trafficking in Human Bodies: Spanish and Brazilian Experience

Organ trafficking, a very profitable worldwide illegal activity today, is frequently overlooked by those involved in combating human trafficking due to its complex and covert nature. Numerous international documents underscore the importance of countering trafficking in human organs and transplant tourism. This article analyzes the legal frameworks of Spain and Brazil, with a particular focus on their compliance with international and supranational standards aimed at combating, inter alia, the illegal circulation of organs and other phenomena associated with it. Firstly, the article distinguishes such phenomena as transplant commercialism, transplant tourism and illegal trafficking in organs and draws attention to the fact that currently there is no uniform understanding of the clear boundaries of the concept of illegal trafficking in organs. Elaborating on the various aspects of the above-mentioned types of criminal activity may allow one to properly determine the legal interests and rights protected by criminal law and the types of behavior subject to imputation in an exhaustive way. Secondly, the authors outline a number of controversial issues that arise due to the complex nature of organ trafficking and suggest several ways to meet these challenges.

International Travel for Organ Transplantation: A Survey of Professional Experiences and Attitudes Toward Data Collection and Reporting.

Lack of data regarding international travel for organ transplantation (ITOT) hampers efforts to evaluate, understand, and respond to trends in ITOT activities, such as those suggestive of organ trafficking or "transplant tourism." This study aimed to assess transplant professionals' experience of ITOT and their attitudes toward reporting ITOT data to a global registry. An international cross-sectional anonymous survey of transplant professionals was conducted online (from October to December 2022). The English language questionnaire assessed professional experiences in providing care to individuals who had traveled to or from a country for living donation or transplantation, and attitudes toward reporting of ITOT data. Data were analyzed with descriptive statistics. Two hundred thirty-nine individuals from 68 countries completed the entire questionnaire, of whom 79% had provided care for ≥1 patient who had traveled internationally for donation or transplantation. Of these, 60.8% of individuals (n = 115) had cared for ≥1 person who engaged in ITOT between 2019 and 2022, with the most recent case experiences involving 89 countries and 157 unique routes of international travel. Predominant concerns regarding reporting of ITOT data to a global registry related to prevention of harm and protection of patient privacy; most (52.7%; n = 126) respondents expressed a preference for anonymous reporting of ITOT data. ITOT is a global phenomenon and transplant professionals' experience with ITOT cases is more common than anticipated. Systems for the collection of ITOT activity data should be carefully designed to address potential ethical concerns of transplant professionals which may influence reporting practices.

Foreign experience of legal regulation of criminal liability for violation of the procedure for transplantation of human anatomical materials established by law

The article examines the experience of individual countries in matters of legal regulation of criminal liability for violation of the procedure for transplantation of human anatomical materials in order to determine important legal assets of foreign legislation, which could be discussed for the purpose of further implementation in Ukrainian legislation. Within the framework of the article, we will analyze national and international legislation, namely, we will compare the content of Articles 143 and 144 of the Criminal Code of Ukraine with the content of the corresponding articles and provisions in the legislation of several countries from the perspective of the used terminology, interpretation of concepts, descriptions of crimes, measures of criminal liability, etc. The Constitution of Ukraine guarantees every person the right to life. However, experts increasingly raise questions about various violations of this right from the perspective of transplantation of human anatomical materials. Today, criminal offenses in relation to both donors and recipients become difficult to detect due to high self-interest and profitability, disguised nature, network systematicity, extensive illegal infrastructure and fast mechanisms for its recovery, group organization and strong connections with other criminal groups, use of deception, coercion, intimidation and other methods of forced donation, corruption in the field of donation, large-scale latent level of crimes related to transplantation. Detection of illegal transplantation is also burdened by their contradictory geography, when potential donors are recruited in the so-called "depressed" countries around the world, and anatomical materials are seized in countries that are highly developed in the field of transplantology, having loyal legislation to carry out such operations. In Ukraine, the detection of such crimes is also aggravated by the fact that people who are ready to illegally donate their organs for payment, travel to remove the organ outside the country and carry out their plans in other countries ("transplant tourism"). Due to the low level of information and enlightenment of the society in matters of transplantation, the detection of crimes in this area is also complicated by the so-called "victimhood" of people (both donors and recipients) – a set of personal traits that cause a high probability of becoming the object of a criminal attack (a tendency to become a victim of crime). These grounds contribute to a dynamic increase in the number of violations of the law-enforced procedure for the transplantation of human anatomical materials, which constitutes a high public danger. At the same time, the legal regulation of criminal liability for such violations still has certain differences. Therefore, the study of foreign experience in matters of transplantation, the comparison of the norms of articles in the Criminal Codes of different countries, and the analysis of concepts used in normative legal documents and their interpretations help to identify gaps in Ukrainian legislation, clarify the wording, expand the range of crimes and facilitate the qualification of their composition, adaptation of the Ukrainian legal system according to European standards.

