World Health Organisation Study Guide Primary Issue: The Question of Transplant Trafficking

Transcription

1 World Health Organisation Study Guide Primary Issue: The Question of Transplant Trafficking

2 Chair Forewords Kok Chun is currently a Year 3 student at Hwa Chong Institution. He made his foray into the local MUN circuit as a blundering greenhorn with UNASMUN 16, and has participated in five conferences thereafter. In his free time, the self-proclaimed normie takes great pleasure in lamenting his uninspiring grades, all while binge-watching BuzzFeed videos and browsing Reddit. Kok Chun can t wait to meet the delegates of WHO and he hopes that they will glean something useful from UNASMUN (and derive great masochistic delight from the futile undertaking that is MUN). Desiree is currently a Year 5 student at Anglo Chinese School (Independent). Finding joy in forced interaction and stepping out of her comfort zone, she has taken part in multiple conferences and is a member of the Young Diplomat Society. In her free time she enjoys water coloring, lettering and des igning puns to eradicate des pondency. She looks forward to seeing delegates grow as speaker, take initiative and gaining invaluable knowledge along the way. She hopes that delegates will enjoy their experience at UNASMUN 2017 and looks forward to the fruitful debate. Yuan En is currently a Year 5 student at Dunman High School and is a member of her school s International Strategic Affairs Council. She chanced upon Model United Nations slightly more than a year ago and has been to a handful of conferences as a capacity of a delegate, political actor and chair. During her precious free time, she can be seen fretting over Chelsea FC s inconsistent performance this season or raving over Martin Garrix s latest hits or binge watching on BBC s infoed variety series. Out of that rare moments, she aspires to become a criminal psychologist. But right before she sets foot on her dreams, she needs to firstly improve on her mediocre grades and secondly, ensure a smooth delivery of WHO at UNASMUN She looks forward to meeting all delegates and is excited to be exposed to mindblowing statements made by various delegates. Dear delegates, welcome to the World Health Organization. Model United Nations may seem like a jarring term that has a set of bombastic Rules of Procedures at first sight, however, as you embark on this journey, you will definitely be exposed to many more perspectives about the world we live in. We understand that public speaking may be a fear for many to overcome but through this conference, the Dais of WHO hopes to see each and every one of you grow by applying the skills we will be imparting to all of you. We understand that there will be obstacles you will face throughout this journey.

3 Regardless of how tough they might be, the last thing you should be doing is to give up. The fruits of your labour will be worth it and you will come to realize that the most valuable takeaway from this conference would be the friendships you ve forged over the course of the 4 days at UNASMUN At the end of the day, it all boils down to whether you decide to take a leap of faith and try your best. As long as you promise to keep your placard up high, the dais of WHO will ensure your spirits are kept high throughout the duration of this conference. Be there or be square. See you there. Introduction to the World Health Organization The World Health Organization (WHO) is a specialised agency of the United Nations that was established on 7 April The WHO is responsible for directing and coordinating health care systems of the 194 member states. The primary focus of the WHO includes providing emergency response, combating both communicable and noncommunicable diseases, and improving sanitation in less developed countries. In the long run, the WHO commits itself to achieving the 2030 Sustainable Development Goals through humanitarian efforts in areas affected by extreme poverty. As a specialised agency under the World Health Assembly, WHO serves as a medium for cooperation between governments and partners that span from funds, foundations to private sectors and civil society organizations so as to achieve health care objectives. I. Introduction Organ transplantation refers to the medical procedure in which an organ is harvested from the body of a donor and implanted in that of a recipient. [1] Jarl and Gerdtham, in their systematic literature review of economic evaluations of organ transplantations, assert that organ transplantation remains the most viable form of treatment for sufferers of end-stage organ failure, as is evident from how the cost of [organ] transplantation has generally fallen over time, while survival and quality of life have improved [as a result]. [2] Due to the aforementioned factors, organs, in particular kidneys and hearts, have been in perpetual high demand, as reflected by the long waiting lists for said organs. The universal shortage of organs has given rise to the practice of illegal organ trade, wherein organs are illicitly and often clandestinely traded in black markets. [3] The existence of such illicit activities is further compounded by the onset of globalization, which has enabled the proliferation of illegal organ selling across international borders. [4]

