Organ transplantation is a vital medical procedure, saving hundreds of human lives every year by providing those unfortunate enough to have encountered problems with their own organs another chance at a normal existence. However, the only legal means of supplying organs for transplant, in most developed countries, is through the organ donation system within that country, which almost invariably fails to provide as many organs as are required. As a result, many eligible organ transplant patients die while still on the waiting list for the transplant that might have saved their life.
For the particularly wealthy and desperate, though, there exists at present an alternative avenue for obtaining an organ-- the illegal organ trade. Organs are taken from desperately impoverished people in developing, often war-torn countries (sometimes with consent given in the hope of earning enough money from the sale to survive, other times without) and implanted into those rich enough to pay, with a very significant commission going to those callous enough to facilitate the exchange. Governments respond in various different ways to the existence of the trade, with some banning it entirely while others create legal channels for it to operate in, ignore it altogether, or even encourage it as a means of creating a temporary form of economic growth.
The obvious question here is: what can now be done to reduce the volume of the organ trade and/or the incidence of exploitative practices, without further compromising the availability of transplant organs? Our research experience suggests a number of different options for tackling these problems. Firstly, the supply side of the problem needs to be addressed; those who hold positions of authority in developing countries need to find more effective methods of combating the organ trade. Unfortunately, the possibility of any action of this kind being taken is remote: for one, governments in such countries are often either powerless, incredibly selfish and corrupt, or too busy trying to address more significant and widespread difficulties in other fields. The factors which seemingly predispose a country to the incidence of organ trafficking-- lawlessness, a history of war and rampant poverty-- are the same factors that would generally be caused by, or contribute to, the existence of ineffective bureaucracy and some degree of disregard for human rights. Even in cases where such governments have tried to find ways of combating the trafficking system, these have often proven unsuccessful (as in the case of India's Transplant Authorisation Committee) or helped to perpetuate some aspects of the problem, as in the case of Iran's paid organ donation system, which continues to provide a financial incentive for poorer people to trade in one of their own body parts while still alive, despite the continuing negative consequences to those people's health that arise as a result.
An alternative way of approaching this difficulty could be to suggest that governments in developed countries ought to address the demand side of the problem by finding ways to increase the numbers of organs donated, domestically and by legal means, such that they satisfy all demand for transplant organs existing within that country. The most obvious, and probably the most effective, way of doing this would be to introduce an opt-out, rather than an opt-in, organ donation model, to counteract the apparent apathy of the general population; such an approach is clearly supported by statistics, as demonstrated by those countries which have chosen such a course. Other possibilities include an increase in public education programs relating to organ donation, in order to diminish the prevalence of misconceptions which might discourage people from donating, or promoting a stronger focus on the nature of organ donation as a generous and life-saving act in order to counteract perceived religious or spiritual qualms certain groups may have with regards to the practice. Such demand-side solutions have the dual benefits of being more effective in reducing the volume of the trade (after all, economics suggests quite clearly that no demand = no market), as well as avoiding a compromise on the quantity of transplant organs available by providing an alternative source, and making access to these additional organs more equitable by encouraging a need-based rather than wealth-based distribution system.
In conclusion, it would seem that the challenges posed by the illegal organ trade, while in no way insignificant or easily dealt with, are not entirely unsolvable if approached proactively and with a real willingness to change. The power to create this change rests in the hands of those in power in developed countries: in reducing the existing shortage of organs, governments can address the demand side of the organ trade equation, helping to end the exploitative practices which ruin so many lives. It can only be hoped that, in future, a more co-ordinated international approach of this type will be able to remove the motivations of desperation and greed which continue to propagate the tragedy of the international organ trade.
