Organ failures can be caused by toxic exposure, chronic diseases, trauma to the organ or serve dehydration. When this occurs, there is a need for the failing organ to be replaced with a healthy one from a deceased or living donor. In the year of 2017 there was 1,675 patients who benefitted from an organ transplant, donated by 510 deceased donors and 273 living donors (donatelife.gov, 2018).
The idea of organ transplants was not a scientific breakthrough, the majority of attempts were found unsuccessful causing many lives to be lost in the process. There were large scientific breakthroughs involving bone and skin transplants in 1900 – 1920, this increased at a massive rate with almost 300 bone donation banks by 1986. In 1954 Dr. Joseph E. Murray successfully transplanted a kidney between two identical twins which earned him the Nobel Prize for Medicine 36 years later. Only 13 years after the first successful kidney transplant the first heart transplant was performed by a South African doctor, Professor Christiaan Bernard (mtfbiologics.org, 2018).
With the advancement of technology and scientific procedures there is a range of different body parts that can be transplanted such as; organs (e.g. bowel, kidneys and liver), corneas, tissues, blood stem cells and bone marrow, varying between the state of the patient being either alive or deceased. There are three categories which organ donations occur in; deceased donors who are determined dead by neurological criteria, deceased donors who are determined dead by the cardiorespiratory criteria or living donors.
Death determined by the neurological criteria is also known as being declared as ‘brain dead’, this is known as “complete cessation of all organized neurological activity throughout the entire brain, including the cerebrum, cerebellum, and brain stem” (Ncbcenter, 2018). When a patient is pronounced brain dead all oxygen supply to the brain is discontinued resulting in a need of assisted breathing while the organs try to continue working. If a donor is declared brain dead, their organs will be removed and recovered if necessary, the needed organs will then be placed in a cold environment to be preserved for transplantation.
Circulatory death is defined as “the irreversible loss of function of the heart and lungs” (Lcnw.org, 2018). When donation occurs after the donor has been declared dead by the circulatory criteria it is usually referred to as donation after circulatory death (DCD). In the majority of DCD cases the patient is on life support and will be expected to pass away within a two-hour radius. Once the patient is taken off life support and have been declared deceased, the relatives will give full consent to their family members organs being donated, and the patient will be transported into an operating theatre were the organs will be removed. Donations within DCD cases normally included the extraction of kidneys, liver and pancreas, while the heart and lungs are rarely used for transplantation, there have been significant advances in procedural methods within the realm DCD specific cases which have allowed this progression.
In 2017 there were a recorded amount of 273 living organ donors in Australia alone (donatelife.gov, 2018). Living donation is the process in which a donor, who is alive, healthy, and meets all criteria, donates an organ or segments of their organ which the donor can continue a healthy life without. There are a wide range of organs which donors can choose to donate such as; one kidney, segments of liver (which can regenerate back to full health), uterus and in rare cases the lobe of a lung and segments of the intestine have been donated in extreme situations (UNOS, 2018). In cases of living donors, there is a profusion of controversy and scepticism revolving around the ideal ethics and procedures of this type of donation.
Prior to the commencement of an organ transplant surgery, there are multiple diagnostic tests that are crucial to confirm the patient’s eligibility for any sort of transplant. Once the patient is determined eligible they are placed on a waiting list, until they can commence the procedure with a matched organ.
A patient needs to be completely prepared for surgery, this includes having any excessive amounts of hair removed from the site of surgery and ensuring there is no bowel movement during surgery. To achieve this, the patient is given a laxative or a urinary catheter is utilised, and the use of a ventilator regulates the patients breathing during the surgery. Every preparation step is vital to the success rate of the transplant. The process of a kidney transplant occurs under general anaesthesia, once the anaesthesia has put the patient to sleep the surgeons will begin the transplant.
An extensive incision is made along the abdomen, situated on the side of the failed kidney. The donor kidney is not placed in the exact position of the native kidneys, instead it is placed in the lower abdomen above the pelvic bone. The reasoning behind the positioning of the new kidney is due to the fact that it is a more reachable area to carry out the procedure. The donor’s kidney is placed within the patient, “the renal artery and vein of the donor kidney will be sewn to the external iliac artery and vein” (National Kidney Foundation, 2018). The artery that is responsible for transporting blood into the kidney and the vein that transports the blood out are connected through two blood vessels situated near the pelvis. The ureter is connected to the bladder through a smaller incision. (Sundar, 2018). The surrounding veins and arteries are connected through a procedure called anastomosis, which is the connection of adjacent tubes and veins through micro stitching (collinsdictonary.com, 2018). In situations where a Radical nephrectomy procedure is performed only occurs when there is a serve infection that can cause further harm to the patient. A Radical nephrectomy the process of an entire kidney being extracted and, depending on the severity of the failed organ, surrounding tissues and structures such as the ureter is additionally removed (Mayoclinic.org, 2018).
Organ transplants are in constant high demand and with these high demands there can be heavy amounts of pressure placed upon doctors and hospitals that can cause unethical ways of retrieving the needed organs.
The operation of having an organ, or section of an organ, removed includes high risks for the donor and patient, before and after the surgery. There is certain criteria that the donor must meet before donating an organ, these include; being psychologically stable, giving full consent to the procedure and not be persuaded, medically fit, have full knowledge of what the surgery entails and the post-surgery effects.
Transplant tourism is defined as “a phenomenon where patients travel abroad to purchase organs for transplants” (Ambagtsheer et al., 2012). This phenomenon can pose serious unethical violations to human rights and wellbeing acts. Transplant tourism is not only dangerous for those who are getting organs transplanted inside of them but for both the people who are having the organ removed and the physicians. If a physician is caught buying illegally donated organs, their license can be revoked, and legal action is required, this can result in jail time or heavy fines.
In 2010 there were major legal investigations into Chinese prisoners having their organs removed without full consent, it was uncovered that 90% of all organs transplanted in China were from prisoners. This violated many human rights laws as the prisoners were already under serious abuse and were undergoing forced surgery, against their will. As a result of this, all prisons were banned from retrieving organs from their inmates and it was prohibited to transplant any organ from a prisoner.
Transplant tourism has obvious benefits including the thousands of lives saved from the successful organ transplantation and the rise of the economy within communities who, would’ve either wise never of gained a profit. On the contrary, transplant tourism can easily turn into organ trafficking where hundreds of people are blackmailed, psychically forced and exploited in order to retrieve and sell these organs at lower value prices to doctors and patients.
Travelling overseas to receive an organ transplant rules out a long waiting list and extreme prices of health care service and insurance, it also means that the patient can most likely go on living a happy and healthy life. The medical field in lesser developed countries also have multiple chances to improve their systems and procedures through having a higher number of patients receive these surgeries.
From the person receiving the organ, there is little to worry about, there is the chance that your body might reject the organ and you will need further medical assistance. Excluding that the benefits seem to outweigh the negatives however this cannot be said for the donor. Majority of donors in countries such as Australia and America require the organ donation process to be completely voluntary, meaning that it is illegal to offer someone money in exchange for an organ extraction. In countries such as Mexico, this is not the case with majority of organ donations. People in developing countries are being exploited or even blackmailed due to their serve need for finical help, which is offered through the exchanging of organs through organ trafficking
In conclusion the idea of transplant tourism is in the best interest of the patients as long as it says within the laws and constrictions of governments and does not turn into something as dark as organ trafficking. With this being said, organ transplants are in high demand and need further assistance from anyone able to offer their help. If there is more support from people with good intentions then the business of organ trafficking will eventually phase out and will no longer push doctors over the edge.