Road To Deceased Donor Transplantation in Egypt.

In Egypt, there is presently a growing need to have a deceased donor transplant program. Egypt conducted its first kidney transplant from a living donor in 1976 and a first partial liver transplant in 2001. Since 2009, the Egyptian Health Authorities Combat Transplant Tourism in concordance with ethics codes and the Declaration of Istanbul Custodian Group has been in place. The Egyptian Transplantation Law of 2011 mentions that organs could be procured from deceased donors based on a will and on family consent. This law has had many critics, including religious authorities who have stressed that organs cannot be taken from a person with brain death because, in their view, life ends with death of all organs. Many intensivists disagree over the definition of death. In addition, the media has communicated contradicting and sometimes misleading health care information. Mummification is rooted in pharos practice and linked to religious beliefs. The ancient Egyptians believed that, by burying the deceased with their organs, they may rejoin with them in the afterlife. Since 2019, the transplant community in Egypt has started collaborations with international transplant organizations and campaigns with doctors and celebrities to donate their organs after death, which have stressed that a deceased donor program could help against end-stage organ mortality. In November 2022, after communications with politicians, President Abdelfattah El Sisi directed the government to establish a regional center for organ transplantation, which aimed to be the biggest in the Middle East and North Africa region. The new center will be part of a new medical city that would replace Nasser Medical Institution in Cairo, Egypt. The Ministry of Health issued an official form to be signed by a person before his death, accepting use of organs, to give hope and support to other patients in need.

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low- and middle-income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low-resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient-physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.

Trafficking and Organs, Tissues, and Cells: An Examination of European and UK Legislation and Gaps

Abstract Substantial custodial sentences were handed down from the English Central Criminal Court for organ trafficking. Attempts to exploit vulnerable people for the purposes of organ removal, and for organ, tissue, and cells (otc) trafficking are ongoing in many jurisdictions. It is also clear from the 2019 EU evaluation of the Union legislation on blood, tissues, and cells that there is increasing commercialization in the procurement of human material for medical use, using global supply chains. Full traceability of all human material, for which there is a shortage to meet global medical needs, is required. The medical profession has drafted the Istanbul Declaration on Organ Trafficking and Transplant Tourism 2008, calling for transplant tourism to be prohibited, and full engagement with transnational law enforcement to address developing transnational organized crime in this area. This paper addresses the global, Council of Europe, EU, and UK provisions in this area.

Ethical aspects of organ transplantation and transplantation tourism

Ethical aspects of organ transplantation and transplantation tourism

Transplantes de órgãos: abordagens éticas e soluções legais

Abstract This integrative literature review investigates legal aspects and ethical solutions involved in the illegal organ trade, an activity that sparks debates about ethics and morals. Bibliographical search was conducted on the Virtual Health Library, PubMed and SciELO databases. A total of 14 papers were analyzed, which pointed to low supply associated with high demand for organs as the main etiology of the problem. This market takes advantage of vulnerable populations to coerce them into organ donations. Additionally, the lack of connection between international databases and instabilities in countries with high trafficking rates hinders police action to confront this crime. Organ trafficking should be combated by encouraging legal organ donation, confronting “transplant tourism” and actions aimed at the most vulnerable countries. International entities play a fundamental role in ensuring that different nations work together to repress this type of crime.

