GOVT. REG DA - 327 SINCE 1974 - SYNDICATION WITH NEWS&VIEWS OF ITALY AND KINGSHUK

1

15N&V15SEP10

TRANSPLANT TOURISM ISSUE TRANSPLANT TOURISM ISSUE TRANSPLANT TOURISM ISSUE

Fairtransplant

Worldwide, thousands of people suffer or die waiting for an organ. While the major-ity of the population favors organ donation and transplantation, for a variety of rea-sons the potential of organ donation is still underexploited. Fairtransplant is a foundation whose aim is to promote organ donation and access to organ transplantation in a transparent, safe, and non-for-profit frame. Fairtransplant contributes to increase awareness on the positive values of organ donation and transplantation by fostering initiatives, producing information mate-rial, and supporting events in the field of organ donation and transplantation. Contact: www.fairtransplant.org

Shocked but not surprised. That might be the best way to sum up India's re-action to the revelation this week that a black market organ transplant ring had been harvesting kidneys from poor Indian, Sri Lanka (Tamils), Nepal-ese, Bangladeshis laborers, sometimes against their wishes, and using them in foreigners desperate for transplants. It is also observed that poor patients from Nepal, Maldives and Bangladesh coming to India for better treatment to low cost hospitals at Calcutta, Chennai and Delhi. And illegal transparent happened due to ignorance or forcibly done by international mafia. Police who busted the ring say doctors paid as little as $1000 for the kidneys and then sold them for as much as $37,500. The racket, based in Gurgaon, a business center close to the capital, New Delhi, drew victims from as many as eight Indian states and lasted for almost a decade. Police say the black market doctors may have illegally transplanted as many as 500 kidneys. The ring, according to the police, was run by two Indian brothers, neither of whom had any medical training but who oversaw the surgery. One of the brothers has been arrested in Mumbai, but the other, Amit Kumar, who po-lice say was the racket's kingpin, is now the focus of an international man-hunt and may have fled to Canada. He sometimes testing them on the spot with equipment in his car and other times luring them to an apartment where he has surgical gear. For years, India has been known as a "warehouse for kidneys" or a "great organ bazaar" and has become one of the largest centers for kidney trans-plants in the world, offering low costs and almost immediate availability. In a country where one person out of every three lives in poverty, a huge trans-plant industry arose after drugs were developed in the 1970's to control the body's rejection of foreign objects. Renal transplants became common in

India about thirteen years ago when the anti-rejection drug cyclosporine be-came available locally. The use of powerful immune suppressant drugs and new surgical techniques has indirectly boosted the kidney transplant activi-ties. The dramatic success rates of operations, India's lack of medical regula-tions and an atmosphere of "loose medical ethics" has also fueled the kidney transplant growth. The result has been that supply and demand created a marriage of unequals, wedding wealthy but desperate people dependent on dialysis machines to those in India grounded down by the hopelessness of poverty. The pace of demand for kidneys hasn't kept up with the demand. Letters and E-mail messages from would-be transplant recipients in nine countries were discovered in Kumar's office, Indian authorities said. "It is believed that during the past eight years around 500 people were forcibly operated on and their kidneys transplanted to foreign patients in a secret operating theater," according to an Interpol alert for Kumar, who has evaded authorities in India. Analysts say the kidney business thrives with foreigners drawn here for many of the same factors that have made India a top destination for medical tourism: low costs and highly qualified doctors. An illegal kidney transplant here can cost a third of the $70,000 price of the operation in China, not to mention avoiding the kind of strict organ-donation rules that apply in west-ern countries.

India's Black Market

KINGSHUK + NEWS&VIEWS Wednesday, September 15, 2010 2

Foreigners visiting China will no longer be allowed find it harder to receive organ trans-plants according to China’s Ministry of Health. Citing the worldwide lack of organs and demand from Chinese nation-als, Ministry of Health spokes-man Mao Qunan said “Due to the lack of organ donors, short-age of organs is a problem in all countries, not just China. Prior-ity must be given to domestic patients in urgent need of an operation. If we started allow-ing organ transplants for tour-ists, the existing order will be disturbed”. While medical facilities that take part in illegal organ trans-plants will be punished, hospi-tals with permission from pro-vincial health authorities will still be allowed to transfer Chi-nese organs into foreign bodies. A Web site for a transplant clinic in China used to advertise a menu in English and Arabic for foreigners looking to buy an organ, with kidneys allegedly going for about $70,000 before it was shut down. Once consid-ered an urban myth, the black market in illegal organ traffick-ing is now growing into a global

concern. Organ trafficking is generally conducted by a criminal net-work connecting organ buyers, sellers and “broker friendly” hospitals where surgeons either look past the organ selling or simply agree to participate in the process reports Newsweek. The World Health Organization estimates 34,000 of the 170,000 kidneys transplanted globally each year are from the black market. “People all over were telling me that they didn’t have to go to a Third World hospital, but could get the surgery done in New York, Philadelphia or Los Ange-les,” anthropologist Nancy Scheper-Hughes, who has stud-ied organ trafficking in several countries, told Newsweek. “At top hospitals, with top sur-geons.” There are roughly 100,000 people waiting for organ trans-plants in the United States alone, with a waiting time of up to three years.University of Pittsburgh medical researcher Harold Kyriazi advocates for the sale of organs. He runs the Web site OrganSelling.com, and argues that if people were

allowed to sell their organs, the supply of transplant organs would increase by 200%. Canadian human rights lawyer David Matas speaks before press in Tokyo 17 October 2006. Matas and former senior Canadian official David Kilgour called for the Japanese govern-ment to change legislation for Japanese seeking organ trans-plants in China, in an effort to

combat the country's alleged harvesting of organs from members of the banned Falun-gong spiritual movement. Transplant-Tourism is also booming in developing world countries such as India, Paki-stan, Afghanistan, Bangladesh, Myanmar, Cambodia, Sri Lanka and the Philippines.

