When professionals in the field apply for membership to The Transplantation Society they must sign a policy statement in acceptance of certain ethical standards. Among these is a statement that reads, "Organs and tissues should be freely given without commercial consideration of financial profit." In addition, prospective members must agree with the society's recommendation that "all countries should enact legislation forbidding all commercial trafficking in tissues and organs."
"No transplant surgeon/team shall be involved directly or indirectly in the buying or selling of organs/tissues or in any transplant activity aimed at commercial gain to himself/herself or an associated hospital or institute," the society's ethics committee concluded in 1986. This statement was made well before some groups suggested that financial incentives for donors be considered as a means to help alleviate the critical shortage of organs and before a recent spate of news accounts of black markets in Third World countries, which make it appear such practices are becoming more common.
"Since arriving at our position in 1986, the ethics committee has, over the years, maintained a consistent position regarding the selling of organs. In the current climate, it is even more important that The Transplantation Society take seriously its role of monitoring and policing transplantation activity in order that such activity adheres to proper principles of practice," stated Dr. Eduardo A. Santiago-Delpín, a member of the ethics committee and a transplant surgeon from the Puerto Rico Transplant Program and Auxilio Muto Hospital, University of San Juan.
For the most part, organ donations are made through a system that is based on the altruism of donors. This applies to both living donors and those who during life expressed the wish that their organs be donated after death.
In most Western countries there is an aversion to any form of payment for organs, although in the United States the American Medical Association (AMA) this year called for a study to investigate whether financial payments, such as reimbursements for funeral expenses, would help ease the shortage of organs. The AMA's actions are reflective of the debate, since even its own panel charged with making a recommendation on the matter thought the practice was unethical and probably illegal under U.S. law that forbids the buying and selling of organs.
But according to Dr. Abdallah S. Daar of the University of Toronto and a member of The Transplantation Society's ethics committee, even in Western countries, "no one seems to know the extent of indirect and unpublicized forms of compensation, which undoubtedly also take place within family donations."
In other countries, such as the Philippines, some form of payment may be culturally appropriate, he added.
"Payment to living donors continues to be a significant part of the transplant experience on the Indian subcontinent, the Middle East and elsewhere," Dr. Daar said in his talk about living unrelated donors and organ commerce. It is in such countries where there are reports of the poor having one of their kidneys transplanted for some monetary payment.
Of the estimated 65,000 transplants that are performed throughout the world each year, about 45,000 are kidney transplants. Many, if not most, are transplants that involve living donors.
Held every two years, the International Congress of The Transplantation Society is recognized as the field's most important international scientific meeting. More than 1,600 abstracts covering basic and clinical science were presented, and about 3,000 delegates from 71 countries were in attendance. Co-chairs of the congress were Dr. Camillo Ricordi of the Diabetes Research Institute at the University of Miami School of Medicine and Dr. Domingo Casadei of the Instituto de Nefrologia in Buenos Aires.