4 While organ trading in black markets has ostensibly granted greater access to organs that are highly sought after, it has also led to complications vis-a-vis exploitation, unsanitary medical practices, disease transmission, and political corruption. Besides these practical concerns, the practice of organ trading has engendered a broad debate with regards to its moral and legal permissibility. Some proponents of organ trading often invoke libertarian principles for their support of the practicethey assert that every human being has a presumptive right to exercise self-determination over their bodies, while others base their support on more tangible concerns, such as the ability to profit from organ sales. However, detractors, often due to ethical and religious considerations, believe that it is fundamentally immoral to market one s organ, and that the legalization of transplant trafficking will send the wrong moral message to the general populace. Delegates are highly encouraged to explore the contentious issue of transplant trafficking through its various facets by analyzing both its moral and practical aspects on a micro and macro level, all while bearing in mind the tangible consequences it has on public health. Delegates should also implement pragmatic solutions that will effectively combat the practice of transplant trafficking, formulate a targeted approach to protect vulnerable individuals and safeguard public health. II. Definitions Transplant trafficking or illegal organ trade is defined as the illegal trade, sale or obtainment of organs, tissues or even cells. The process includes the engagement, removal, delivery, transfer and the transplant [5]. Transplant trafficking is most commonly done so through threats, force, power, coercion, fraud or payments. A vulnerable individual is commonly targeted for such exploitation. III. Scope of debate Seeing that the WHO cannot dictate legalization and international law, they serve a primary function of providing guidance through avenues such as but not limited to statistics, facts, evidence and advice, therefore directing and coordinating international health. Cross Border Transplant Trafficking Cross border transplant trafficking is gaining popularity, where patients travel across national borders for health care typically due to the inability to obtain a particular organ or transplantation services in a timely fashion in their home country. Despite commercial transplantation and cross border transplantation being illegal, transplant trafficking continues to occur through corruption and bribery. The ethical concerns with this are the risks involved especially for the donor where morbidity and mortality increases greatly [6]. To tackle this issue, cooperation between countries is key.

5 Vulnerable populations Impoverished persons are often tempted by the hefty cash payouts promised for the sales of their organs and perceive transplant trafficking as a means to escape poverty. It does not help that said impoverished individuals are often not fully aware of their basic human rights, which renders them susceptible to deception and exploitation by malicious entities. Their vulnerability and desperation culminate in a series of problems- many a time, said donors find themselves helpless when recipients renege on their promise to offer restitution for the purchase of their organs. Strategies of syndicates In addition, some crime syndicates target corrupt medical professionals or provide false medical prognosis and treat less educated individuals for false illnesses in order to obtain a particular organ, more often than not without their consent. In various countries, organized crime syndicates have been found to coerce individuals into harvesting their kidneys in exchange for debt relief. Their kidneys were then sold for profit on the black market. It is, therefore, clear that it would be impossible to combat organ trafficking without a clamping down on said crime syndicates. Delegates can consider strengthening existing punitive measures against crime syndicates, through means such as extended incarceration periods and corporal punishment. However, as the case study of Pakistan will later show, the presence of such punitive measures may not be enough to combat illegal organ trade by crime syndicates - there must be strong political will to enforce existing legislation. Religion Despite common misconceptions, almost all mainstream religions permit, or even encourage the practice of organ donation. However, conservative denominations of Christianity have been much more cautious in embracing organ donation. The Catholic Church, in particular, supports organ donation with one major caveat- it should not involve the transplant of stem cells, which, owing to the limitations of current technology, must be extracted from aborted embryos. Nevertheless, mainstream religions have indubitably been the staunchest opponents of organ trade. In the Abrahamic religions, the human being is a psychophysical being, comprising body and soul. Ergo, the body cannot be viewed as being just an extension of the essential self. Rather, the body is part of that self, because the human being is essentially an embodied being. In their opinion, allowing the trade of human organs is to reduce these human body parts into mere commodities, which they perceive as an affront to morality. Principle Opposition Another major contention with organ trafficking is the moral objection to commercial organ trade. Common arguments include commodifying humans by putting a price on human life. From an altruistic standpoint, organ trafficking reduces altruism as it involves the