The Spanish National Trans-plant Organization, Organi-zación Nacional de Trasplantes (ONT), is the technical coordi-nating institution that belongs to the Spanish Ministry of Health and Social Policy. It is in charge of coordinating dona-tions and transplantations per-formed on a national scale, as-suring the best use of organs, tissues and cells. According to the principles of cooperation, efficacy and solidarity, ONT coordinates and facilitates the activities of donation, extrac-tion, preservation, distribution, exchange and transplantation of organs, tissues and cells across the Spanish health sys-tem. ONT also acts as a service agency for the national health system, promoting a continuous

increase of availability of or-gans, tissues and cells for trans-plantation. Therefore its main objective is to promote altruis-tic donation with the sole goal that every Spanish citizen who needs a transplant has the best possibility of obtaining one. Since the creation of ONT in 1989, Spain has progressively reached the highest rate of or-gan donation thanks to the im-plementation of the well-known Spanish Model. The model takes into consideration organ-izational measures to improve organ donation which are con-sidered key issues for the suc-cess of the transplant system. Thus, the Spanish Model has become the international refer-ence when facing the problem of scarcity of organ donors.

As global demand for live trans-plants keeps growing, the shad-owy organ trading business is rapidly expanding, dominated by unscrupulous brokers and facilitated by inadequate na-tional legislations, widespread corrupt practices and a general lack of public awareness on the extent of the trade. The illegal trade in body parts is largely dominated by kidneys because they are in greatest de-mand and they are the only ma-jor organs that can be wholly transplanted with relatively few risks for the living donor. Organ trafficking accounts for around 10 per cent of the nearly 70,000 kidney transplants per-formed worldwide annually, although as many as 15,000 kid-neys could be trafficked each year.

China, India, Pakistan, Egypt, Brazil, the Philippines, Moldova, and Romania are among the

world's leading providers of traf-ficked organs. If China is known for harvesting and selling organs from executed prisoners, the other countries have been deal-ing essentially with living do-

nors, becoming stakeholders in the fast-growing human traffick-ing web.

Trafficked organs are either sold domestically, or exported to be transplanted into patients from the US, Europe, the United Arab Emirates, Saudi Arabia, and especially Israel.

Ten years ago, organ trafficking was largely seen as a rumor. Since then a number of coun-tries (Brazil, South Africa, India, Moldova) have taken decisive steps to go after the traffickers, criminalize the trade in human organs, or ban transplants from living donors. Nonetheless, this has come at the risk of driving the trade underground, or shift-ing it to other countries. Arguing that laws and policies are insufficient to effectively curb organ trafficking, Organs Watch, COFS and other non-governmental organizations say it is essential for civil society to be actively engaged in this com-bat so organ trafficking is uni-versally recognized as a medical human rights abuse and a "body tax on the poor".

Organ theft is the practice of stealing people's organs via surgery while they are under the influence of drugs, or once the person is dead, when the organs can be illicitly removed and then used for further pur-poses such as transplants or sold on the black market. The practice is occasionally advanced as a theory into mysterious disappearances or murders, and is then advanced by sensationalist news reports, followed by word-of-mouth promotion as an urban legend. Its semi credible basis, in fact, is the extreme difficulty with which organs can be preserved postmortem (usually requiring a brain-dead but still functionally alive patient), and the long waiting lists for available organs. There has never been sufficient evidence, how-ever, to suggest that the practice has ever occurred on an organized basis.

WHO is governed by 193 Member States through the World Health Assembly es-tablished on 7 April 1948. Following the World Health A s s e m b l y R e s o l u t i o n WHA57.18, transplantation became an area of work at WHO. The mission of WHO in transplantation is carried out by the Clinical Procedures unit in the Department of Essential Health Technologies (EHT/CPR). This unit is re-sponsible for promoting the ethics of donation and trans-plantation and the appropri-ate effective and safe use of cells, tissues and organs for transplantation. The objectives are summa-rized as follows: 1. To work with Member States and to provide assis-tance at their request to en-sure effective national over-sight of allogeneic and xeno-geneic transplantation activi-ties. This would ensure ac-countability, traceability and appropriate surveillance of adverse events. 2. To increase access of citi-zens to safe and effective transplantation of cells, tis-sues and organs. Additionally, to ensure ethical and technical practices from procurement of human material for trans-plantation to the follow-up of recipients and live donors. 3. To promote international cooperation to encourage the global harmonization of tech-nical and ethical practices in transplantation. This would include the prevention of the exploitation of the disadvan-taged through transplant tourism, and the sale of hu-man material for transplanta-tion. 4. To encourage the donation of human material for trans-plantation, in particular pro-moting deceased donor dona-tions.

