Organ Transplantation: The Jekyl and Hyde Phenomenon

‘Organ Transplantation: The Jekyl and Hyde Phenomenon’



In this essay I examine the complex topic of organ transplantation and the ethical considerations involved in the practices that surround it. I discuss the bio-politics of transplantation, focussing on the interaction between technological development and legislation. I argue that new developments have a direct influence on policies designed to regulate organ transplantation and refer to ethnographic examples to illustrate certain points. In addition to this I mention different approaches employed by various governments to address the same issue. These examples are taken mainly from ethnographic texts by well-known anthropologists such as Nancy Sheper-Hughes. I briefly outline the current debates surrounding the organ trade, providing the main points of each respective argument. I do this drawing on the works of: Anderson (2006); Cohen (1999); Das (2000); Grant (2006); Helman (1988); Joralemon (1995); Koening & Hogle; Scheper-Hughes (2000; 2003); Sharp (2000), Siminoff & Chillag (1999) and Teo(1991).




INTRODUCTION

Science has had a profound effect on modern lives, with new technological advances influencing not only the way we live, but also the way we think (Helman: 1988; Joralemon: 1995; Sharp: 2000). Organ transplant surgery is one such biomedical breakthrough that has challenged conceptions of the body and its place in society (Cohen: 1999; Das: 2000; Helman: 1988; Scheper-Hughes: 2003). The body has become fragmented and industrialised. Turning it in to a machine, with various parts that can be replaced when they wore out (Helman: 1988). These changes are not always welcome and since it’s conception transplant surgery has been a matter of contestation (Das: 2000; Helman: 1988; Joralemon: 1995; Teo: 1991). Subsequent developments have provided more questions than answers bringing new possibilities, but also creating new dilemmas (Koening & Hogle). New commoditised perceptions of the body eventually led to problems such as: organ sales, disputes regarding live donors and human trafficking (Anderson: 2006; Cohen: 1999; Scheper-Hughes: 2000; 2003; Sharp: 2000).

DISCUSSION

In a era when capitalism and industrialisation is forever growing and extending its hold on the world, transplant surgery found its niche in the global market (Anderson: 2006; Das: 2000; Scheper-Hughes: 2000; Teo: 1991). Making use of biomedical metaphors and offering the ‘gift of life’ to those in need (Siminoff & Chillag: 1999; ), provided that they can afford it (Cohen: 1999; Koenig & Hogle; Scheper-Hughes: 2000, 2003; Siminoff & Chillag: 1999; Sharp: 2000). The growing demand for organs suitable for transplant far surpasses the available supply of willing donors (Joralemon: 1995; Sharp: 2000). Transforming vital organs in to the ultimate commodity, expensive, exclusive and life changing (Cohen: 2000; Scheper-Hughes: 2003; Sharp: 2000). Such Commodification of the human body and its parts highlighted historical inequalities and exploitative practices, as well as giving rise to a whole gamut of new exploitation methods (Das: 2000; Joralemon: 1995; Sharp: 2000; Siminoff & Chillag: 1999; Teo: 1991). The bodies of the poor became a resource of vital organs for the wealthy (Anderson: 2006; Cohen: 1999; Das: 2000; Grant: 2006; Scheper-Hughes: 2000-2003 ). Neither Commodification nor exploitation are new concepts, but in their contemporary forms they have raised questions regarding ownership and control over the individual body (Das: 2000; Sharp: 2000). Governments have turned to legislation, passing new laws regulating body parts in an effort to halt the organ trade, or at the very least reduce exploitation ( Cohen: 1999; Das: 1988; Joralemon: 1995; Scheper-Hughes: 2000; Siminoff & Chillag: 1999). These laws were not entirely successful (Cohen: 1999; Grant: 2006).