6 transaction of money between the organ donor and the organ recipient. IV. Major stakeholders Asia In India, it is estimated that approximately 2000 Indians sell a kidney every year, making India one of the top organ-exporting countries. This is largely fueled by a rise in chronic kidney diseases in the country, where around 350 to 400 people per million population suffer from end-stage renal disease. [7] Organs from local donors are also frequently transplanted to foreigners by means of sales. Organ trade is, however, officially against Indian law with the enactment of the Transplantation of Human Organs and Tissues Act, a pivotal piece of legislation that oversees organ transplantation in India and explicitly bans the sales and purchasing of organs. [8] Yet, some Indians are still willing to shoulder the potential legal risks for financial gains. This is especially true in impoverished rural areas of the country, where many sell their organs out of economic distress. To evade legal scrutiny, organ donors often pose as the immediate family members of their recipients as family members are permitted to donate their organs with the approval of a hospital authorization committee. In neighboring Pakistan, organ trafficking is often carried out by organized gangs and crime syndicates. In April 2017, the Federal Investigation Agency of Pakistan apprehended two medical practitioners, two foreign individuals and two potential organ donors for allegedly being involved in an organ trade gang, issuing its first-ever arrest under the Human Organ Transplant Act. [9] Elected politicians and human rights activists have toiled for years to eradicate organ trafficking, punishing those involved in organ trade with jail terms up to a decade, and suspending the medical licenses of physicians who perform illegal organ transplantations. However, these efforts have been undermined by the immense political leverage that organized gangs, the main perpetrators of illegal organ trade, wield. This is evinced by how the former chief of the Human Organ Transplant Authority, Dr Ishtiaq A. Malik, was compelled to resign after expressing his will to crack down on organ trafficking, which prompted organized gangs to wage a media campaign against him. The impetus for his resignation was simple- he felt that even prominent officers of the ministry seemed helpless in the face of powerful mafias that were not willing to submit to those laws. China is also a nation where organ trafficking is prevalent. In July 2006, the Kilgour-Matas Report alleging that the Chinese government had been engaging in organ pillaging was released. Practitioners of Falun Gong, an outlawed spiritual practice in China, had allegedly been held captive by the government of China and put to death so their organs could be subsequently harvested and implanted in recipients. [10] Manfred Nowak, the former United Nations Special Rapporteur on Torture, wrote in the 2010 UN Report on Falun Gong Persecution in China that the

7 nation maintains the most institutionalized method of opposing political dissents that I have encountered, [11] hypothesizing that organs harvested from Falun Gong practitioners accounted for the discrepancy between the low number of voluntary organ donations and the number of organ transplantations performed. V. Possible solutions Before adopting the next course of action to tackle transplant trafficking, it is imperative for all delegates to cogitate about the international regulatory frameworks currently in place to prevent organ trade, namely the UN Protocol to Prevent, Suppress, and Punish Trafficking in Persons, especially Women and Children, [12] and the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. [13] Apart from outlining the principal tenets which undergird the fight against organ trafficking, these existing treaties and agreements should serve as a scaffold for delegates to build on when instituting new legal frameworks. It is also of utmost importance for all delegates to recognize that at the heart of transplant trafficking is the issue of organ shortage, and seek to implement measures that support the augmentation of donor pools in well-resourced countries so as to stem the flow of transplant tourism in LEDCs, through means such as compulsory cadaveric organ donation, and encouraging altruistic organ donation. A case in point is the tiny island-state of Singapore, which adopts a presumed consent system for cadaveric organ donation. Under the Human Organ Transplant Act, all Singaporeans and Permanent Residents who turn 21 years of age will be automatically opted in the aforementioned system, and will have four of their organs - the kidneys, liver, heart and corneas- extracted upon death for transplantation. Delegates can consider the implementation of such a system in countries which have not already done so. This has to be calibrated judiciously, however, as the general public may not be amenable to legislation mandating cadaveric organ donation due to religious considerations. To mitigate these concerns, countries can consider the allowance of their citizens to opt out of the system through the explicit expression of objection. Information Despite countries already having laws in place, information regarding legitimate means to obtain organs, risk and support are unfortunately not readily available especially in developing countries. A multi-pronged approach is required to tackle the prevalence of illegal trade, by targeting those more susceptible to organ trafficking and providing them with the aforementioned information. Relevant stakeholders such as Non-Governmental Organizations (NGOs), government authorities, law enforcers, or immigration agencies should take measures to support such appropriate information sharing. This can be done through increased research, better access to information and effective communication.

