Bulletin of the World Health Organization

Organ trafficking and transplantation pose new challenges

The international trade in human organs is on the increase fuelled by growing demand as well as unscrupulous traffickers. The rising trend has prompted a serious reappraisal of current legislation, while WHO has called for more protection for the most vulnerable people who might be tempted to sell a kidney for as little as US$ 1000.

Yet the Guiding Principles on human organ transplantation, adopted by the WHA in 1991, state that organs should “be removed preferably from the bodies of deceased persons,” and that live donors should in general be genetically related to the recipient.

They also prohibit “giving and receiving money, as well as any other commercial dealing”.

This year’s WHA resolution therefore asked WHO Director-General Dr LEE Jong-wook to consider updating the guiding principles in the light of current practices.

“There is a real risk that standards devised in the 1990s with the emphasis on prohibition will be undermined and we have to react to this,” said Dr Nikola Biller-Andorno, ethicist at WHO’s Department of Ethics, Trade, Human Rights and Health Law. “What is needed is a critical and thorough analysis of the different proposals that have been made particularly with regard to expanding the use of living donors, by providing incentives and/or removing disincentives.” Dr Biller-Andorno said.

Dr Luc Noel, coordinator of the newly created Clinical Procedures team in WHO’s Department of Essential Health Technologies, said part of the review process included examination of how to minimize health risks to living donors after the donation.

“Removing disincentives is a must. Adding incentives is where things get difficult,” Noel said.

For instance, should a donor in a country with no health insurance be offered free coverage in case he or she gets a complication after the operation? And would this qualify as an incentive or removing a disincentive?

A WHO consultation on organ and tissue transplantation in Madrid last October, grouping 37 clinicians, social scientists, ethicists and government officials from 23 countries, reached no consensus on how and where to draw the line between removing disincentives and providing incentives.

The Madrid consultation unanimously agreed that there should be a WHO expert advisory panel both for allogeneic transplantation, involving organs from an organism of the same species, and xenogeneic transplantation, involving those from another species, and for global safety and quality principles for the regulation of organs and tissues.

Noel said there was a need for more epidemiological data and for more global transparency — especially with regard to the long-term health, psychological and socio-economic consequences for both living donors and recipients.

Clare Nullis-Kapp, Cape Town