Legislation was not passed simultaneously and the local organ trade simply went global in the hunt for transplant organs, transcending national boundaries in an effort to gain an advantage (Cohen: 1999, Das: 2000; Koenig & Hogle; Scheper-Hughes: 2000; 2003; Sharp: 2000; Siminoff & Chillag: 1999). For a while the mobile wealthy could legally circumvent their own laws regarding transplantation by turning to countries where such regulations were not yet in effect or not properly enforced (Das: 2000; Grant: 2006). This created a phenomenon known as transplant tourism which is still taking place at the present time ( Das: 2000). Examples of this are countries such as India and Turkey, where live donors offer up kidneys to rich foreigners, who visit the country with the sole intention of procuring organs (Cohen: 1999; Joralemon: 1995).

India became notorious during the early 90’s for a booming trade in live donor organs, commonly referred to as the “Organ Bazaars” (Cohen: 1999; Grant: 2006; Scheper-Hughes: 2000). Expose articles and media coverage such as Grant’s (2006) documentary “A Pound of Flesh” led to a public outcry and the practice of selling organs was outlawed in 1994 (Cohen: 1999; Scheper-Hughes: 2003). Instead of ending it, the new legislation simply pushed the practice underground where the ‘black market’ in organ trade thrived (Cohen: 1999; Das: 2000; Sharp: 2000). Despite live donations being illegal the law makes exceptions in its restrictions regarding live donations provided that there was a existing close relationship between the donor and the recipient (Cohen: 1999; Grant: 2006, Scheper-Hughes: 2000). Those involved with transplant coordination, capitalised on this weak spot, bribing officials and family members in a bid to procure organs (Cohen: 1999; Sharp: 2000).

Globalisation is not without its merits, because in some cases the public needs to be protected not only from unscrupulous organ dealers, but from the state itself (Anderson: 2006; Scheper-Hughes: 2000; Teo: 1991). This was the case in Brazil and Argentina in the 70’s and 80’s before the switch to democratic government was made and continued in Eastern countries till the late 90’s (Scheper-Hughes: 2000). Trade sanctions and outside pressure brought about official policy changes in countries such as Singapore and China. After pressure from international human rights organisations, first Taiwan and later China passed legislation making buying and selling of organs illegal (Scheper-Hughes: 2000; 2003). Before this law was passed, the organs of executed Chinese prisoners were routinely sold off to foreign buyers and influential locals (Siminoff & Chillag: 1999).

Yielding to pressure and passing the laws was not enough in China and allegations of human rights abuses remain rampant (Scheper-Hughes: 2000; 2003). These allegations mainly involve the organs of condemned criminals, but claims that harsh new anti-crime campaigns are motivated by the growing demand for transplant organs have fuelled numerous international enquiries.The Chinese government has denied the allegations, but passed legislation forbidding medical and administrative staff involved with transplant procedures from providing information to anyone outside the system (Scheper-Hughes: 2000).

On web sites such as www.organtransplant.bz transplant surgeries are offered with the organ that is to be used including the quotation price. With prices ranging between $ 45 000,00 and $ 60 000,00 for a kidney and a liver transplant going up to a possible $ 100 000,00 plus the added $ 5000,00 coordination fee, transplant surgery is expensive even without added complications. The complete control of the Chinese state over the individual body creates an environment where state funded exploitation can flourish, while effectively silencing those who would protest (Anderson: 2006; Scheper-Hughes: 2000).

The Aadhil hospital in Pakistan is more discreet. On its website http://www.aadhilhospital.com it advertises a living donor registry, guarantees a match and promises a short waiting period. They do not have direct quotes for the surgery posted on the website as is the case in China, but they make it clear that the package that is eventually negotiated will include the medical and other costs of the donor as well. Their surgeons operate in a high-tech facility and are internationally qualified.

Some countries such as Belgium, Spain, Italy, Greece and Austria have taken a more direct approach in a bid to eliminate the global organ trade, by introducing ‘presumed consent’ laws (Das: 2000; Joralemon: 1995; Koenig & Hogle; Scheper-Hughes: 2000, 2003 ). Such a laws dictate that any permanent resident over a certain age is automatically considered to have consented to organ donation, in the event of an untimely death. The only way to avoid donation in these countries is to officially ‘opt out’ of donation (Das: 2000). In some countries such as Spain, the family of the deceased still holds the right to decide whether or not they are willing to consent to donation (Scheper-Hughes: 2000).