ONT (www.ont.es)

WHO AND TRANSPLANTATION www.who.int

Organ Trafficking: Fast Expanding Black Market

Transplant Tourism: Chinese Organs

Wednesday, September 15, 2010 KINGSHUK + NEWS&VIEWS 3

Sha

re yo

ur li

fe by

D

onat

ing O

rgan

s

Reports have surfaced of British willing to sell internal organs to the highest bidder. 60,000 British pounds for a kidney, 20,000 for a liver and 20,000 for a cornea. The middle men normally contact potential clients via the internet. There are actually sites where people can post organs for sale. A meeting is then arranged if the client appears willing to go through with the procedure. People who agree to sell their organs may consider selling a liver in order to renovate the house. Poor families desperate to send a son or daughter to university, might be equally tempted. One man said he was doing it to purchase a home for relatives back in Pakistan. Even though buying and selling organs is illegal in most countries, there is a thriving black market worldwide. Bizarre though it seems, organ selling has

become the way-to-get-ahead for some peo-ple. In poorer nations such as the Philippines, Togo and Bangladesh there is a large market in human organs. It is also an underground trend in the US, Australia and France. In China it has a sinister aspect. The authori-ties have been accused of harvesting the or-gans of prisoners. Some of the organs were taken from executed prisoners. The British Transplantation Society blew the whistle on this practice as evidence accumulated. For example the suspicious speed with which the Chinese were able to provide organs that matched the needs of patients, suggested that prisoners were being pre-selected prior to their executions. Chinese authorities have admitted that some organs had indeed been harvested from executed prisoners, but claim it took place with permission and in only a small number of cases. There is a big demand for organs. In the UK -

National Health Service records show that more than 8,000 Brits are waiting for organ transplants. Fewer than 3,000 procedures are carried out each year. The need is also high in the US. It is estimated that roughly 10 Ameri-can patients die each day while waiting for an organ. Finally it's a person's choice, but you have to wonder how the removal of an organ effects the long term health prognosis. A surgeon who was asked about this, said there is one in 3,000 chance of a person who donates a kid-ney dying after the operation. For a liver it is one in 200. There is also an ethical concern when the poor begin to feel pressured to sell organs in order to simply survive. Unfortunately in many countries the lack of enforcement means that these transactions can take place with very little official scrutiny.

Organ harvesting operations flourish in Tur-key, in central Europe, mainly in the Czech Republic, and in the Caucasus, mainly in Georgia. They operate on Turkish, Moldovan, Russian, Ukrainian, Belarusian, Romanian, Bosnian, Kosovar, Macedonian, Albanian and assorted east European donors. They remove kidneys, lungs, pieces of liver, even corneas, bones, tendons, heart valves, skin and other sellable human bits. The organs are kept in cold storage and air lifted to illegal distribu-tion centers in the United States, Germany, Scandinavia, the United Kingdom, Israel, South Africa, and other rich, industrialized locales. It gives "brain drain" a new, spine chilling, meaning. Organ trafficking has be-come an international trade. It involves In-dian, Thai, Philippine, Brazilian, Turkish and Israeli doctors who scour the Balkan and other destitute regions for tissues.

Underground World Market

Malaysian Objectives on Cadaveric organs About 10,000 Malaysians have been listed on the "urgent waiting list" for or-gans such as kidneys, livers, hearts and lungs."Cadaveric organs (from those who died) is still very low in the country despite all the aggressive cam-paigns."This is why organ transplants cannot be per-formed as much as the sur-geons want to and save as many lives as possible," said health director-general Tan Sri Dr Ismail Merican. Fur-thermore, the WHO's guiding principles on Human Organ Transplantation and that of the National Organ, Tissue and Cell Transplantation pol-icy prohibit giving and receiv-ing money as well as any other commercial dealings.

MEPs back European rules on organ donations and transplants

Yet the queues are long - about 60,000 patients are now on waiting lists in the EU - and every day 12 people die while on a list. Common qual-ity and safety standards are needed at EU level to facilitate the donation, transplantation and exchange of organs. Par-liament voted by 643 votes to 16 with 8 abstentions to en-dorse an agreement with the Council on a directive laying down such standards. The MEP who steered the legisla-tion through Parliament was Miroslav Mikolášik (EPP, SK).

Contact: Jana JALVI-ROBERTSON (+32) 2 28 32192 envi-press@europarl.europa.eu, simon.duffin@europarl.europa.eu

Wednesday, September 15, 2010 KINGSHUK + NEWS&VIEWS 4

The term, "TRANSPLANT TOURISM” is an offshoot of the now vibrant term, "medical tourism," and it usually means traveling to another country to purchase medical care or transplant organs that's either unavailable or more expensive in your home country. The less famous terms are "flesh trade" and "organ mar-ket."

