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Ramaekers Z, Reinders MEJ, Staring R, Ambagtsheer F. Migrants' Kidney Sales, Fortress Europe and the Transplant Community: a Call for Awareness. Nephrol Dial Transplant 2024:gfae100. [PMID: 38684483 DOI: 10.1093/ndt/gfae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Zanna Ramaekers
- Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, University Medical Center Rotterdam, The Netherlands
| | - Marlies E J Reinders
- Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, University Medical Center Rotterdam, The Netherlands
| | - Richard Staring
- Criminology, Department of Law, Society, and Crime, Erasmus University Rotterdam, The Netherlands
- Bureau Beke, Arnhem, The Netherlands
| | - Frederike Ambagtsheer
- Erasmus MC Transplant Institute, Nephrology and Transplantation, Department of Internal Medicine, University Medical Center Rotterdam, The Netherlands
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Ambagtsheer F, Annema C, Forsythe J, Jansen N, Paredes-Zapata D. Ethical and Legal Aspects of Organ Donation and Transplantation. Transpl Int 2024; 37:13011. [PMID: 38655205 PMCID: PMC11036411 DOI: 10.3389/ti.2024.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - John Forsythe
- Department of Health and Social Services, Implementation Steering Group for Organ Utilisation, London, United Kingdom
| | - Nichon Jansen
- Department of Policy, Dutch Transplant Foundation, Leiden, Netherlands
| | - David Paredes-Zapata
- Donation and Transplant Coordination Section, Hospital Clínic, Barcelona, Spain
- Surgical Department, University of Barcelona, Barcelona, Spain
- Donation and Transplantation Institute Foundation, Barcelona, Spain
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Ambagtsheer F, Bunnik E, Pengel LHM, Reinders MEJ, Elias JJ, Lacetera N, Macis M. Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda. Transpl Int 2024; 37:12483. [PMID: 38644936 PMCID: PMC11027084 DOI: 10.3389/ti.2024.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/04/2024] [Indexed: 04/23/2024]
Abstract
The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment's framework as a blueprint for European research on this topic.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eline Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Liset H. M. Pengel
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marlies EJ Reinders
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Julio J. Elias
- Department of Economics, School of Business, University of CEMA, Buenos Aires, Argentina
| | | | - Mario Macis
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
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Ambagtsheer F, Columb S, AlBugami MM, Ivanovski N. Kidneys for Sale? A Commentary on Moeindarbari’s and Feizi’s Study on the Iranian Model. Transpl Int 2022; 35:10530. [PMID: 35812157 PMCID: PMC9266991 DOI: 10.3389/ti.2022.10530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: Frederike Ambagtsheer,
| | - Sean Columb
- School of Law and Social Justice, The Liverpool Law School, University of Liverpool, Liverpool, United Kingdom
| | - Meteb M. AlBugami
- Multi-Organ Transplantation Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ninoslav Ivanovski
- Clinical Hospital Zan Mitrev, University “Sts Cyril and Methodius”, Skopje, North Macedonia
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Ambagtsheer F, Haase-Kromwijk B, Dor FJMF, Moorlock G, Citterio F, Berney T, Massey EK. Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal. Transpl Int 2020; 33:989-998. [PMID: 32349176 PMCID: PMC7540591 DOI: 10.1111/tri.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
This paper addresses ethical, legal, and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the nonpayment principle, exploits donors in low- and middle-income countries, and detracts from the aim of self-sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE's procedures and outcomes. Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients' and donors' voices are missing in this debate.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | | | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Franco Citterio
- Renal Transplantation Unit, Fondazione Policlinico Universitario, A. Gemelli, Rome, Italy
| | - Thierry Berney
- Division of Transplantation, University of Geneva Hospitals, Geneva, Switzerland
| | - Emma K Massey
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
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Ambagtsheer F, van Balen LJ, Duijst-Heesters WLJM, Massey EK, Weimar W. [Proposal for an anonymous reporting code organ trafficking: how transplant professionals can play a role in preventing this trafficking]. Ned Tijdschr Geneeskd 2018; 162:D1992. [PMID: 29623861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients travel worldwide to undergo kidney transplantations. Care providers in the Netherlands encounter these patients, both before and after the transplantation. We present the results of a survey that was distributed among Dutch transplant professionals about their experiences with patients who have undergone a kidney transplantation abroad. We propose that care providers should report illegal transplantations. Of the 241 surveyed professionals, 100 treated patients who travelled to a country outside the European Union for a kidney transplant. Thirty-one professionals were certain that patients purchased their kidney, and sixty-five had suspicions that it had been purchased. The majority reported a conflict of duties. Professionals can help prevent organ purchase by detecting and disclosing information about organ trafficking networks. The aim of reporting is two-fold. Firstly, such disclosure can lead to increased knowledge and information about organ trafficking. Secondly, it can support the police and law enforcement agencies to investigate if networks are involved in facilitation of these transplantations. In this manner, those who facilitate organ trafficking can be prosecuted and exploitation of donors can be prevented.