Although the effort was made to regulate and thus limit the uses to which the body could be put, public resistance to such restrictions is growing (Cohen: 1999; Helman: 1988; Joralemon: 1995). The idea of individual rights and autonomy are built in to the fibre of western ideology and such regulations seem to contradict this fundamental element (Siminoff & Chillag: 1999). Despite resistance, state regulation of the individual body is nothing new (Sharp: 2000). Various local and international human rights laws enforce certain restrictions with the presumed intention of protecting the public (Scheper-Hughes: 2000; 2003).





CURRENT DEBATES

Although trade in organs is currently illegal, there are those who favour regulation over legislation outlawing organ sales. These advocates of regulation often base their arguments on two points, the first is ownership and individual property rights. They argue that since you own your body you should be able to decide what happens to it. The second argument rests on the perceived global scarcity of organs. The demand for transplant organs surpass the supply and it is argued that compensation would provide an incentive that would raise donation numbers. Regulation advocates claim to take a pragmatic approach to a established and complicated social problem, but fail to take in to account the true costs associated with the surgery (Scheper-Hughes: 2000). Simply claiming that organ trade is taking place in anyway so both the donor and the recipient might as well benefit from the transaction is not enough justification for legalising a potentially exploitative practice (Cohen: 1999; Joralemon: 1995; Scheper-Hughes: 2003; Sharp: 2000; Siminoff & Chillag: 1999). Kidney sellers are almost desperate

Those who support the continued ban on organ sales raise issues such as exploitation and the potential social impact of donation on both the donor and their family (Scheper-Hughes: 2003). They argue that by reducing organs to this extend, one is simply profiting from the desperation of the poor (Cohen: 1999). An argument that is often countered by pointing out that live donors often defend their decision and many claim that they would make the same choice again if they had the opportunity (Das:2000). Live donation of organs from the bodies of the poor to those of the rich, often represent a desperate attempt on the part of the donors to get out of debt. While such donations are premised on the idea of presumed consent, it fails to take in to account that those making the choices are often not fully aware of the impact it could have on their lives (Das: 2000; Helman: 1988; Scheper-Hughes: 2000; 2003).




CONCLUSION

The multifarious nature of organ transplantation complicates discussions about the subject. Transplant surgery leads a strange double life, treading and sometimes crossing the line between good and evil ( Scheper-Hughes: 2000, Siminoff & Chillag: 1999). Each interpretation is as valid as the next leaving it up to context to define its nature. Dominant biomedical narratives surrounding transplant surgery highlights the potential benefits, while skilfully masking the potential pitfalls (Siminoff & Chillag: 1999). Potential benefits of transplant surgery are significant, but ignoring the dark side is not doing anyone any favours. Control represents a strong theme in the transplantation narrative even when it is not overtly expressed, with various parties taking part in a negotiation that only personally affects a select few (Scheper-Hughes: 2000; 2003; Sharp: 2000). Biomedical technology needed to change accepted social perceptions of the human body in order to gain individual support for transplant surgery. Such alterations represent control over the individual body, but also control over the mind (Helman: 1988; Joralemon: 1995). The exact location where this power ultimately resides is still a matter of contestation. Governments pass laws to regulate transplant practices while society resists such dominance, in various ingenious ways (Scheper-Hughes: 2000).








