Organ transplantation is, not surprisingly, a difficult but lifesaving procedure used all over the world. However, the potential benefits of organ transplantation for the many deserving recipients are limited by one crucial factor—namely, that the enormous demand for transplant organs in fact exceeds the available supply. (According to the Australian Government initiative for organ donation, “Donate Life”, at any one time around 1700 people in Australia alone are on the waiting list for life-saving or life-improving organs; in 2009 there were only 247 deceased organ donations in Australia, meeting less than half of the overall need for transplants.) This failure on the part of Australia and other developed nations to meet their population’s demand for transplant organs creates the basis for the international illegal organ trade. Unfortunately, the underlying causes for this scarcity of organs are not quite so simplistic as there are a number of different factors contributing to the issue. This paper will discuss the various reasons why Australia and other developed nations are unable to provide sufficient transplant organs for their population, as well as suggesting a few possible improvements that could be made to the existing system to reduce the scale of the shortage.
(For a general background or further information on the illegal organ trade, refer to http://smartsgroupd.blogspot.com/p/joshua.html -- a concise explanation of this topic from our contributor Joshua Hetherington.)
At present, developments in medical science allow for the transplantation of the heart, lungs, liver, kidneys and pancreas. In fact, medical technology has advanced so far as to potentially allow the first ever reproductive organ transplant to occur: this was recently reported in the global media, when it was announced that 25 year old UK citizen Sara Ottosson hoped to receive a uterus from her 56 year old mother Eva (Sample, I 2011). In Australia the deceased can donate organs if they register, are given family consent and still possess organs which have been maintained in a useable condition. It is also possible to make a kidney or partial liver donation whilst the donor is still living, although at present this usually occurs only in the event that a family member is in need of the organ in question. Transplant organs are used to replace failed organs only once all other possible treatments have failed, or alternatively, if permission is granted, donated organs can be used for medical research and testing (Donate Life, 2011). Nevertheless, it is often a long wait on the receiving end—even once a transplant has been approved, the shortage of available organs means it may be many years before a suitable organ is made available. Many prospective organ recipients die before ever getting the chance to have a transplant.
These long waiting periods for organ recipients help to drive the illegal organ trade. A person is placed on the organ donation waiting list after all other potential medical treatments have failed. In Australia organs are allocated by a complex system designed to promote fairness, as it takes no account of race, religion, gender, social status or disability. Allocation is based on the organ involved and the state or territory in which this organ becomes available. If there is no suitable recipient in the state or territory it is offered to another based on a roster system used to ensure equality of distribution of organs (Donate Life, 2011). The waiting time is dependent upon the availability of the required organ and as well as the number of people already on the waiting list for this organ. In Australia, it usually takes between six months and four years for an organ to become available, but there are cases where it may take even longer (Donate Life, 2011). It seems this wait (and its equivalent in other developed countries) is what fuels the illegal international trade in organs, as it can provide an alternative organ source for recipients with a shorter wait period required. Those that can afford it may make the choice to travel overseas where organs can be purchased for money. Not only does wealth have the ability to reduce the waiting time for an organ, statistics show there is a higher supply of organs in countries where governments have a more opportunist and avaricious approach to organ harvesting, mostly due to the questionable organ donation systems that are able exist (Shroff, S 2004). For example, in Israel, Saudi Arabia and Iran, compensation in the form of money and health insurance is given by the government to those that donate organs and to the family of a deceased donor, providing the citizens with an additional incentive to donate organs (as opposed to the model of purely altruistic donation favoured by most other countries), and hence resulting in an increased number of donations (AsiaOne, 2011). Although there are a number of dubious ethical issues associated with such a system, and the motivations it provides for the impoverished or downtrodden in society to donate parts of their body for quick cash, its variants could be said to deserve some consideration as our government looks towards solving the great shortage of transplant organs available in Australia today.
(For more information on the state of the organ trade in countries other than Australia, and the ways in which these countries have responded to the challenges associated with organ transplantation, visit http://smartsgroupd.blogspot.com/p/jakov.html.)