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Affiliation(s)
- F Ambagtsheer
- * Dit artikel is gebaseerd op een onderzoek dat eerder werd gepubliceerd in American Journal of Transplantation (2015;15:1759-67) met als titel 'Reporting organ trafficking networks: a survey-based plea to breach the secrecy oath'. Afgedrukt met toestemming
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Ambagtsheer F, de Jong J, Bramer WM, Weimar W. Reply to Comment on the Article "On Patients Who Purchase Organ Transplants Abroad". Am J Transplant 2017; 17:305. [PMID: 27620833 DOI: 10.1111/ajt.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J de Jong
- Analysis and Research Department, Central Division of the National Police, Driebergen, the Netherlands.,Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W Weimar
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Columb S, Ambagtsheer F, Bos M, Ivanovski N, Moorlock G, Weimar W. Re-conceptualizing the organ trade: separating "trafficking" from "trade" and the implications for law and policy. Transpl Int 2016; 30:209-213. [PMID: 27896866 DOI: 10.1111/tri.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Seán Columb
- School of Law and Social Justice, The Liverpool Law School, University of Liverpool, Liverpool, UK
| | - Frederike Ambagtsheer
- Section Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Michael Bos
- Ethics Chair, Eurotransplant International Foundation, Leiden, The Netherlands
| | | | - Gregory Moorlock
- Social Studies in Medicine, University of Birmingham, Birmingham, UK
| | - Willem Weimar
- Section Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Ambagtsheer F, de Jong J, Bramer WM, Weimar W. On Patients Who Purchase Organ Transplants Abroad. Am J Transplant 2016; 16:2800-2815. [PMID: 26932422 DOI: 10.1111/ajt.13766] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/25/2023]
Abstract
The international transplant community portrays organ trade as a growing and serious crime involving large numbers of traveling patients who purchase organs. We present a systematic review about the published number of patients who purchased organs. With this information, we discuss whether the scientific literature reflects a substantial practice of organ purchase. Between 2000 and 2015, 86 studies were published. Seventy-six of these presented patients who traveled and 42 stated that the transplants were commercial. Only 11 studies reported that patients paid, and eight described to what or whom patients paid. In total, during a period of 42 years, 6002 patients have been reported to travel for transplantation. Of these, only 1238 were reported to have paid for their transplants. An additional unknown number of patients paid for their transplants in their native countries. We conclude that the scientific literature does not reflect a large number of patients buying organs. Organ purchases were more often assumed than determined. A reporting code for transplant professionals to report organ trafficking networks is a potential strategy to collect and quantify cases.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J de Jong
- Analysis and Research Department, Central Division of the National Police, Driebergen, the Netherlands.,Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W Weimar
- Department of Internal Medicine, Transplantation and Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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van Balen LJ, Ambagtsheer F, Ivanovski N, Weimar W. Interviews With Patients Who Traveled From Macedonia/Kosovo, The Netherlands, and Sweden for Paid Kidney Transplantations. Prog Transplant 2016; 26:328-334. [DOI: 10.1177/1526924816667951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patients travel worldwide for paid kidney transplants. Although transplantations abroad are not always illegal, they are commonly perceived to be illegal and unethical involving risks. Aim: We aimed to describe the motivations and experiences of patients who traveled abroad for paid kidney transplantations and to examine how these transplantations were facilitated. Methods: We interviewed 22 patients who traveled from Macedonia/Kosovo, the Netherlands, and Sweden for paid kidney transplantations between years 2000 and 2009. Results: Patients traveled because of inadequate transplant activity in their domestic countries and dialysis-related complaints. However, 6 patients underwent preemptive transplantations. Cultural factors such as patients’ affinity with destination countries, feelings of being discriminated against by the health-care system, and family ties also help explain why patients travel abroad. Seven of the 22 patients went to their country of origin. They were able to organize their transplantations by arranging help from family and friends abroad who provided contacts of caregivers there and who helped cover the costs of their transplants. The costs varied from €5000 to €45 000 (US$6800-US$61 200). Seven patients paid the hospital, 5 paid their doctor, 4 paid a broker, and 6 paid their donors. Conclusion: Research should include interviews with brokers, transplant professionals, and other facilitators to achieve a full picture of illegally performed transplantations.
