Frederike Ambagtsheer

Incentives for organ donation: proposed standards for an internationally acceptable system.

Incentives for organ donation, currently prohibited in most countries, may increase donation and save lives. Discussion of incentives has focused on two areas: (1) whether or not there are ethical principles that justify the current prohibition and (2) whether incentives would do more good than harm. We herein address the second concern and propose for discussion standards and guidelines for an acceptable system of incentives for donation. We believe that if systems based on these guidelines were developed, harms would be no greater than those to todays conventional donors. Ultimately, until there are trials of incentives, the question of benefits and harms cannot be satisfactorily answered.

Living organ donation practices in Europe – results from an online survey

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.

Cross-border quest: the reality and legality of transplant tourism.

Background. Transplant tourism is a phenomenon where patients travel abroad to purchase organs for transplants. This paper presents the results of a fieldwork study by describing the experiences of Dutch transplant professionals confronted by patients who allegedly purchased kidney transplants abroad. Second, it addresses the legal definition and prohibition of transplant tourism under national and international law. The final part addresses the legal implications of transplant tourism for patients and physicians. Methods. The study involved seventeen interviews among transplant physicians, transplant coordinators and policy-experts and a review of national and international legislation that prohibit transplant tourism. Results. All Dutch transplant centers are confronted with patients who undergo transplants abroad. The estimated total number is four per year. Transplant tourism is not explicitly defined under national and international law. While the purchase of organs is almost universally prohibited, transplant tourism is hardly punishable because national laws generally do not apply to crimes committed abroad. Moreover, the purchase of organs (abroad) is almost impossible to prove. Conclusions. Transplant tourism is a legally complex phenomenon that warrants closer research and dialogue. The legal rights and obligations of patients and physicians confronted with transplant tourism should be clarified.

A criminological perspective: Why prohibition of organ trade is not effective and how the declaration of Istanbul can move forward

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.

The battle for human organs: organ trafficking and transplant tourism in a global context

While the trade in human organs remains largely in the darkness as it is hardly reported, detected or scientifically researched, a range of key institutional stakeholders, professionals, policy-makers and scholars involved in this field show remarkable high levels of moral condemnation and share a rather unanimous prohibitionist line. Some have equated this phenomenon to genocide or talk about ‘neo-cannibalism’, others present it as dominated by mafias and rogue traders. However, organ trafficking takes very different shapes, each one with their own ethical dilemmas. Simplistic formulaic responses purely based in more criminalisation should be critically evaluated. Based on a qualitative study conducted on the demand for kidneys (transplant tourism) in and from the Netherlands, we present in this article some of the main empirical results and discuss their implications. But before doing that, this contribution briefly describes the global patterns of contemporary organ trade and the way the problem has been framed and constructed by international policy bodies, professional (transplant) organisations and some scholars.

Organ Trade: Knowledge, Awareness, and Nonlegislative Responses.

Organ Trade: Knowledge, Awareness, and Nonlegislative Responses Frederike Ambagtsheer, LLM, MSc and Willem Weimar, MD, PhD Links [A] http://www.osce.org/secretariat/ 103393 [B] http://www.declarationofistanbul.org/ [C] https://wcd.coe.int/ViewDoc.jsp?id= 2214787&Site=DC&BackColorInternet= F5CA75&BackColorIntranet= F5CA75&BackColorLogged=A9BACE [D] https://www.politie.nl/binaries/content/ assets/politie/documenten-algemeen/ onderwerpteksten/trade-in-human-organsand-trafficking-in-human-beingsan-exploratory-study-into-the-involvementof-the-netherlands-and-europe.pdf [E] http://hottproject.com/home.html [F] http://www.who.int/bulletin/volumes/85/ 12/06-039370/en/ [G] http://www.gfintegrity.org/wp-content/ uploads/2014/05/gfi_transnational_crime_ high-res.pdf [H] https://www.unodc.org/documents/ human-trafficking/2015/UNODC_ Assessment_Toolkit_TIP_for_the_Purpose_ of_Organ_Removal.pdf [I] http://hottproject.com/userfiles/ HOTTProject-TraffickinginHumanBeings forthePurposeofOrganRemovalAComprehensiveLiteratureReviewOnlinePublication.pdf [J] http://hottproject.com/userfiles/Reports/ 2ndReportHOTTproject-OrganRecipients WhoPaidForKidney TransplantsAbroad.pdf [K] http://hottproject.com/userfiles/Reports/ 3rdReportHOTTProjectTraffickinginHumanBeingsforthePurpose ofOrganRemoval-ACaseStudyReport.pdf The trade in human organs is a hot topic that receives increasing scrutiny from international organizations [A], the transplant community [B], researchers, and the popular press. According to the Council of Europe, the trade is growing worldwide [C]. Governments, international organizations, and transplantation societies are establishing new laws against organ trade or tightening existing regulations. Organ trade however receives little consideration from law enforcement authorities, and only few successful convictions have taken place [D]. In addition, there are no partnerships between transplant professionals and law enforcement. The HOTT project (2012-2015) is a European Union-funded international research that addresses “trafficking in human beings for the purpose of organ removal.” The project has 3 objectives: to increase knowledge, raise awareness, and improve the nonlegislative response. The project is coordinated by Erasmus MC in collaboration with 3 cobeneficiaries and more than 10 associate partners [E]. This article collates online resources with relevance to the readership of Transplantation providing guidance on the current state of organ trade. In 2007, the World Health Organization estimated that 5-10% of the approximately 60 000 kidney transplants performed annually around the globe occur via organ trade [F]. In 2011, the Institute, “Global Financial Integrity” ranked organ trade in the top 10 of the worlds most profitable crimes, with an estimated annual illegal profit of US

On patients who purchase organ transplants abroad.

614 million to US

Indicators to Identify Trafficking in Human Beings for the Purpose of Organ Removal.

1.2 billion. [G].How exactly these figures were established or validated is unclear. The World Health Organization indeed recognizes that the current state of organ trade remains obscure because of scarce data and acknowledges that figures should be regarded as “provisional and tentative.” The United Nations Office on Drugs

Interviews With Patients Who Traveled From Macedonia/Kosovo, The Netherlands, and Sweden for Paid Kidney Transplantations

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.

Re-conceptualizing the organ trade: separating “trafficking” from “trade” and the implications for law and policy

Abstract This article presents indicators to support transplant professionals, judicial and law enforcement authorities and victim support workers with the identification of trafficking in persons for the purpose of organ removal. It outlines the legal and illegal service providers that facilitate trafficking in human beings for the purpose of organ removal and guides the reader through the following criminal process: recruitment, transport, entrance, documents, housing, transplant, aftercare, and finance. Identification of illegal transplant activities by transplant professionals can support police and judiciary with the investigation, disruption, and prosecuting of trafficking networks.