Should Physicians Be Permitted to Refuse Follow-Up Care to Patients Who Have Received an Organ Transplant Through Organ Trafficking?

In 2018, the Istanbul Declaration stated that organ transplantation via organ trafficking is a crime. Since then, the number of medical institutions in Japan who refuse follow-up care to patients who have undergone unethical organ transplantation overseas has been gradually increasing. Deterring transplant tourism involving organ trafficking is an issue that must be addressed by the government, medical institutions, and individual physicians. The refusal of medical institutions and individual physicians to provide follow-up care after organ transplantation may challenge the idea of the incompatibility thesis; moreover, it may be ethically justified in the context of conscientious objection if it is based on the belief of deterring transplant tourism instead of punitive motives or a reluctance to support a criminal activity. However, conscientious objection based on a belief in fair transplantation care is conditional; according to the compromise approach, it is limited to particular conditions, such as that the patient's medical state does not require urgent care and that the patient is reasonably able to receive follow-up care at another institution.

Transplant tourism - a missed opportunity.

To explore the resurgence of transplant tourism (TT) despite the recent reiteration of the Declaration of Istanbul (DoI) in 2018. As demand grows exponentially and supply remains static, novel approaches to bridging the gap should be explored. TT is estimated to comprise up to 10% of transplants worldwide. Prosecuting patients seeking organs through TT has been unsuccessful. Extra jurisdictional prosecution of brokers, vendors and institutions participating in illicit TT has been difficult. Resurgence of TT has occurred in both "traditional" and new countries. The public attitude towards TT and paid donation is largely positive. The Iranian experience with state regulated paid donors merits attention and perhaps emulation. Numerous philosophers, ethicists and transplant professionals find it acceptable to promote financial consideration for organ donors. Acknowledging the autonomy of persons, including poor and vulnerable ones, to receive financial consideration for their sacrifice should not be considered morally reprehensible. Strict international regulation, oversight and legislation should be implemented to assure adequate compensation, donor wellbeing, elimination of brokers and excellent medical care. Implementing such a system internationally may eliminate kidney waiting lists, provide great benefits to vendors, improve transplant facilities in developing countries and provide substantial savings to insurers.

Ethical and policy considerations for organ trafficking and transplant tourism: Based on the UK's first international case of human trafficking for the purpose of organ removal

AbstractThis study examines the UK's May 2023 judgment in an international organ trafficking and organ tourism case. Human trafficking for organ removal is one of the least understood but growing forms of trafficking worldwide. Countries in the Middle East, Asia, and the Americas are often widely criticized by the international transplant community as sites for organ trafficking. However, we believe that when discussing this issue, it is not just these areas that need to be addressed. What is particularly special is that this case not only involves transnational human trafficking, organ trafficking, and illegal organ transplantation interest chains but also involves the participation of national political officials and complex social and humanistic factors. This article focuses on the current ethical and policy issues involved in organ transplant tourism and organ trafficking and analyzes the implications of this case for our country's donation and transplantation work.

Трансплантационный туризм как актуальная гуманитарная проблема в современном медицинском образовании

Важным компонентом современного медицинского образования является биоэтика, которая позволяет дискутировать об актуальных гуманитарных проблемах. Одной из них, несомненно, является трансплантационный туризм. Имеющиеся сведения о попытках некоторых россиян решать свои проблемы со здоровьем посредством выезда заграницу, получения там донорского органа и проведения операций позволяют судить о растущей значимости данного явления. Его объективными предпосылками являются дефицит донорских органов и неспособность системы здравоохранения единовременно удовлетворить потребности всех нуждающихся пациентов. Основным направлением для трансплантационного туризма в последнее время являются страны Азии: Индия и Китай, но ситуация там меняется, поскольку власти предпринимают усилия, направленные на устранение данного неприглядного явления. Риски, сопровождающие выезд российских граждан в качестве трансплантационных туристов, разнообразны. Они включают в себя как медицинские, так и этические аспекты.