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Affiliation(s)
- L. J. van Balen
- Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Frederike Ambagtsheer
- Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands
| | - N. Ivanovski
- University of St Cyril and Methodius, Medical Faculty Skopje, Republic of Macedonia
| | - W. Weimar
- Department of Internal Medicine, Section of Nephrology and Transplantation, Erasmus MC University Hospital Rotterdam, Rotterdam, the Netherlands
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Ambagtsheer F, Van Balen LJ, Duijst-Heesters WLJM, Massey EK, Weimar W. Reporting Organ Trafficking Networks: A Survey-Based Plea to Breach the Secrecy Oath. Am J Transplant 2015; 15:1759-67. [PMID: 25873198 DOI: 10.1111/ajt.13245] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 01/25/2023]
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.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L J Van Balen
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - E K Massey
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W Weimar
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van Balen L, Ambagtsheer F, Weimar W, Erasmus M. Experiences, behavior, attitudes and knowledge of Dutch transplant professionals towards patients who travel abroad for kidney transplantation: Results of a national survey. Transpl Immunol 2014. [DOI: 10.1016/j.trim.2014.11.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lennerling A, Lovén C, Dor FJMF, Ambagtsheer F, Duerinckx N, Frunza M, Pascalev A, Zuidema W, Weimar W, Dobbels F. Living organ donation practices in Europe - results from an online survey. Transpl Int 2012. [PMID: 23198985 DOI: 10.1111/tri.12012] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In Europe, living organ donation (LOD) is increasingly accepted as a valuable solution to overcome the organ shortage. However, considerable differences exist between European countries regarding frequency, practices and acceptance of donor-recipient relations. As a response, the Coordination Action project 'Living Organ Donation in Europe' (www.eulod.eu), funded by the Seventh Framework Programme of the European Commission, was initiated. Transplant professionals from 331 European kidney and liver transplant centres were invited to complete an online survey on living kidney donation (LKD) and living liver donation (LLD). In total, 113 kidney transplant centres from 40 countries and 39 liver transplant centres from 24 countries responded. 96.5% and 71.8% performed LKD and LLD respectively. The content of the medical screening of donors was similar, but criteria for donor acceptance varied. Few absolute contraindications for donation existed. The reimbursement policies diverged and the majority of the donors did not get reimbursed for their income loss during recovery. Large discrepancies were found between geographical European regions (the Eastern, the Mediterranean and the North-Western). As a result of this survey we suggest several recommendations to improve quality and safety of LOD in Europe.
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Affiliation(s)
- Annette Lennerling
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
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Ambagtsheer F, Weimar W. A criminological perspective: why prohibition of organ trade is not effective and how the Declaration of Istanbul can move forward. Am J Transplant 2012; 12:571-5. [PMID: 22150956 DOI: 10.1111/j.1600-6143.2011.03864.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Declaration of Istanbul is the first document that has been established by the international transplant community that defines and prohibits transplant commercialism and organ trafficking. Its Custodian Group has successfully led various countries to implement legislation against trafficking and commercialism. The question arises, however, whether efforts to prohibit organ trade are realistic and effective. The Declaration differentiates trafficking from commercialism, yet it does not mention how both acts should be approached by policy. Policies that address transplant commercialism work differently from policies that tackle organ trafficking. There is considerable room for improvement in the current prohibitive approach to commercialism and organ trafficking. The Custodian Group and World Health Organization (WHO) should address commercialism by encouraging the expansion of living donation in the same manner as they encourage deceased donation. Furthermore, the Custodian Group and the WHO can improve their strategy to combat organ trafficking by raising awareness for enforcement. To achieve a consistent and effective prohibition of trafficking, legislation and law enforcement must go hand in hand. Ideally, this can best be achieved by close collaboration between the medical field and (international) criminal justice agencies.
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Affiliation(s)
- F Ambagtsheer
- Department of Internal Medicine (Section Transplantation), Erasmus Medical Centre, Rotterdam, the Netherlands.
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