8 In addition, proper documentation is essential. Documentation regarding organ donors, recipients, doctors and procedures need to be available and moderated to ensure proper practice and to prevent exploitation. Prevention Prevention is better than cure. Relevant stakeholders such as government officials, medical professionals and even NGOs should employ measures to reach out to those more prone to participate in such illegal organ trade. Some of those who are especially susceptible to exploitation are those who live in poverty with limited options and lack information. Providing Support to Victims of Trafficking There are many cases where exploitation and medical complications can occur. Governments or health authorities can compensate victims or take measures to regulate such practices through harsher policies. This is especially important in the case of forced services whereby patients are coerced or tricked by medical professionals into undergoing illegal organ-harvesting procedures. The relevant authorities should strike a balance and uphold the law whilst providing support to such parties. Detection and monitoring especially in more impoverished locations should also be improved. Greater efforts must also be made to educate impoverished communities on the legal frameworks in place to safeguard their interests. Strengthening current structures Furthermore, governmental institutions should strive to foster cooperation between NGOs, healthcare institutions and other relevant government authorities, and establish standardized rules pertaining to overseas transplantation to curtail illicit trade worldwide. [14] Governmental institutions can consider the establishment of a legal, regulated international market for organ purchases. [15] This grants governmental institutions oversight over the transaction of organs, and may eliminate the need for a black market. Lastly, delegates must also adopt measures to bolster lawful intermediaries that are in charge of the procurement and supply of organs, such as legitimate transplant centers. Delegates can consider the establishment of a transnational accreditation body to regularly monitor and supervise the activities of different transplantation centers, which be instrumental in fostering public trust in the transplantation healthcare system. Patients will be best served by authorized, trained physicians who are able to offer necessary medical counsel needed to make an informed decision. VI. Conclusion Organ trafficking is a multifaceted issue that is deeply intertwined with both public health and public morality. Serious considerations have to be taken from the perspectives of various stakeholders. The economic level, religious practices and healthcare infrastructure of countries are the key

9 determinants to how effective the solutions posed can be. VII. Further Questions 1. Is the commodification of human organs morally justifiable? 2. What role do the respective relevant stakeholders such as WHO, NGOs, relevant government authorities play with regards to transplant trafficking? 3. How can governmental institutions greater involve the aforementioned stakeholders in the fight against transplant trafficking? 4. What measures can the World Health Organization take to ameliorate the problem of organ trafficking and improve the status quo? 5. What limitations are there with regards to the solutions implemented currently? 6. What other alternatives are there to transplant trafficking and organ trading as a whole? 7. Should governmental bodies introduce new regulations and/or tighten existing regulations regarding the practice of organ transplantation? 8. What are some measures that can be taken to prevent impoverished communities from falling prey to illicit organ harvesting?

10 VIII. Bibliography 1. "Organ Donation Facts & Info Organ Transplants." Cleveland Clinic. Accessed September 02, Economic Evaluations of Organ Transplantations. Accessed October 18, MailOnline, Simon Tomlinson for. "Inside the illegal hospitals performing thousands of black market organ transplants every year for $200,000 a time." Daily Mail Online. April 09, Accessed September 02, usands-black-market-organ-transplants-year time.html. 4. Wessels, Budiani-Saberi, D. A., and F. L. Delmonico. "Organ Trafficking and Transplant Tourism: A Commentary on the Global Realities." American Journal of Transplantation. April 14, Accessed September 02, Key issues in transplant tourism. (2017). US National Library of Medicine National Institutes of Health. Retrieved 7 October 2017, from 7. Bundhun, Rebecca. "India s dire need for organs still fuels a deadly trade." The National. June 04, Accessed September 02, "Pakistan, March Transplantation of Human Organs and Tissues Act." GODT. Accessed September 02, ssues-act-pakistan-march-2010/. 9. Junaidi, Ikram. "Mafia runs trade in human organs with impunity." DAWN.COM. May 07, Accessed September 02, "The reality of human organ harvesting." NewsComAu. November 14, Accessed September 02, ting-in-china/news-story/14d3aa5751c39d6639a1cc5b39f223b Falun Gong Human Rights Working Group. Accessed September 02, "UN, United Nations, UN Treaties, Treaties." United Nations. Accessed September 02, 2017.

11 =18&lang=en. 13. "Epistemic Communities, Human Rights, and the Global Diffusion of Legislation against the Organ Trade." Organ Tourism, Organ Trafficking, news and what you need to know. Accessed September 02, Aric Bendorf Doctoral Scholar at the Centre for Values, Ethics and the Law in Medicine (VELiM), University of Sydney. "Black-market lottery: organ donation and the international transplant trade." The Conversation. August 15, Accessed September 02, ansplant-trade Jafar, T. H. "Organ trafficking: global solutions for a global problem." American journal of kidney diseases : the official journal of the National Kidney Foundation. December Accessed September 02,