Rapporteur concerned at results of study on organ trafficking

Many health care professionals who treat kidney patients know of patients who have travelled abroad for a transplant. A large majority of them suspect, or know for certain, that the patient paid for the organ, according to a study conducted by the Erasmus Medical Center in Rotterdam. The National Rapporteur is concerned at the results of the study because transplant tourists might be using donors who have been forced to surrender their organ. She feels that the subject should receive greater political attention.

Although the study reveals nothing about the circumstances under which the organs were donated, other studies have identified the risk of human trafficking by organ trade networks. Donors can be forced to surrender their kidney, for example. ‘Wherever money can be earned from exploiting people, there is the threat of human trafficking,’ says Corinne Dettmeijer-Vermeulen, who calls for proper information for patients who are on a waiting list for an organ, including specific warnings of the risks associated with securing an organ abroad. According to her, the uncertainty about the circumstances under which a donor surrenders a kidney means that irregular organ donation – although understandable from the perspective of the patient– is highly undesirable.

The study was based on a survey of 241 health care professionals, including 133 nephrologists. Forty-six percent of the respondents said they had treated patients who had been given a kidney transplant abroad. Ninety percent of them suspected that the patient had paid for the kidney, which is a criminal offence. Nine transplant professionals had suspicions of human trafficking in the period between 2008 and 2013.

Role of doctors

The National Rapporteur feels that doctors must clearly inform their patients about the risks of securing a kidney abroad, something also advocated by the researchers from Erasmus MC. They also call for the establishment of a reporting centre where health care professionals can disclose information about commercial organ donation, such as the names of hospitals and intermediaries that facilitate the practice. According to the researchers, however, the law will have to be amended to create such a facility because disclosure of this type of information would generally constitute an unlawful violation of medical professional secrecy under existing legislation. The researchers observe that many health care professionals are uncertain what to do when they encounter patients who intend to pay for an organ donation. ‘I endorse the appeal by the Erasmus MC for the drafting of guidelines to help doctors in making the difficult choices they face in these situations,’ says Dettmeijer-Vermeulen. The option of a reporting centre is a good place to start a discussion of the role of the medical community in preventing organ trafficking and organ tourism, according to the National Rapporteur ‘The medical, academic and political communities should start a dialogue on the role of the medical community in preventing organ trafficking and organ tourism,’ says the National Rapporteur. According to her, the option of a reporting centre is a good place to start that discussion.

National Rapporteur’s recommendations

In 2012, the National Rapporteur recommended the establishment of a reporting centre in her study into human trafficking for the purposes of organ removal. At the time, she called on the government to create an agency with responsibility for gathering and registering information about possible cases of organ trafficking and organ tourism.

Organ trade driven by shortage of donors

Organ trafficking and organ tourism are driven by the urgent worldwide shortage of organ donors. The Dutch Transplant Foundation reports that at the end of 2013 there were 710 persons on the waiting list for post-mortal donation of a kidney. The waiting period is roughly four years, according to the Kidney Foundation. Every year, 200 kidney patients die because no donor can be found in time. To tackle the shortage of donor organs, in 2012 the National Rapporteur repeated the recommendation made by the Council for Public Health and Care in 2007 that consideration should be given to introducing a very strictly regulated form of financial incentive for kidney donation. For example, rather than taking the form of a direct monetary reward, the incentive could be provided indirectly through a lifelong exemption from health insurance premiums. The Rapporteur has observed that there has been little political discussion of this suggestion. ‘That is regrettable, since academics have been studying the theoretical possibilities of a sound system of financial incentives for years. The subject deserves to receive wider political attention.’

NB: The report on the Erasmus MC’s study in the printed version of De Volkskrant (21-10-2014) stated that the National Rapporteur had spoken out earlier in favour of an active donor registration system. That is incorrect. The Rapporteur would welcome a debate about the design of the registration system, but has never expressed a preference for one system or another.

On 21 November, Corinne Dettmeijer-Vermeulen will act as moderator at an international conference on human trafficking for the purpose of organ removal in The Hague.