Transplant Tourism: New Zealand Residents Deciding on Commercial Transplantation Overseas

<p>The demand for organs exceeds supply in almost every country, including New Zealand. As such, scholars have argued that this has contributed to a rise in illegal kidney purchase and commercial transplantation. Taking into account the likelihood that patients in New Zealand have been involved, this research considers the factors that motivate these patients to circumvent the transplant opportunities here in favour of a commercial transplant overseas. In addition, this project examines the ethical concerns that arise for medical professionals who suspect or become aware of a patient’s intention to procure an organ outside of New Zealand. Interviews were conducted with eight medical professionals working in the field of kidney donation and transplantation, two key informants (stakeholder and academic), and two patients. The patients have previously undergone a kidney transplant in New Zealand and have both — to varying degrees — considered transplant tourism. Using narrative thematic analysis, the data was organised into three predominant themes; The Desire for Health, Transplant Tourism: An Uncommon Phenomenon, and The Healthcare Response. Numerous insights were generated from this analysis. While transplant tourism is considered by many patients in New Zealand, it is pursued infrequently and arguably only by those with connections to common destination countries. When such instances occur, medical professionals in New Zealand encounter a variety of ethical, legal, and professional dilemmas that affect their ability to prevent transplantrelated crimes. This research concludes that patients (regardless of whether or not they pursue transplant tourism) experience feelings of frustration and hopelessness as a result of their illness experiences along with the current healthcare infrastructures. Assisting patients in setting realistic expectations of their treatment options, as well as increasing the transparency of the deceased donor waiting list is recommended. Moreover, it is suggested that transplant professionals at all levels are offered education about organ trafficking and transplant tourism, and a policy statement on organ trafficking and transplant tourism should be developed to clarify the rights and obligations of medical professionals in relation to organ purchase and offer guidance on how they can interact with patients who travel or plan to travel abroad for a transplant.</p>

Transplant Tourism: New Zealand Residents Deciding on Commercial Transplantation Overseas

<p>The demand for organs exceeds supply in almost every country, including New Zealand. As such, scholars have argued that this has contributed to a rise in illegal kidney purchase and commercial transplantation. Taking into account the likelihood that patients in New Zealand have been involved, this research considers the factors that motivate these patients to circumvent the transplant opportunities here in favour of a commercial transplant overseas. In addition, this project examines the ethical concerns that arise for medical professionals who suspect or become aware of a patient’s intention to procure an organ outside of New Zealand. Interviews were conducted with eight medical professionals working in the field of kidney donation and transplantation, two key informants (stakeholder and academic), and two patients. The patients have previously undergone a kidney transplant in New Zealand and have both — to varying degrees — considered transplant tourism. Using narrative thematic analysis, the data was organised into three predominant themes; The Desire for Health, Transplant Tourism: An Uncommon Phenomenon, and The Healthcare Response. Numerous insights were generated from this analysis. While transplant tourism is considered by many patients in New Zealand, it is pursued infrequently and arguably only by those with connections to common destination countries. When such instances occur, medical professionals in New Zealand encounter a variety of ethical, legal, and professional dilemmas that affect their ability to prevent transplantrelated crimes. This research concludes that patients (regardless of whether or not they pursue transplant tourism) experience feelings of frustration and hopelessness as a result of their illness experiences along with the current healthcare infrastructures. Assisting patients in setting realistic expectations of their treatment options, as well as increasing the transparency of the deceased donor waiting list is recommended. Moreover, it is suggested that transplant professionals at all levels are offered education about organ trafficking and transplant tourism, and a policy statement on organ trafficking and transplant tourism should be developed to clarify the rights and obligations of medical professionals in relation to organ purchase and offer guidance on how they can interact with patients who travel or plan to travel abroad for a transplant.</p>

P1841THE JOURNEY OF KIDNEY TRANSPLANTATION IN EGYPT: STILL EXTRA-MILES TO GO

Background and Aims Kidney transplantation is the renal replacement therapy of choice for patients with end-stage kidney disease. Egypt is a developing country with social, religious and demographic characteristics having enormous impact on the development and progress of its own national transplant program. Method A web-based review of relevant bibliography: articles and textbooks, reporting the progress in the transplant practice in Egypt and its legislations was conducted. Results Kidney transplantation started in Egypt about 43 years ago when the first transplant was performed at Mansoura Urology and Nephrology Center (UNC) in March 1976. The practice of kidney transplantation in Egypt has then evolved over the years. While about ten thousand transplants were performed from 1976 to 2011, the annual mean number of kidney transplantation between 2011 and 2016 increased to 1100 cases/year. The number of transplant centers has also grown from 12 in 1997 to 35 currently licensed centers. However, Egypt is still lacking a national transplant registry data. The legal framework developed over the last decade towards establishing a national transplant program. Until 2010, organ transplantation was only regulated by the professional code of ethics and conduct of the Egyptian Medical Syndicate. Representatives of the Istanbul Declaration met with the Egyptian Minister of Health and Egyptian Society of Nephrology leaders in Cairo in October 2008; since then, Egypt has been working to terminate illegal practices associated with organ transplantation, organ trafficking and transplant tourism. The first legislation for a national organ transplant program “The executive list for law number 5 of the year 2010 regarding regulating human organ transplants” was then issued after approval by the parliament. The law established “The Higher Committee for Organ Transplants” which includes 7 - 11 experts and is responsible for regulating and supervising all organ and tissue transplant procedures in the country. The new law criminalizes organ trafficking and set strict penalties for physicians, hospitals and medical facilities performing illegal organ transplant procedures. In 2017, the legislation has been further modified to make the penalties even harsher “Law number 142 of the year 2017 modification of some articles in law number 5 of the year 2010 regarding regulating human organ transplants”. Transplantation practice is still limited to live transplants. The cadaveric transplant program has not yet been put into action despite the new 2010 legislation has set the legal framework, yet lacking a clear definition of the legal death. Cadaveric transplantation was performed twice in Egypt in 1992 at Cairo (kasr El Aini hospital) from 2 criminals after execution in Alexandria. This was faced with social anger and rejection which led to legal restrictions for non-living organ procurement at that time. Barriers to establishment of a national transplant program in Egypt include cultural and religious rejection of deceased donation, organ shortage, and long waiting time in national transplant centers. Conclusion Despite the recent ameliorations in the current Egyptian transplant practice, the overall progress has been slow. This can be attributed to a complex interaction between social, religious and financial factors. Further advances are vital to reduce the burden implied by the state-funded dialysis therapy and to demolish organ trafficking and transplant tourism. As such, state efforts would continue to further improve the living donor and to implement the deceased donor transplantation programs.

Transplantation

For many of us the heart is still symbolic of the soul. Therefore, the advent of heart transplantation opened up new avenues for movie plots. The experience of the transplant recipient has captured screenwriters’ attention. Screenwriters are intrigued by the complexity of heart transplantation and, with it, themes based on the centrality of the heart in emotions, the possibility of a donor’s personality traits being transmitted to the recipient, quests to find the donor’s family and cloning organ donors to treat complex disease. Transplant tourism and trafficking are other commonly covered topics. This chapter reviews the history of transplantation and connects it with its cinematic representations– from horrific to compassionate.