References

BOOKS & JOURNALS

• Cohen, L. 1999 ‘Where it Hurts: Indian Material for an Ethics of Organ Transplantation’ in Daedalus 128(4): 135-165
• Das, V. 2000 ‘The Practice of Organ Transplantations: Networks, Documents, Translations’ in M. Lock, A. Young, and A. Cambrioso (ed.) in Living and Working with the New Medical Technologies Cambridge: Cambridge University Press
• Helman, C. 1988 ‘Dr. Frankenstein and the Industrial Body: Reflections on ‘Spare Part’ Surgery’ in Anthropology Today 4(3): 14-16
• Joralemon, D. 1995 ‘Organ Wars: The Battle for Body Parts’ in Medical Anthropology Quarterly 9(3): 335-356
• Koenig, B.A. & Hogle, L.F. ‘Organ Transplantation (Re) Examined?’ in Medical Anthropology Quarterly 393-397
• Scheper-Hughes, N. 2000 ‘The Global Traffic in Human Organs’ in Current Anthropology, Vol.41, No.2, 2 April 2000
• Scheper-Hughes, N. 2003 ‘Keeping an Eye on the Global Traffic in Human Organs’ in Lancet 362: 1645-1648
• Sharp, L.A. 2000 ‘The Commodification of the Body and Its Parts’ in Annu. Rev. Anthropology 29: 287-328
• Siminoff, L.A. & Chillag, K. 1999 ‘The Fallacy of the “Gift of Life” in Hastings Centre Report 29, no. 6 34-41
• Teo, B. 1991 ‘Organs For Transplantation: The Singapore Experience’ in Hastings Center Report, November/December 1991



LINKS
(General)
• www.about.com
• Cline, A. 2007 ‘Selling Organs for Transplants: Commodification and Ownership of Bodies’ on About.com, Link: http://atheism.about.com/od/bioethics/a/sellingorgans.htm?p=1
• www.cnn.com
• Anderson C. 2006 ‘ Heading to China for an Organ Transplant’ in How Far Would You Go? An AC360◦ Special Series, on CNN.com, Link: http://www.cnn.com/CNN/Programs/anderson.cooper.360/special/
• CNN.com ‘China alters transplant laws’ in World on CNN.com, Link: http://www.cnn.com/2007/WORLD/asiapcf/04/07/china.organs.ap/index.html
• CNN.com ‘Tuskegee’s ghosts: Fear hinders black marrow donation’ in Health on CNN.com, Link: http://www.cnn.com/2007/HEALTH/02/07/bone.marrow/index.html
• CNN.com ‘Modern Medical Breakthroughs’ in Health on CNN.com, Link: http://www.cnn.com/2007/HEALTH/01/12/vital.signs.overview/index.html
• CNN.com ‘Your Emails: How Far Would You Go?’ in US on CNN.com’ Link: http://www.cnn.com/2006/US/12/14/how.far.emails/index.html
• www.youtube.com
• Mcai, N.J. ‘Children’s Organ Transplant Association PSA’ on youtube.com, Link: http://www.youtube.com/watch?v=NCom7o0YXYk posted by: Richguitarblue
• Youtube.com 2006 ‘Organ Harvesting in China’ Link: http://www.youtube.com/watch?v=Ia04u0u8J8s posted: Georgia Y August 20, 2006
• http://www.pbs.org
• Grant, S. 2006 “A Pound of Flesh- Selling kidneys to survive” July 20, 2006 http://www.pbs.org/cgi-registry/mediaplayer/videoplayer.cgi?playeraddress=videoplayer.cgi&media=%2Ffrontlineworld%2Findia_kidneys_rc25_lo.rm%2C%2Ffrontlineworld%2Findia_kidneys_rc25_hi.rm%2C%2Ffrontlineworld%2Findia_kidneys_rc25_lo.mov%2C%2Ffrontlineworld%2Findia_kidneys_rc25_hi.mov&title=FRONTLINE%2FWorld%20.%20Rough%20Cut.%20India%3A%20A%20Pound%20of%20Flesh%20%7C%20PBS&playertemplate=%2Ffrontlineworld%2Frough%2Fvideotemplate1.html&description=India%3A%20A%20Pound%20of%20Flesh%20%2810%3A52%29


Hospitals and Organisations Involved with Transplants

• Aadhil Hospital. Pakistan – http://www.aadhilhospital.com
• Bek-Transplant – http://bek-transplant.com
• Kidney Transplant Associates. Pakistan – http://kidney.com.pk
• Organ Donor Foundation of South Africa – http://www.odf.co.za
• Organs Watch at Berkley – http://sunsite.berkley.edu/biotech/organswatch
• Organ Transplant – www.organtransplant.bz
• Unesco – http://www.unesco.org