Consider these premises: while humans have 2 kidneys, they can live with only one there is a worldwide shortage of or-gans for transplantation, and the waiting list of patients is growing longer and longer there is now widespread accep-tance of a kidney transplant from a live donor who is genetically unrelated (close genetic matching between the donor and recipient is no longer perceived as a hin-drance to achieve a highly successful out-come) there are many people willing to sell their kidneys in developing countries Over the years, organ transplantation has proved to be a safe and successful means of extending one's life. Because it is a successful surgical option, more and more patients with chronic renal failure or end stage renal disease want it. Today, there are many reasons why you should end up with a diseased kidney --- diabe-tes, hypertension, inherited disorders, glomerular diseases (kidney inflamma-tion and progressive destruction), auto-immune diseases, lithiasis (stones), trauma, and many others. When demand exceeds supply, two things happen --- there would be a shortage, and prices will rise. Consequently, when there is short-

age and rising prices, there will always be shameless fleecers who will exploit the situation. Organ shortage can give birth (and it has!) to a global organ black mar-ket. There are 110,000 patients on the waiting list in the US, of whom 6,000 die every year. The existence of a global or-gan black market today is partly due to the so-called repugnance factor over the whole idea of organ transplantation be-tween donor and recepient who are both genetically and emotionally unrelated. Governments and health authorities should sit down and start formulating clear and accepted guidelines (or laws if that's possible) that would benefit both recepient and donors. Organ black mar-kets should be eliminated. No one but exploitative middlemen earn immoral profits from the existence of organ black markets. How far would sick people go to express their need to buy kidneys? Very far. Very creative, too. Some would go to the extent of advertising on highway billboards. Some would make personal requests on nationwide TV and radio. Some would list themselves in multiple registries. Some will do a bit of Googling or pepper friends

and strangers with email requests. Fi-nally, some will go to medical tourist sites and hope to find a kidney. How much do people sell their kidneys? Here in the Philippines, the officer in charge of medical tourism has said that it should at least be in the ballpark of US $4,000 and not the pathetic US $2,000 you see in the image above. The Filipino kidney donors selling their kidneys are always duped with lower prices ranging from US $1,000 to $1,400, and in a coun-try of poor people, those amounts of money are already okay with them as payment. Kidney sellers abound in Pu-lang Lupa, Luneta, Bacood and the Baseco compound in Manila, Novaliches in Quezon City, and Addition Hills in Mandaluyong City. Should kidneys be exchanged for cash? While it is highly discouraged, of course, not only due to ethical issues but because of a catalogue of life-thereatening compli-cations (usually infectious), answer here is still a yes, especially if the donor re-quests it. Otherwise, it's always a blessing when recipients can find altruistic do-nors.

Transplant Tourism: Filipino Kidney Donors 

Corrupt doctors in India work in tandem with organized middlemen adept at cir-cumventing Indian law. The 1994 Trans-plant of Human Organ Act permits only relatives of patients to donate kidneys for transplantation (or a reciprocal arrange-ment between two needy families). But middlemen manage to masquerade do-nors as relatives or otherwise find ways to elude the rules, with little interest in the well-being of kidney providers. A kidney recipient here may pay as much as $25,000 to illegally get a new organ, of which perhaps $2,500, and often half that much, goes to the donor, according to Action Aid India, an international NGO that has worked with kidney trade victims in the southern state of Tamil Nadu. That leaves a lot of money for unscrupulous organ hunters. "These middlemen act more like cut-and-grab men whose only interest is to hack out the organ," says Annie Thomas, a field coordinator for Action Aid in Chennai. "This is a repre-hensible abuse of the poor, and this prac-tice needs to be curbed." Consequently, the poor and destitute, victims of poverty, have either willingly sold their kidneys to pay for a daughter's

dowry, build a small house or to feed their families or have been duped or conned into giving up their kidneys un-knowingly or for very little sums of money. Ironically, medical technology meant to advance and save human lives has been abused to such lengths, that in some cases, it has resulted in the death of inno-cent individuals. India's illegal organ trade is driven in part by the incredible imbalance between sup-ply and demand for legal organs. The Indian government banned the sale of kidneys for commercial gain in 1994; lawbreakers can be jailed for up to five years. But legal organ donations remain rare in India. The Multi Organ Harvest-ing Aid Network (MOHAN), a Chennai-based non-government group that pro-motes legal organ donation, puts dona-tion rates in India at well under 1 per million, compared to rates of more than 20 per million in places such as Spain, the U.S. and France. The group's head Dr Sunil Shroff rejects the idea that Indian culture or religion is behind the low do-nation rates. "The reason is we haven't got our act together basically," he says.

"The infrastruc-ture is not there. The general per-ception is lack-ing." The Indian gov-ernment has en-couraged more people to donate, and a few years ago began a cam-paign to increase the rate of cornea donations to try to fix the country's huge problems with blind-ness. But despite some success — the high-profile cricketer Anil Kumble and Bolly-wood actress Aishwarya Rai both prom-ised to donate their eyes when they die — a 2003 study in the Indian Journal of Opthamology found that illiteracy and rural residence (read poverty) meant that only half of those persons interviewed "had knowledge of eye donation, 20% knew about corneal transplantation and only 4.34% of them knew when to donate their eyes." Dodgy doctors exploit those same factors — illiteracy and poverty — to buy cheap organs on the black markets. There are

millions of poor young men in India, des-perate for a job and only too ready to travel to India's big cities at the promise of a quick buck. And even if they're not willing, they're still potential fodder. The Associated Press reported that while some donors sold their kidneys willingly, some were forcibly brought to clinics, held at gunpoint and then forced to un-dergo operations that they didn't want. "India is not such a literate population," says a spokeswoman from the National Human Rights Commission. "That's the main thing. There are a lot of people who are easy to take advantage of."

