© Springer International Publishing Switzerland 2016
Alireza Bagheri, Jonathan D. Moreno and Stefano Semplici (eds.)Global Bioethics: The Impact of the UNESCO International Bioethics CommitteeAdvancing Global Bioethics510.1007/978-3-319-22650-7_99. The Risk of Discrimination and Stigmatization in Organ Transplantation and Trafficking
(1)
Tehran University of Medical Sciences, Tehran, Iran
Abstract
The global shortage of organs for transplantation has led to unethical practices in organ transplantation, such as organ commercialism and trafficking. Concerns have been raised about unjust and discriminatory allocation of the available organs in organ transplant programs as well as exploitation and stigmatization of individuals who provide their organs through organ trafficking and tourism. There have been global efforts to describe unethical practices in organ transplantation and in tackling organ commercialism and trafficking, international documents have justified their arguments mostly based on the exploitation inherent in organ sales and trafficking. Missing in the discussion of organ transplantation and trafficking are the perspectives of vulnerable patients as organ recipients and poor people as organ providers, and the discrimination and stigmatization they experience.
This chapter elaborates the risk of discrimination and stigmatization in organ transplantation and trafficking, and reviews current global efforts against unethical practice in organ transplantation, including the recent UNESCO report on non-discrimination and non-stigmatization. It calls all stakeholders to ensure that in the process of organ transplantation, organ donors and recipients are not subject to discrimination and stigmatization.
9.1 Introduction
Life-saving transplant technology has grown dramatically; however, there is a shortage of human organs and this is not limited to solid organs; there is an increasing demand for cell and tissue transplantation as well. In the current situation, the demand for transplants has grown far faster than the supply of available organs. In order to overcome the shortage of organs, several proposals have been introduced to expand the donor pool (Bagheri 2007). However, the controversial practice of organ markets and commercialism to address the local need for organ transplantation, and the ethically condemnable practice of organ trafficking to provide organs for international patients have been subject to critical examinations. In fact both practices cause exploitation, discrimination and stigmatization of organ providers and/or organ recipients (UNESCO-IBC Report 2014). Although, discrimination and stigmatization may occur in all areas of healthcare and medical research, the focus of this chapter is to explore how individuals may become subject to discrimination and/or stigmatization in the application of transplant technology. Over the last two decades, international organizations such as the World Health Organization (WHO 2010) and professional associations have developed guidelines and recommendations to tackle organ commercialism and trafficking, however, none of them have examined the issue in the context of discrimination and stigmatization in adequate detail. It is important to thoroughly explore how the application of transplant technology may cause stigmatization and/or discrimination in a legitimate procurement program as well as through organ trafficking and tourism. The recent UNESCO-IBC Report on The Principle of Non-stigmatization and Non-discrimination has focused on this issue and if its recommendations are implemented, it will be very instrumental in preventing stigmatization and discrimination in organ transplantation.
9.2 Organ Transplantation and Trafficking: Current Global Initiatives
For more than two decades, international organizations and governments around the world have recognized the global problem of organ trafficking and the exploitation of poor people as organ providers around the world. There are several major international initiatives to regulate organ transplantation and to tackle organ trafficking (Bagheri and Delmonico 2013).
Since 1987, the World Health Organization (WHO) became involved in regulating organ transplantation when the World Health Assembly expressed concern about the commercial trade in human organs. In 1991, the document, WHO Guiding Principles on Human Organ Transplantation was endorsed by the member states. Later, after a long process of extensive consultations at national, regional and sub-regional levels with all stakeholders, this document was revised and renamed the WHO Guiding Principles on Human Cells, Tissues and Organ Transplantation, and was endorsed in May 2010. The Guiding Principles were intended to provide an orderly, ethical and acceptable framework for the acquisition and transplantation of human cells, tissues and organs for therapeutic purposes. The document introduced 11 guiding principles which emphasize the need for: organ donation without any monetary payment or other reward of monetary value; protection of personal anonymity, and privacy of donors and recipients; donor’s informed and voluntary consent for live donation; and allocation of organs, cells and tissues based on clinical criteria and ethical norms, not financial or other considerations (WHO 2010).
In another initiative, led by the Transplantation Society and the International Society of Nephrology in 2008, the Declaration of Istanbul on Organ Trafficking and Transplant Tourism was developed during a summit attended by more than 150 representatives of scientific and medical bodies. This initiative was specifically intended to address the urgent and growing problems of organ sales, transplant tourism and trafficking. In tackling organ trafficking and transplant tourism, this international document has encouraged the development of: programs to prevent organ failure; national self-sufficiency in organ transplantation; and enhanced deceased organ donation programs.
In 2007 another initiative, the Asian Task Force on Organ Trafficking, was led by an international working group to develop a set of recommendations on how to tackle the issue of organ trafficking, particularly in Asia. For instance, it recommends health authorities to: establish a monitoring system and national registry for organ transplantation; rely more on deceased organ donation; restrict transplantation to donors and recipients from the same nationality; and address the needs of the population who suffer from economic disadvantages.
It is more than a decade that the United Nation s has been fighting against human trafficking and has issued several documents regarding organ commercialism and trafficking. However, in its efforts on this issue the United Nations has recently recognized the link between organ trafficking and human trafficking. Following the UN General Assembly Resolution 63/14 of December 2008, a research plan on “organ trafficking and human trafficking” was jointly conducted by the United Nations and the Council of Europe . The idea was to establish some essential facts that would facilitate policy formulation and norm setting regarding trafficking of organs as well as trafficking in human beings for the purpose of the removal of organs.
Following the above mentioned study carried out jointly by the Council of Europe and the United Nation s in 2009, the Council of Europe has recently focused on the possibility of criminalizing organ trafficking (Council of Europe 2012). It should be noted that all previous efforts have not yet been effective enough to stop the rapid growth of organ markets and trafficking.
As mentioned earlier, the above international documents have built their argument against organ trafficking and transplant tourism mostly based on exploitation, and not by addressing on discrimination and stigmatization. This oversight was recently addressed by the UNESCO Report on the Principle of Non-discrimination and Non-stigmatization (2014).
9.3 UNESCO’s Principles of Non-discrimination and Non-stigmatization
The UNESCO International Bioethics Committee (IBC) Report on the Principle of Non-discrimination and Non-stigmatization (2014) has focused on the global problem of organ transplantation and trafficking in the context of the principles of Non-discrimination and Non-stigmatization as stipulated in Article 11 of the Universal Declaration of Bioethics and Human Right s (2005). Article 11 of this Declaration provides that, “No individual or group should be discriminated against or stigmatized on any grounds, in violation of human dignity, human rights and fundamental freedoms” (UNESCO 2005). The general aim of this principle is that in any decision or practice, no one shall be subjected to discrimination based on any grounds, including physical, mental, or social conditions, diseases or genetic characteristics, nor shall such conditions or characteristics be invoked or used to stigmatize an individual, a family, or a group (Guessous 2013). The UNESCO report also intends to ensure that organ transplantation programs further human rights and upholds the highest ethical principles especially as it pertains to Article 3 (Human dignity and human rights), Article 4 (Benefits and harm), Article 8 (Respect for human vulnerability and personal integrity), Article 10 (Equality, justice and equity), as well as Articles 11 and 13 (Solidarity and cooperation) of the Declaration.
The UNESCO Report on Non-discrimination and Non-stigmatization defines discrimination as, “From the wording of the principle one can deduce that only those distinctions that impair human dignity, human rights or fundamental freedoms are rightfully called discriminatory under Article 11. A decision or a practice that is discriminatory is one that infringes upon these fundamental notions and such decisions or practices are objectionable”.
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