In our brand new section ‘Throwback Thursday’ we dive into the rich and long history of Girugten by revisiting or republishing interesting (translated) articles of the past. For our third edition, we delve a little bit deeper in our archive and present to you a translated version of an article from 2016. The original article, written by our former team member Marins Hettinga was first published in Dutch here, and this English translation (including updated information about the new Dutch donor system) was done by Elisa Lanting.

Travel for transplantation that involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals and transplant centers) devoted to providing transplants to patients from outside a country undermine the country’s ability to provide transplant services for its own population.” – Definition of the Istanbul Declaration on organ trafficking and transplant tourism.

Worldwide there is still a huge shortage of organ donors. On January 1st 2016, 1.146 people were on the waiting list for an organ in the Netherlands, slightly less than a year earlier. 150 people die each year because the wait for a new organ is too long. A body must be voluntarily donated: worldwide, buying or selling is prohibited according to the law with Iran as an exception. Yet there are countries where the waiting list is very short because there are often entire trade circuits with brokers. This is therefore illegal but in some countries the standard, such as India, Pakistan and China. Usually, these donors are not voluntary; they are forced to ‘give’, they are forced to donate their bodies because of debts. The most common trade organ is the kidney; one has two, but can live well with one. Organ trade is a lucrative market, perhaps because it is forbidden. If you prohibit something, the price goes up. And because the importance is literally vital, people are also willing to break the laws.

Yet organ trading is not necessarily something that doesn’t keep you busy, as you might think at the first moment. An international study by, among others, Erasmus MC shows that nearly 100 of the 241 health care providers surveyed in the Netherlands indicate that they know for certain or there are strong suspicions that the patients they treat have purchased a kidney abroad. Among them are transplant surgeons, renal doctors, nurses and social workers who have experienced that patients suddenly appear in the hospital with a kidney. Usually, they are vague about where the kidney comes from or sometimes they also admit that they have paid for the organ. Although the caregivers indicate that the majority of patients traveled outside the EU for a transplant, 17 caregivers state that between 2008 and 2013 they treated patients whom they suspected had purchased the organs in the Netherlands themselves. However, due to the professional secrecy of doctors, it is not possible to report this.

Seven Dutch people that were also interviewed in the same study, who crossed the borders to undergo an organ transplant abroad. In principle. This, of course, does not have to be illegal at all, they may well undergo a transplant in another country because a family member lives there who makes his organ available. It becomes illegal when a payment is made for this, and of course, that is something the donor himself will not admit. Two men in the study admitted that they had paid for the donor.

How does this work? The interviewees indicated that they did not know anything about a broker or that the acquaintances had direct contacts with the donor; everything was mediated through the hospital. With the exception of one person, nobody brought his hospital data from the Netherlands or asked their doctor for advice. The amounts they paid for the transplant differed per case and per country (€ 6,000 – € 25,000) and for some it was possible to negotiate the price. In a case in China it was also possible to make a choice in which “kidney type” they wanted: the better the match, the higher the price. Some indicated that they would pay directly to the hospital and for others it is unclear where exactly their payments went. The duration of their hospital visit also varied: one week and another one and a half months. There were also many complications with the medicines: they were very expensive, there were also many fake medicines on the market and there was a shortage of them. They were not the only ones there; they also met other foreign tourists, including a total of three other Dutch people. All in all, it seems to be trips that are not entirely proper.

People are tackling and mapping the problems of organ trafficking worldwide; it also involves other problems such as human trafficking, kidnapping and murder. The World Health Organization assumes that 5 to 10 percent of the organ transplants are made through illegal transactions. Nonetheless, when asked what exactly is the cause, the answer is not necessarily the illegal brokers. They respond to the underlying cause that there are far too few voluntary donors worldwide. The average waiting time for a suitable kidney is currently four years. The deficit could be resolved by allowing compensation for a donor, which requires an adjustment to the law. That is why bio-ethics also argue for a regulated system through the government. A system of paid organ donations via a regulated protocol discourages the black market where there are so many abuses. It must be a system in which donors receive comprehensive information, undergo a safe operation and receive proper aftercare. A system, too, in which people sign up as donors and are not approached by the patient or their representatives. In this way, you eliminate the medical risks and prevent people from being exploited or actively recruited. And because the government buys the kidneys itself, every patient, rich or poor, has the same chance to receive a transplant. The ban on “selling your body” is a social taboo. But it does not belong in the same category as a prostitute, a professional boxer who is at risk of brain damage or a soldier who goes on a mission.

But the knife cuts both ways. The biggest counter-argument is that you should not force poor people out of desperation to give up their kidneys. To avoid this, there are ideas in which the money is distributed in installments, settled through the tax or a lifelong free health insurance policy; all methods to make it less attractive to put your organs up for sale. A 2007 dissertation from Leonieke Kranenburg shows that half of her respondents are against. You can also start paying in installments so that the donor does not suddenly have tens of thousands of euros in his account. Or you get payed via tax or a lifelong free health insurance policy. All methods to make it less attractive to put your organs up for sale in an emergency.

The dissertation of Leonieke Kranenburg showed that half of the respondents were against compensation. The rest is divided: a quarter doesn’t know, and a quarter thinks it’s a good idea. Of the respondents, 5 percent would consider donating a kidney for a fee. Half a percent said they were “very likely”. They had the choice of two reimbursements: 25.00 euros or free health insurance for the rest of your life, the last of which is the most chosen option. We apparently find it pleasant and honest not to be rewarded with money.

However, such a regulated system still seems far away. An option that may be easier to achieve is a system that is used in Spain, Austria, Belgium, France, Italy and Sweden. In the Netherlands we have a so-called no-unless donor system, in the aforementioned countries, this is a yes-unless system. This means that it is assumed that being a donor is the norm. You must take action yourself if you do not want to be a donor, whereas in the Netherlands you must actively register yourself. As a result, the majority of the population is not registered in the donor register. 

The 1stof July 2020, the Active Donor Registration will be introduced. This entails that from that moment, every person that is 18 or older will be added. Everyone has to respond to the letter if they want to become a donor or not. In the case of no response, people automatically will get a ‘no obstruction’ in the register. ‘No obstruction’ means that the person never made an active choice and that they do not mind donating their organs.

Nevertheless, the government is currently also doing a lot of promotion to become a donor. In addition to many commercials and advertising, there are donor weeks and you receive various letters about this: when you turn 18 or when you return to live in the Netherlands. It is also very easy and simple; with your DigiD you can easily stateonline what your own, voluntary choice is what can be done with your organs after death. Saving a human life has never been so easy from behind your computer.

Cover picture by: Donald Trung Quoc Don (Chữ Hán: 徵國單) – Wikimedia Commons.(Want to use this image?) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]

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