Transplant of Human Organ Indian Act

Although most organ transplant tourism has been illegal in The Philippines since 2008, the country is struggling to eradicate the problem. The Department of Health (DOH) has issued two administrative orders to fight organ trafficking, in particular the selling of kidneys to foreign patients. It has issued tighter revised rules on donating and transplanting organs from living persons through Administrative Order 2010-0018, which seeks to ensure that organ donations are “voluntary and truly altruistic.” The new administrative order reiterates the ban imposed on foreigners from receiving organs from living Filipino non-related donors, and categorically prohib-its health professionals from engaging in the kidney trade. Health Secretary Esperanza Cabral says, ”We issued the or-der because we wanted to make sure that nobody is exploited during the transplantation, and that organs are donated only for altruistic purposes. We want to make sure that illegal traffic of organs that has victimized many of our countrymen for many years will not be repeated. Hope-fully the international medical community will recognize that

our country is indeed serious in curtailing illegal organ dona-tion." The DOH orders confirm that kidney transplantation is not a legal part of medical tourism in the country. In 2005, The World Health Organization identified the Philippines as one of the global hotspots for organ traf-ficking, along with China, Paki-stan, Egypt and Colombia. In the last decade the Philippines gained an international reputa-tion as a hub for the illegal traffic in human organs from living donors, with some hospitals ca-tering for wealthy foreign pa-tients requiring kidney trans-plants. Following criticisms that her administration was promot-ing transplant tourism, in 2008 president Gloria Macapagal-Arroyo ordered a total ban on all kidney transplant to foreigners. Prior to the 2008 ban, 800 for-eigners each year had illegal kid-ney transplants. In 2008 the country also signed an interna-tional declaration on organ traf-ficking and transplant tourism, but it seems that a handful of doctors still participate in organ transplant tourism, which is more lucrative than ever after many countries successfully

killed the business. The new order sets up a system for the allocation, harvesting and transplantation of organs from deceased donors to Filipinos to provide people who need kidneys with the kidneys they need as 9000 Filipinos develop perma-nent kidney failure each year. Each region must set up a desig-nated organ procurement or-ganization, which will become part of the Philippine Network for Organ Sharing (PHILNOS). It has been established under Ad-ministrative Order 2010-0019 that set rules on "organ donation and organ transplantation in-volving deceased donors in the country." The Philippine Organ Donor and Recipient Registry System, another agency created by the administrative order, will maintain a nationwide database of "all organ transplant candi-dates, transplant recipient, and organ donors." Transplant ex-perts, believes that these guide-lines are important for organ transplantation in the Philip-pines and offers to assist in training and development to allow the rapid and effective im-plementation. The existing vol-untary donation system is not effective.

“PHILNOS of Philippines” Fighting against the Black Market

KINGSHUK + NEWS&VIEWS Wednesday, September 15, 2010 5

“Transplant Tourism” A Global Black Market & Asian Unawareness The shortage of transplantable kidneys around the world and the availability of these kidney markets have attracted many wealthy patients from other countries to travel to these markets to buy kidneys. The market that provides the transplant tourism is always changing. First it was India, then markets for transplant tourism developed in China, Iraq, Pakistan, Bangla-desh, the Philippines, South America, and Moldova. Transplant tourism is illegal in these countries, but the governments are either unaware, or they do not react strongly against selling kidneys to foreigners. In some cases, transplant docu-ments are carefully prepared to show that the kidneys are altruistically given to family members; in other cases, it is more likely that appropriate people have been paid. The kidney market for transplant tourism is so complex and well-organized that a single transaction often crosses 3 continents. Ac-cording to a New York Times Magazine documentary report, a kidney broker from the United States matches an Italian client with kidney failure, to a seller in the Middle East, for surgery in Eastern Europe. The article describes one patient who paid USD $145,000 to a broker to buy a kidney, saying that the money he paid in advance covered hospital fees, a payment to the seller, ac-commodations for accompanying family members, and a chartered, round-trip flight to the country where the surgery would take place. The patient said that the destination was kept secret until it was time to leave.

During the flight, he met other kidney pa-tients from different countries, their travel-ing companions, the surgeon, nurses, and the broker. The plane landed in an airport where everything had been taken care of; there was no need to clear customs, and no one asked for passports. The patients were driven to a hospital, and their families were taken to a hotel. The taxis that transported the patients had been prearranged. The cab driver had sold his kidney and had bought the cab with that money. The transplant surgeries were performed late at night, when the hospital had a smaller number of staff, and fewer people could question what was going on.

Most patients from the United States and Europe are reluctant to travel to kidney markets to receive renal transplants. They prefer to undergo surgery in their own country. They pay donors to come to them. According to another report in the New York Daily News, “An international trans-plant Mafia based in the former Soviet Un-ion is capitalizing on America’s organ-shortage crises by smuggling live donors into the country and selling their kidneys. Illicit organ donors from Moldova, the poor-est country in the former Soviet Union, en-ter the United States with false student or tourist visas. Then they are taken quickly to hospitals where their organs are removed and sold.” In the United States, there is no national transplant screening board; in-stead, every hospital has its own committee. Some facilities, especially those struggling

financially, appear to use a sort of “don’t ask, don’t tell” policy when it comes to transplant surgeries with foreign donors. Brokers are familiar with these hospitals where buyers and sellers sign documents attesting that no money has changed hands. One of the reasons that transplant tourism is steadily increasing is that the outcomes of such commercial transplants have remarka-bly improved.