Normothermic Perfusion: A Game-Changer For Kidney Transplantation?

Respected Madam, Organ transplantation has revolutionized the field of medicine. Kidney transplant, in particular, is of significant importance in Pakistan as there is an estimated prevalence rate of patients with end-stage renal disease (ESRD) of 100 per million population. The annual transplant rate is only about 8 to 10 cases per million.1,2 Due to this shortage in organ transplants, over 15,0000 people lose their lives each year due to end-stage organ failure, among which 15000 are patients with end-stage kidney failure. These numbers can be reduced greatly if the number of kidneys available is increased.3 As the number of organs available for a kidney transplant is limited in Pakistan owing to strict regulations to end transplant tourism, it is crucial to increase the viability of the organs available to ensure the success and survival of patients suffering from ESRD.4 An exciting finding was revealed by Kidney Research UK, where 100 kidneys could potentially be saved for transplant each year after being retrieved from donors in the UK via normothermic perfusion, This technique has shown promising results in numerous research.5 As evident from the name, in this technique, oxygen is provided to organs during preservation to allow aerobic metabolism. In a review conducted by Franka Messner et al, it was concluded that this technology may be used as an ex-vivo organ assessment and treatment platform. During renal NMP, mesenchymal stromal/stem cells, multipotent adult progenitor cells, and microRNA have been used in studies, and preliminary data shows that these therapies do indeed reduce kidney injury and inflammatory response. Furthermore, in comparison to any cold preservation approach, normothermic ex vivo kidney perfusion (NEVKP) revealed a considerable reduction in preservation harm in a study conducted by Laura I Mazilescu et al.6 As the demand for kidney transplants increases in Pakistan, normothermic perfusion can be studied further to provide an efficient technique for the preservation of organs. By ensuring the better viability of the available organs, we can perhaps help to increase the chances of survival of patients suffering from ESRD since we already face a shortage in the number of organs available for transplantation.

Organ Trafficking in Africa: Pragmatist Ethical Reconsiderations

Abstract This article focuses on examining the situation of organ trafficking in Africa from the aspect of pragmatist ethics. In the mainstream thought, the broader ethical dilemma of organ trafficking is viewed within the moral contestation of altruism as a rule for organ procurement and the resulting worldwide organ shortage. The incapability of altruistic transplant orthodoxy to serve as an applicable foundation for a public policy is considered as a reason for organ trafficking. In fact, to battle organ trafficking, utilitarian-inclined studies suggest organ selling, compensated donations, and non-directed paid donations as practical alternatives. However, when investigating the context of organ trafficking in Africa, the issue goes beyond the mere moral dilemma of altruism and organ shortage. In the region, organ trafficking is rooted within more systemic, structural, socio-economic, and political problems, grounded in the abuse of transplantation, and connected to transplant tourism and migration, which needs a pragmatic multimodal solutions than the earlier mainstream pathways. In pragmatist ethics, the moral assessment and solutions to the underlying problems depend on the context wherein the moral problem arises. Pragmatist ethics does not stick to absolute moral theories; instead, it focuses on the relevant assessment of the felt moral problem in a given context and aims at seeking solutions afresh. Thus, in the subsequent sections, this article looks at the context of organ trafficking in Africa and reassesses it by incorporating it into the ethical debates of transplantation and organ procurements and trading. The final part of this article reflects on solutions with the reconsideration of the context of transplantation and organ trafficking in the region.