Another contributing factor to the shortage of organ donations in First World countries such as Australia, and thus the reliance of their wealthier transplant-seeking population on the illegal organ trade, is the system of organ donation used by the home country. Australia’s organ donation system is in the “Opt-In” category, a system where a prospective must nominate to have their organs donated once they are deceased, as opposed to their organs automatically being donated unless they state they wish otherwise (an “Opt-Out” system). Unfortunately, this system requires much more effort from potential donors than an opt-out model, and has recently been adapted to be even more cumbersome, with the removal of the driver’s licence pathway to organ donation. Family consent, which can be given both before and after death, is also required. Statistics show only 58% of families give consent for organ and tissue donation to succeed (Donate Life, 2011). This system has been proven to be much less effective than the opt-out system used by other countries including France, Belgium, Italy and Spain: in Belgium, for example, only 3-4% of the population opt out, leaving 96-97% of the population still in the pool of potential donors, as compared with the roughly 30% of Americans who are organ donors in the opt-in system (Crofut-Brittingham, A 2007). Overall, it is clear that the opt-in system maintained by the majority of First World countries, including Australia, the United States and Germany, is ineffective in satisfying domestic demand for organ transplants and therefore fuels the growth of the illegal organ trade; the adoption of an opt-out system would therefore be recommended as a means of reducing further shortages of transplant organs in these countries.
Many misconceptions currently surrounding organ donation discourage people from becoming organ donors and hence exacerbate the existing shortage of organs. Firstly, people are often led to believe that by having registered to be an organ donor their organs will donated upon the occasion of their death. In reality, there is much more involved in the donation system than this. Possibly the most important factor is that consent must be given by family members; as previously discussed, only 58% of families give permission for the organ and tissue donation to proceed due to being unaware of the wishes of the deceased or finding that the decision is too traumatic (Donate Life, 2011). Moreover, even if a donor is properly registered with family consent their organs cannot always be used in a transplant. Very few people die in such a way that donation is possible, as the person must die in a hospital where their body can be kept on a ventilator until the organs can be donated (Donate Life, 2011). A second common misconception is that the organs of those who die beyond a certain age are no longer useful. However, this is not necessarily true—the organs and tissues of many elderly people or even children have the ability to save the lives of those in desperate need of a transplant. According to Professor James Neuberger, associate medical director at NHS Blood and Transplant, organs can be successfully transplanted from people in their 70s and 80s. Thirdly, the belief that organ donation is not endorsed by most religions due to the fact that a deceased body is being altered in some way, affecting its spiritual wellbeing, prevents many people from agreeing to donate their organs. In reality, organ donation is recognised as an extremely generous act that helps to save or improve the lives of many—so in actuality, organ donation is endorsed by many of the world’s major religions including Christianity, Islam, Buddhism, Hinduism and Judaism (Donate Life, 2011). Lastly, those who are unhealthy and/or suffering from lifestyle diseases can still often donate their organs. Although smoking, drinking and being overweight affects the functioning of some organs there are many other organs in the body still useful for donations and medical research. There are only a few conditions that can prevent a person from becoming a donor, mostly transmissible conditions such as HIV (Donate Life, 2011). The misconception that there is a certain age limit or degree of heath that is required for a person to be able to donate useful organs, as well as the false belief that organ donation is not endorsed by most religions, discourage people from donating their organs and contributes to the shortage of organs that exists in society.
In summary, long waiting periods, the opt-in organ donation system and misconceptions about the facts of organ transplantation create an extreme shortage of organs in Australia and other developed nations, prompting the wealthy, unscrupulous and desperate to look for suitable organs on the illegal international market. Illegal trades generally operate under corrupt systems of government which often lead to the exploitation of members of lower socioeconomic groups in developing countries. Improvements in the organ donation systems of industrialised nations would reduce demand for illegally obtained organs overseas and therefore the many problems created by the international organ trade.