The World Health Organization issued guidelines in 1991 to avoid the coer-cion or exploitation of organ donors. They were endorsed by 192 countries, including the United States, Brazil and South Africa. But the guidelines are not binding, and the recommendations have been widely ig-nored. At least one country, Iran, has a le-gally regulated system to trade organs. In the mid-1990's, many of the Israeli organ brokers took their patients to Turkey, flying in teams of Israeli surgeons and relying on donors from Moldova, Romania and Russia. But after some patients died and Dr. Scheper-Hughes of Organs Watch and the Turkish and European news media raised ethical questions, the brokers were forced to search for new locations. Donors and recipi-ents were not related, in contrast to the usual preference for legal and medical rea-sons. In fact, they did not even know each other. But they were linked by a trafficking ring that the authorities now say exploited two very different sets of needs -- for money and for life itself -- at opposite ends of a tangled chain thousands of miles long.

Madrid: The World Health Or-ganisation and the European Un-ion have led the way in tackling the prob-lem, the Madrid conference on organ dona-tions and transplants heard. "Stopping the illegal trafficking of organs and ending transplant tourism is an objective shared by all countries," Spanish Health Minister Trinidad Jimenez said. Rafael Matesanz, the head of the Spain's national transplant organisation, said ef-forts to curb transplant tourism "began in 2005 with the very decisive action of the

World Health Organisation and the interna-tional Transplantation Society to establish laws in the countries where it does not ex-ist." He noted that laws against the traffick-ing of organs had been adopted in five coun-tries considered among the worst offenders: China, the Philippines, Pakistan, Egypt and Colombia. Noel said that although organ transplant tourism continued in China, legislation passed there in 2007 had already led to the arrest of a gang of traffickers. China's Dep-uty Health Minister Dr Huang Jiefu at-tended the Madrid conference to emphasize

his country's efforts in this regard. "Since the beginning of this century, organ trans-plantation has become a booming health industry" in a country where "over 90 per-cent of the organs still come from executed prisoners," he said. He admitted that "we still have some hospitals trading with illegal organ agencies and ... selling organs to for-eigners for profit" . The Spanish newspaper El Pais recently reported the case of a Span-iard, Oscar Garay, who paid 135,000 euros (180,000 dollars) to receive a new liver in a hospital in the Chinese city of Tianjin in 2008.

Madrid’s main offenders: China, the Philippines, Pakistan, Egypt and Colombia

Mr. Prathap C Reddy Chairman Apollo Hospital Plot # 81, Block # E Bashundhara R/A Dhaka-1229 Mr. Khondoker Moniruddin Managing Director Apollo Hospital Plot # 81, Block # E Bashundhara R/A Dhaka-1229

Mr. Faridur Rahman Khan Managing Director United Hospital Plot # 15, Road # 71 Gulshan Dhaka- 1212

Mr. Samson H. Chowdhury Chairman Square Hospital & Group 18/F, west Panthapath Dhaka-1205 Mr. Tapan Chowdhury Managing Director Square Hospital & Group 18/F, west Panthapath Dhaka-1205 Dr. Shamim Ahmed Managing Director Labaid Group House # 1, Road # 4 Dhanmondi, Dhaka- 1205

Mr. Zahid Hasan Khan Director PARKWAY HEALTH-CARE INFORMATION CENTER Suite # B-3, Level # 4 House # 10, Gulshan-2 Dhaka-1212

HOSPITALS

The arrest of ‘Doctor Kidney’ Amit Kumar for running a sizeable racket in live kidneys has highlighted the role that South Asia plays as the hub of an inter-national trade in human organs. A sophisticated but unregulated health-care industry, a "donor pool" of desper-ately poor people ready to sell a kidney and a corrupt monitoring system have combined to create a special brand of ‘medical tourism’ in the region, especially in India and neighboring Pakistan. While India's Transplantation of Human Organs Act (THOA), 1994, is observed mostly in the breach, the impact of Paki-stan's Transplantation of Human Organs and Tissues Ordinance passed in 2007, is yet to be gauged. Till last year, the organ trade was legal and flourished openly in that country. Top transplant surgeons are collaborating with criminal organ trafficking networks to target the desperate, noted Nancy Scheper-Hughes, founding director of Organs Watch, an academic research project at the University of California, Berkeley, United States while speaking at the Vienna Forum to Fight Human Traf-ficking. "The latest arrests reveal a global network larger in scale than any other one," said Dr Samiran Nundy, gastroenterological surgeon at the prestigious Sir Gangaram Hospital in New Delhi. Nundy was one of the architects of India’s transplantation laws that should have put an end to paid transplants in this country. The THOA was the result of activism by a small

