Academic journal article Bulletin of the World Health Organization

The State of the International Organ Trade: A Provisional Picture Based on Integration of Available information/Situation Du Commerce International D'organes : Un Tableau Previsionnel Reposant Sur L'integration Des Donnees disponible/Situacion del Comercio Internacional De Organos: Panorama Provisional Basado En la Integracion De la Informacion Disponible

Academic journal article Bulletin of the World Health Organization

The State of the International Organ Trade: A Provisional Picture Based on Integration of Available information/Situation Du Commerce International D'organes : Un Tableau Previsionnel Reposant Sur L'integration Des Donnees disponible/Situacion del Comercio Internacional De Organos: Panorama Provisional Basado En la Integracion De la Informacion Disponible

Article excerpt

Introduction

Organ transplantation is an effective therapy for end-stage organ failure and is widely practised around the world. According to WHO, kidney transplants are carried out in 91 countries. Around 66 000 kidney transplants, 21 000 liver transplants and 6000 heart transplants were performed globally in 2005. The access of patients to organ transplantation, however, varies according to their national situations, and is partly determined by the cost of health care, the level of technical capacity and, most importantly, the availability of organs.

The shortage of organs is virtually a universal problem. In some countries, the development of a deceased organ donation programme is hampered by sociocultural, legal and other factors. Even in developed countries, where rates of deceased organ donation tend to be higher than in other countries, organs from this source fail to meet the increasing demand. The use of live donors for kidney and liver transplantation is also practised, but the purchase and sale of transplant organs from live donors are prohibited in many countries. (1)

The shortage of an indigenous "supply" of organs has led to the de velopment of the international organ trade, where potential recipients travel abroad to obtain organs through commercial transactions. The international organ trade has been recognized as a significant health policy issue in the international community. A World Health Assembly resolution adopted in 2004 (WHA57.18) urges Member States to "take measures to protect the poorest and vulnerable groups from 'transplant tourism' and the sale of tissues and organs". (2) Despite growing awareness of the issue, the reality of the international organ trade is not well understood due to a paucity of data and also a lack of effort to integrate the available information.

This paper is a preliminary attempt to bring together the available information on the international organ trade. It aims to present a tentative global picture of the context and forms of the organ trade; the major organ-exporting and -importing countries; and the outcomes and consequences of commercial organ transplants.

Methods

This paper originated from a literature review commissioned by the Clinical Procedure Unit of WHO's Department of Essential Health Technologies and was undertaken during July and August 2006. Its purpose was to gather information on the international organ trade and transplant tourism, and to synthesize this into a tentative global picture using multiple research strategies.

Medical articles on the outcome of commercially arranged overseas transplants were collected through Medline/ PubMed. Using Reference Manager, the first search was conducted using two parameters: "kidney transplantation" AND "nonrelated" OR "unrelated"; the second search was made with "kidney transplantation" AND "commerce" OR "commercial". The abstracts were checked and, if judged relevant, the entire items were retrieved; their references were also consulted. Academic articles containing information on the scope and trends of the international organ trade were obtained using the same search procedure.

Because the paucity of scientific research was anticipated, media reports were identified as significant complementary resources. Articles published in the past five years that were accessible in both English and Japanese were examined. The initial search was made using online database services [LexisNexis Global Business and News Service, accessed through Oxford University Library Services (OXLIP; available at: http://www.bodley.ox.ac.uk/ oxlip/index.html)]. Articles indexed as "organ trafficking" were examined and items containing factual information on the organ trade were retrieved. After the identification of the major "organ importing and exporting" countries, reiterative searches were made to gather further information from the aforementioned database and Google searches. …

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