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There is a fundamental weakness in the living donor side of
the transplant - there isn't much donor advocacy and there are
no agreed upon standards for how to deal with assessment or make
decisions about who is eligible to be a living donor. Without
those standards, then there is danger all over the place in
terms of solicitation of strangers.
-
Arthur Caplan, Science and Theology (July 25, 2005 |
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Transplant technologies have resulted in life-saving or
enhancing results for hundreds of thousands of patients in need
of organs or tissues. These technologies have also created a
vast and growing market for a supply of organs. Many countries
rely primarily on organ and tissue donations from “non-living”
donors (brain stem dead and non-beating heart cadavers). Other
countries have very low consent rates of non-living donorship
(Japan, the Middle East
and Islamic societies) or prohibit the procurement of organs
from the non-living (Egypt) and instead rely on living- related
and non-related (or recruited, commercial) donors as a source of
organs. Despite international declarations on transplants that
condemn the solicitation of financial-incentive driven donorship, the demand for
organs has nevertheless created a global trade in human organs.
The international literature
documents exploitative and unsafe practices of individuals who
have been solicited, recruited, and/or trafficked to serve as a
commercial organ donor
(Abouna 2003; Budiani 2005, 2006; Goyal et. Al. 2002; Scheper-Hughes
2000; Shaheen 2001; Zargooshi 2002). Organ sellers have been
reported to suffer significant health, economic, social and psychological consequences as a result of the organ procurement (Budiani 2006; Goyal et. Al. 2002; Scheper-Hughes 2000, 2002, 2004; Zargooshi
2002). There are also increasing reports of donor death,
particularly within the developing world (Abdel-rahman
2006; Bansal 2003).
Medical professionals agree that transplant therapies have very
positive results when proper recipient care is continued with
adequate (yet costly) immuno-suppressant medications. However,
the World Health Organization (WHO), the World Medical
Association (WMA), the international Transplantation Society,
and almost universal religious statements are opposed to the use
of financial incentives and reliance upon the poor as suppliers
of organs and tissues for transplant.
The
Coalition for Organ-Failure Solutions (COFS) recognizes the
increasing rates of diagnosed organ failure and the subsequent
increasing demand for organs and tissues for transplant. Accordingly, COFS seeks to unite key stakeholders to advance
ethical solutions for organ-failure patients and potential
donors as well as assistance to individuals who have been or may
be solicited for donorship of an organ or tissue.
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COFS Mission:
- encourage state accountability for establishing solutions to the problem of organ trafficking.
- support movements to secure solutions for patients in need of organs and tissues other than the reliance upon global underclasses of living unrelated, solicited donors as a source of organ supplies.
- provide assistance to individuals who have already been solicited for donorship.
- provide outreach to vulnerable groups of potential donors.
COFS Vision:
- COFS envisions a world of ethical solutions for organ failure patients and donors that does not rely upon and exploit underclasses.
Strategic Goals:
COFS addresses the problems of both demand and supply for organs in its patient-donor integrated approach.
- Organ failure patients: COFS supports and facilitates efforts to prevent and treat organ failure and to encourage systems of fair and equitable distribution of organs to patients in need.
- Donors: Non-related, solicited living organ donors are among the most marginalized and vulnerable segments of a population. After “donating” an organ, they are largely abandoned by everyone involved in the transaction– clinical institutions, brokers, recipients, the state, and they may also experience rejection by their inner social circles if made aware of their organ sale. Furthermore, these victims of the trade may also be criminalized for their participation in this illegal procedure.
COFS partners with grassroots organizations to provide assistance to individuals who have undergone solicited organ donorship including health care services, long-term clinical follow up, income generation/ employment assistance, emotional support, and referral to legal services.
- Potential donors: COFS aims to ensure that living organ donorship is obtained via voluntary and informed consent and not the exploitation of positions vulnerability or coercive means. Donors should be adequately informed of the risks and long-term consequences of organ donation, including the limitations of the clinical knowledge about risks and consequences. Similarly, COFS aims to ensure that consent obtained for donorship upon death is also informed, voluntary, and not via methods of induced coercion.
Countries that host transplant surgeries must maintain accountability for the ethical procurement and fair and equitable distribution of organs from non-related donors. We bring key stakeholders involved in transplants and organ trafficking together at the table to find ethical solutions for supplies of organ and tissues for transplant. Solutions could include but are not limited to:
- stricter measures of verifying that organ donation is not
induced, coerced, or exploitative
- penalties to all parties involved in recruiting and facilitating a transplant with a
 recruited donor
- encouraging alternative sources for organs such as via organ
sharing programs, permitting and increasing prior consent of donation from the
non-living, supporting advances in xenotransplants
- encouraging other treatment measures such as
hemodiafiltration (an advanced dialysis treatment that is
reported to have as good of results as renal transplants in
treating end stage renal failure) in the case of renal failure.
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