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Abstract and Introduction
Abstract
Patients travel worldwide to purchase kidneys. Transplant professionals can play a role in identifying kidney purchase. However, due to the tension between their rights and obligations, a lack of understanding and knowledge exists on how to prevent and report purchase. We present the results of a national survey that describes transplant professionals' experiences, attitudes, behaviors, conflicts of duties, legal knowledge and needs for guidelines toward patients who purchase kidneys abroad. Second, we clarify professionals' rights and obligations regarding organ purchase and propose actions that they can take to report purchase. Of the 100/241 (42%) professionals who treated patients who traveled to a country outside the European Union for a kidney transplant, 31 (31%) were certain that patients purchased kidneys. Sixty-five (65%) had suspicions that patients had bought kidneys. The majority reported a conflict of duties. Eighty percent reported a need for guidelines. Professionals can help prevent organ purchase by disclosing information about organ trafficking networks to law enforcement. Such disclosure can support the investigation and prosecution of networks. We offer key components for guidelines on disclosure of these networks.
Introduction
The purchase of organs is prohibited in almost all countries. Nevertheless, patients buy organs (mostly kidneys) for transplantation and commonly do so by travelling overseas. Commonly reported destination countries are China, Pakistan and India. Transplant professionals (TPs) who treat these patients pre- and post-operatively can play a role in identifying and reporting kidney purchase. TPs however report a tension between their obligations to provide medical care and maintain secrecy on the one hand and their duty to prevent harm on the other. This conflict of rights and duties may underlie "the blind eye" that TPs turn toward patients who (plan to) purchase an organ.
TPs who keep their "eyes wide shut" to kidney purchase juxtapose initiatives fuelled by, for instance, the World Health Organisation and the Declaration of Istanbul on Organ Trafficking and Transplant Tourism (DOI). The DOI calls upon TPs to help eradicate the harm and sufferings inflicted upon victims of organ trade. Building upon the DOI, the Policy Statement on Organ Trafficking and Transplant Tourism by the Canadian Society of Transplantation and Canadian Society of Nephrology (CPS) clarifies TPs' rights and obligations in relation to organ purchase. It also presents guidance and recommendations on how doctors can interact with patients. The DOI Custodian Group (DICG) in its 2013 'Doha Communiqué' resolves to "develop […] systematic ways for physicians to identify and report to appropriate registries […] patients returning with a donor organ from an 'unverifiable source"'. It further proposes "a 'white paper' discussing professional responsibilities in responding to patients who travel or plan to travel abroad for a transplant that would be illegal in their country of residence."
Notwithstanding the importance of these initiatives, there is a lack of knowledge and understanding concerning TPs' experiences, conflicts of duties and needs for guidelines toward patients who purchase organs. A better understanding of TPs' regard for patients who buy organs, as well as a clarification of their rights and obligations is needed. In this paper we first present the results of a national survey that describe TPs' experiences, attitudes, behaviors, conflicts of duties, their legal knowledge and their needs for guidelines toward patients who purchase kidneys abroad. We then clarify TPs' rights and obligations in relation to organ purchase and propose actions that TPs can take to report the purchase of organs.
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