HUMAN ORGAN TRAFFICKING AND TRANSPLANTATION: A LEGAL ANALYSIS OF CAUSES, CHALLENGES AND IMPLEMENTATION OF EXISTING LAWS IN PAKISTAN

Organ transplant save many lives every year throughout the world. But at the same time lives of donors are in danger because of illegal organ trade which is common in third world countries. People from all over the world especially from developed countries including Europe, Australia, and United States come to developing countries including Pakistan, India, and other developing countries every year. They used to hunt poor donors who are all set to sell off their healthy organs in return of money. Recent repot of World Health Organization (WHO) says that annually almost ten percent kidney transplants of the overall kidney transplants that happen in the world involve donors from the above mentioned developing countries. Current research is based on laws which can overcome this alarming situation and also highlights the issues regarding implementation of existing laws and policies. Transplant of Human Organ and Tissue Act 2010 is a relevant law which provides removal, storage and transplantation for therapeutic purposes. This research is of qualitative and exploratory nature. It is such as to find out the most relevant information for the topic and made evaluation using tools to take out research through articles, books, case studies and online materials. This research critically evaluates the laws which are related to organ trade in Pakistan. Primary source of research is relevant laws and their critical evaluation and secondary source of this research is journals and articles of relevant topic. This research concludes that Organ trafficking is one of the most common illegal activities in the world and particularly in Pakistan. In the last few decades, there have been a number of transnational issues. The most highlighted causes are poverty, exploitation of minors, and lack of viable organs. However, the root cause for the current scenario is the lack of proper legislation regarding illegal organ trade and the implementation of existing laws. The government and other public/private organizations shall observe the relationship between donors, donor health and organ trafficking in order to develop efficient policies against organ trafficking and transplantation tourism (Naziha Syed Ali, 2017). Keywords: Human Organ Trafficking; Legal Challenges; Transplant Tourism; THOTA Act

HUMAN ORGAN TRAFFICKING AND TRANSPLANTATION: A LEGAL ANALYSIS OF CAUSES, CHALLENGES AND IMPLEMENTATION OF EXISTING LAWS IN PAKISTAN

Organ transplant save many lives every year throughout the world. But at the same time lives of donors are in danger because of illegal organ trade which is common in third world countries. People from all over the world especially from developed countries including Europe, Australia, and United States come to developing countries including Pakistan, India, and other developing countries every year. They used to hunt poor donors who are all set to sell off their healthy organs in return of money. Recent repot of World Health Organization (WHO) says that annually almost ten percent kidney transplants of the overall kidney transplants that happen in the world involve donors from the above mentioned developing countries. Current research is based on laws which can overcome this alarming situation and also highlights the issues regarding implementation of existing laws and policies. Transplant of Human Organ and Tissue Act 2010 is a relevant law which provides removal, storage and transplantation for therapeutic purposes. This research is of qualitative and exploratory nature. It is such as to find out the most relevant information for the topic and made evaluation using tools to take out research through articles, books, case studies and online materials. This research critically evaluates the laws which are related to organ trade in Pakistan. Primary source of research is relevant laws and their critical evaluation and secondary source of this research is journals and articles of relevant topic. This research concludes that Organ trafficking is one of the most common illegal activities in the world and particularly in Pakistan. In the last few decades, there have been a number of transnational issues. The most highlighted causes are poverty, exploitation of minors, and lack of viable organs. However, the root cause for the current scenario is the lack of proper legislation regarding illegal organ trade and the implementation of existing laws. The government and other public/private organizations shall observe the relationship between donors, donor health and organ trafficking in order to develop efficient policies against organ trafficking and transplantation tourism (Naziha Syed Ali, 2017). Keywords: Human Organ Trafficking; Legal Challenges; Transplant Tourism; THOTA Act