group of conscientious medical profes-sionals appalled by the trade. Kumar is accused of luring poor labour-ers to his ‘hospital’ in the New Delhi sub-urb of Gurgaon with promises of job of-fers or large sums of money. Typically, they were promised Rs 300,000 (7,500 US dollars) but paid only Rs 30,000 (750 dollars) after the surgery, police said. He is alleged to have conducted more than 500 transplants over an unspecified pe-riod, charging up to Rs two million (50,000 dollars) for each operation. In-vestigators say his patients came from Britain, the United States, Turkey, Nepal, Dubai, Syria and Saudi Arabia. The racket first came to light on Jan. 24 when police raided Kumar's hospital following a com-plaint by a ‘donor’ who had been paid less than the amount promised. At his hospi-tal police found recipients recovering from surgery and arrested a number of doctors, nurses and support staff. "Under the THOA, the powers to investi-gate and take action lie with the authori-zation committee," says Chennai-based surgeon Dr George Thomas, editor of the Indian Journal of Medical Ethics, who has campaigned against the kidney trade. "However, this usually consists of govern-ment doctors without the infrastructure to investigate infringements. Many hospi-tals where these transplants take place are linked to politicians. And members of the authorization committee never com-plain to the police." A series of investigations by the news-magazine ‘Frontline’ has documented the extent of kidney trade in various states of India, with "donors" drawn from the poorest parts of the country. State au-

thorization committees have approved almost all the hundreds of applica-tions for unrelated dona-tions for "reasons of af-fection" despite clear evidence that money had changed hands. "But Amit Kumar did not even use the legal loop-hole of pretending that the donors were donat-ing out of affection for the patient," says Tho-mas. "He did not even bother to seek permis-sion from the authoriza-tion committee to perform these unre-lated transplants as required by THOA." The kidney trade requires the collusion of highly trained surgeons. Kumar was the organizer of the enterprise and seems to have either hired or partnered with sur-geons and other medical personnel. He had contacts all over the world who di-rected patients needing transplants to him, and a network of brokers all over India who ensnared poor people into parting with a kidney with promises of large rewards. THOA was meant to stop kidney trading, and is "one of the most important pieces of medical legislation in India," said Nundy. But "to a certain extent it has been a failure though trading is much less than it was before the law." Though India's THOA permitted the transplant of organs from cadavers by recognising brain death, doctors esti-mated that fewer than 600 organ trans-plants between 1994 and 2003 were ca-

daver-based. On average 2,000 transplants are recorded in India annu-ally. One reason that the ca-daver transplant pro-gramme has not devel-oped in India is that the lucrative trade in live "donations" has not been checked. Other reasons are a lack of infrastruc-ture and public aware-ness. "We need the infra-structure and regulations to harvest organs from smaller hospitals, we need more publicity about cadaver donation, people don't know what brain death is, and that organs can be harvested

from the brain dead," says Nundy. "There is a poor understanding of brain death even among medical profession-als," says Thomas. "We also need a sys-tem to seek and obtain consent from rela-tives of brain dead people. What is needed is a social movement for organ d o n a t i o n . " One option to increase the number of cadaver organs is the "presumed consent" policy followed by Spain, which has 31.5 donors per million population (compared to 21.2 in the U.S., 16.9 in France and 16.7 in Portugal). Every citizen is considered a donor unless he or she specifically opts out. "I would prefer the 'opt in' policy in India at present because the poor and less literate will not know that they can opt out," says Thomas. "This is exploitation of the worst kind, where you want to remove a body part of the poor to help a rich man survive,’’ said Nundy.

Comparison Hub For Global Organ Trade Summarized from HEALTH-SOUTH ASIA By Sandhya Srinivasan

KINGSHUK + NEWS&VIEWS Wednesday, September 15, 2010 6

Pakistan’s laws, passed last year, has been criticised by some as inadequate. "The ordinance came about after a strug-gle by professionals, civil society and the media for almost two decades against a strong pro-organ trade lobby," explained Dr Farhat Moazam, professor and chair-person of the Centre of Biomedical Ethics and Culture at the Sind Institute for Urol-ogy and Transplantation (SIUT), Karachi. Moazam was part of the campaign to get the law passed against what she prefers to call organ "trafficking" rather than the more neutral "trade". "I believe it is a step in the right direction. But it needs to be strengthened in some areas and also im-plemented honestly and transparently if it is to work,'' she said in an e-mail inter-view. She notes that the Indian law was ''a moral victory, an important statement by (Indian) society, and it has given the

teeth to go after those involved in this racket. Of course, no law completely eliminates the practice''. \In 2003, SIUT estimated that a little over 2,000 kidney transplants were done in Pakistan every year, said Moazam. Eighty percent were from unrelated do-nors, and, of these, almost two-thirds were done on patients from outside Paki-s t a n . The 2007 ordinance makes it mandatory for institutions doing transplants to regis-ter and be monitored, prohibits and pro-vides punishments for commercial deal-ings in human organs as well as donation by Pakistani citizens to 'citizens of other countries'. However, 'donation' by non-related indi-viduals is permitted if it is 'voluntary', a term Moazam views as "vague" and prone to abuse. She also notes that since

spouses may donate "sham marriages are inevitable in an andocentric society." Fi-nally, the same problems of corruption in giving permission for non-related "donations" exist as in the Indian law. "Development of deceased donor pro-grammes at least in some of the major institutions to supplement living organ donation is absolutely essential to ad-dress the needs in Pakistan," said Moazam. "But this will require raising public and professional awareness, and e d u c a t i o n . " In Pakistan, only the SIUT has carried out deceased, or cadaver donor, kidney transplants, and of the 20 such trans-plants only six were from deceased Paki-stanis. The rest were flown in from the Netherlands through a special arrange-ment with a transplant association there.

