The best magazine
Results
Study Participants
Of the 546 transplant professionals, 241 (44%) completed the survey. One hundred thirty were male (53.9%). The median age was 48 (range 26–68).
Experiences of Transplant Professionals With Patients who Purchased Kidneys Abroad
One hundred eleven out of 241 TPs (46%) responded that they treated patients between 2008 and 2013 who had traveled from NL for a kidney transplant. One hundred TPs (42%) responded that they treated patients who had traveled outside the European Union (EU). Thirty-one of these (31%) wrote that they were certain that patients bought the kidneys. TPs' reasons for certainty were: "The patient said that he/she had bought the kidney" (29 TPs), "The patient said that the donor had received money for the kidney" (8 TPs), "The patient said that he/she had paid a large amount for the transplantation" (7 TPs), "The kidney purchase was mentioned in the patient's medical record" (4 TPs). Sixty-five of the 100 TPs had suspicions that the patients had bought the kidney. Because patients are treated by more than one TP, these numbers do not represent the number of patients that travelled. However, the survey was completed by TPs from all transplant centers, and all centers reported clusters of patients that travelled.
Attitudes of Transplant Professionals Toward Patients who Purchased Kidneys
Table 1 reveals that most TPs report that they understand why patients buy kidneys (85%), believe that the purchase of a kidney is covered by the secrecy oath (72%) but also feel that they have a duty to prevent kidney purchase (72%). The majority believes that kidney purchase harms the relationship with their patients (53%), deems a regulated organ market unacceptable (68%) and judges their patients for buying kidneys abroad (53%). A minority (27%) believes that patients should be prosecuted for buying kidneys. On the other hand, 58% argue that prevention is impossible. Most TPs answer that they disagree with a kidney purchase abroad, even if the patient's chances of survival will otherwise be small (63%), even if the patient cannot find a domestic donor (73%) and even when the destination country does not prohibit kidney purchase (73%). The longer the career of a TP, the more likely he/she is to agree with the statement that "the purchase of a kidney is covered by my secrecy oath" (rs = −0.257, p < 0.001). No other significant relationships were found.
Behavior of Transplant Professionals Toward Patients who Purchased Kidneys
The results in Table 2 reveal that there are few differences in reported behavior when TPs have suspicions of intended kidney purchase versus when the patient tells them that he/she is going to buy a kidney. In both situations the majority would share their opinion with the patient (90%), they would not give the medical record (63%), they would ask colleagues for advice (80%) and they would not refer the patient to a colleague in their hospital (85%) or to a colleague abroad (95%). If a patient tells the TP he/she is going to buy a kidney, the TP is more likely to consult a lawyer and less likely to prepare the patient for transplant a usual. Although none of the professionals would report their patients in case of a suspicion, 6 (out of 130) TPs answered that they would report their patient to the police if the patient tells them he/she is going to purchase a kidney. These 6 TPs however had not actually seen or treated patients who traveled abroad for a transplant.
Conflict of Duties and Confidentiality
The majority of the TPs, 157/241 (65%), indicated that they experience a conflict of duties when suspicions arise about a patient's kidney purchase. TPs' most commonly reported explanation for a conflict of duties is that because of their secrecy oath, they are unable to protect the possible victim-donor (75%). Sixty-four percent emphasized that because of their secrecy oath, nothing is done to prevent the crime. Others reasons were that by giving the patient his/her medical record, TPs possibly participate in an illegal act (50%), and because of their secrecy oath, the patient can commit the crime unpunished (44%).
Knowledge About the Law Against Organ Purchase
In NL, TPs are released from their duty of confidentiality "if the patient grants consent, in the event of a legal duty to provide information, during consultations with care providers who form part of the treatment unit and in the case of conflicting obligations". Although the purchase and sale of organs is forbidden in NL, doctors do not have an obligation to report patients who will buy organs to the police. Yet, they may do so if the disclosure prevents severe harm to the patient or another individual. Doctors are prohibited from reporting patients who have committed a crime. The Royal Dutch Medical Association has installed a reporting mechanism to which TPs may report child abuse and domestic violence. However, no guidelines or bodies exist for the reporting of organ purchases and sales.
Almost all TPs (98.3%) correctly stated that purchase of kidneys in NL is forbidden. A minority correctly believed that they may (15%) and wrongly assumed that they must (4%) report a patient to the police who considers to purchase a kidney abroad. Only a minority wrongly assumed they may or must report patients that return from abroad with a purchased kidney (15% and 8%, respectively). While 53% of the TPs believed that they are never allowed to report a patient because of the secrecy oath (and 25% did not know), still 22% disagreed and saw possibilities to report the patient.
Finally, TPs' needs for guidelines were asked. Most participants expressed a need for guidelines in treating patients and/or donors who purchase and/or sell organs. The indicated need was highest (86%) when TPs treat patients whom they suspect are going to buy an organ. The need was lowest (71%) when treating donors whom they suspect have sold an organ.
Source: ...