#4635 CIRCULATING NEPHRIN AUTOANTIBODIES IN PATIENTS WITH POST-TRANSPLANT RECURRENCE OF PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Abstract Background and Aims Post-transplant recurrence of primary focal segmental glomerulosclerosis (FSGS) is a major challenge in the field of nephrology and kidney transplantation. Primary FSGS is thought to be caused by circulating factors (CFs) that injure podocytes, but these factors remain unknown despite intensive efforts to identify them. Recently, one post-transplant recurrent FSGS patient with pretransplant nephrin autoantibodies was reported (Watts AJB et al, JASN 33:238, 2022). Furthermore, we reported very early post-transplant recurrence changes of podocytes and possible roles of circulating nephrin autoantibodies in a patient with FSGS recurrence (Hattori M et al, AJT 22:2478, 2022). To confirm these preliminary results, we examined the autoantibodies to nephrin and the punctate deposition of IgG colocalized with nephrin using stocked plasma samples and grafted kidney biopsy specimens of the patients with FSGS recurrence. Method This study was approved by the local Ethics Committee of Tokyo Women's Medical University (approval no. 2021-0184). The clinical and research activities reported here are consistent with the Principles of the Declaration of Istanbul as outlined in the “Declaration of Istanbul on Organ Trafficking and Transplant Tourism”. From 1989 to 2022, a total of 78 patients with FSGS underwent kidney transplantation in our institution, and 16 patients experienced post-transplant recurrence of FSGS. Since the stoked plasma samples were available in 14 out of 16 patients, these 14 patients were included in this study. All 14 patients showed immediate post-transplant recurrence and had no pathogenic variants in FSGS-related genes including NPHS1. Circulating anti-nephrin autoantibodies were measured using the ELISA methods based on the Watts's report with one modification, that is, recombinant extracellular domain of human nephrin was obtained commercially (R&D systems, USA). To validate the ELISA system, circulating anti-nephrin autoantibodies were also measured in 9 genetic FSGS patients, 13 membranous nephropathy (MN) patients, 4 lupus nephritis (LN) patients, and 13 healthy controls. Dual immunofluorescence (IF) staining of nephrin and IgG and image acquisition using the two-dimensional structured illumination microscopy mode with a Nikon microscope were performed as previously reported (Hattori M et al, AJT 22:2478, 2022). Results The cut-off level of anti-nephrin antibody calculated from the results of a total 30 cases including 13 MN patients, 4 LN patients, and 13 healthy controls using Frey's formula (J Immunol Method, 1998) was 172.2 U/mL All 14 recurrent patients enrolled in this study had higher titter than the cut-off level and the mean ± SD of the anti-nephrin antibody level in these patients was 939.9 ± 261.8 U/mL. In contrast, the mean anti-nephrin antibody level in patients with genetic FSGS was 98.6 ± 77.3 U/mL, which was comparable with healthy controls. The IF staining of graft biopsy specimens showed punctate depositions of IgG colocalized with nephrin in all 14 recurrent patients. Conclusion The autoantibodies to nephrin in plasma samples and the punctate deposition of IgG colocalized with nephrin in grafted kidney biopsy specimens were observed in all 14 patients with post-transplant recurrent FSGS. Further studies in larger numbers of patients as well as in patients of other ethnicities are clearly required to confirm this surprising result; however, circulating nephrin autoantibodies could be a possible candidate for CFs in the pathogenesis of recurrent FSGS.

Transplant tourism: a literature review on development, ethical and law issues

This study aims to narratively review the progression of ethical and legal issues related to transplant tourism. PubMed search and Google search with keywords were used in March 2022 to identify relevant studies and law documentation. The progression of transplant tourism was classified into three main periods. Before 2000, the most popular destination country was India (1,308 cases), this period was characterized by the absence of laws and regulations worldwide. The period from 2000 to 2010 was the peak explosion of transplant tourism, China became the most popular destination of tourists (7,591 cases). This triggered alarms by World Health Organization (WHO) resolution in 2004 and Istanbul declaration in 2008 calling for regulations to prohibit transplant tourism. From 2010 till today, additional scientific publications reported several complications in overseas transplanted patients. Laws and regulations restricting transplant tourism were promulgated by many countries such as Israel, Taiwan, Spain and others. Transplant tourism is considered as illegal worldwide. WHO and many developed countries announced laws and measures to prevent this activity. The incidence of transplant tourism is currently decreasing, continued efforts should persist to end this criminal act.

Forced Organ Harvesting

Forced Organ Harvesting