In 2007 the World Health Organisation estimated that 10 percent of all trans-plants involved patients from developed countries travelling to poor countries to buy organs. They depended on local agents who "sourced" kidneys and ar-ranged the transplant. At least 15,000 kidneys are believed to be trafficked in this way each year. While there is evi-dence of people being forcibly deprived of a kidney, clearly most "donors" are peo-ple in desperate need for money. "In my opinion, organ trafficking involves societal and global issues that must be discussed within the broader paradigm of global injustices," said Moazam. "It must be a debate about communities of one kind of people being systematically ex-ploited by communities of other kinds, both internationally and internationally."

Pakistan Practice on Organ Trade E

ditor

ial C

alen

dar o

f Dec1

0-A

pril1

1

 

Bureau Head office: BANGLADESH 57 D.O.H.S. (OLD) Dhaka 1206 Bangladesh 

Base TEL: +8802 8715838 M: 88 01821100313 E:  info@newsandviews.eu 

Daisy Ahmed >Managing Editor Sanowar Hossain Milon > English Version Editor 

Fatima Ahmed Jayantee > Syndicate Editor Mohammad Ibrahim > News Editor Marium Ahmed > Business Reporter  

 

Bureau offices: ITALY, USA & SWITZERLAND Avv. Y. A. Shanchoy, Via Ernesto Pelloni 5, 6900 Lugano, Switzerland M: + 41765412005 E: info@shanchoy.com, editorinchief@newsandviews.eu Editor & Publisher< Y. A. Shanchoy, Switzerland Editor‐in‐Chief < Rukunuddin Ahmed, Italy Feature Editor < Faizun Nahar Shanchita, Italy Art & Design Director < Shafiqul Kabir Chandan, Milan USA Bureau Chief < Mujibuddin Ahmed, USA 

 

Bureau offices: SOUTH EAST ASIA AND UK Baridhara DOHS, Road‐ 3 House‐ 242 (2nd Floor) Dhaka‐1206, Bangladesh  Tel/Fax: +880‐2‐8416789 Cell:+880 01715094227, 01678074801 E: sagar@parshicomm.com, sagar@travelasiabd.com Editor< Md. Badrodduja Sagar  Publisher< Rukunuddin Ahmed UK Bureau < Sayed Chowdhury, Media Mohal Ltd. 

Managing Editor T: +8802 8715838 M: 88 01821100313 Email: editorinchief@newsandviews.eu

04 Water Report, SAARC regional politics & Business/Trade Blue Prints of Global Business & Investment Relations

11 Aerospace , Aviation, Marin & Tourism in Australasia Asian 50 Top Tourism Destination & Boards

18 National Code of Ethics for Franchise, Branding & Partnership IT, Telecommunication & Computer Report of Bangladesh

25 Conflict Management and Asian Countries Realization Top 5 Event Management Firms and Exhibition Calendar

WRITEUPS OF 8-32 P. Reports sz: 850-1000 words, Interview sz: 350-550 words, High resolution photos JPG or PNG

08 Infrastructure Boom in Tourism Spots in Australasia Top 10 design and Architectural firms in Bangladesh

15 Banking and it's Growth, Problems and Investment process Brand & Licensing control in Global business Development

22 Comparison study on Overseas VS Local Education & Training Investment Finance, Franchise & Partnership in SAARC region

29 Top Environmental friendly Firms in South East Asian Region Investment prospects using Environment and Natural Resources

WRITEUPS OF 8-32 P. Reports sz: 850-1000 words, Interview sz: 350-550 words, High resolution photos JPG or PNG

05 Automobile & Automotive Market & Distribution Technology Transfer in Electronics & Electrical products

12 Business & Investment Highlights in Asian Energy, Oil and Gas Leasing Companies, Investors and it's Growth and Problems

19 Property & Real Estate Building & Construction Broadcasting, TV, Media, Music and Entertainment in Tourism

26 Printing, Graphics, Publishing & Visual Communication Food, Drink, Catering & Hospitality Technology

WRITEUPS OF 8-32 P. Reports sz: 850-1000 words, Interview sz: 350-550 words, High resolution photos JPG or PNG

05 Processing and Packaging Industries in Bangladesh Foreign Brands VS Local servers in Medical, Health & Beauty

12 Foreign & NRB investments in Travel & Recreation Sector Future of Furniture & Accessories Companies with it’s growth

19 NRB’s (Non Resident Bangladeshi) investment & Incentives Medical & Health Tourism in Australasia/South pacific

26 Yearly Franchise, Brand, licensing and destination reviews Business Process Outsourcing in Print, Software and IT

WRITEUPS OF 8-32 P. Reports sz: 850-1000 words, Interview sz: 350-550 words, High resolution photos JPG or PNG

09 Engineering, Manufacturing & Distribution in Global Business link Business Intelligence Report/Surveys in Regional Cooperation

16 Insurance Companies in Nation Building regional Programs Multinational Companies achievements verses local Brands

23 Garments & Textile World Market Overview and Bangladesh Shoe and Leather Products export to US and Europe

30 Asian Power Project Highlights and Bangladeshi stack Customs, Inspections and Trade barriers between Europe & Asia

WRITEUPS OF 8-32 P. Reports sz: 850-1000 words, Interview sz: 350-550 words, High resolution photos JPG or PNG

Ja

nu

ary

’11

F

ebru

ary’

11

Mar

ch’1

1 A

pri

l’11

Dec

emb

er’1

0

ATTENTION: THE DATES ARE SUBJECT TO VARIATIONS