Medical Tourism

Medical tourism is the practice of cross country traveling, with the destination usually being India or China, of patients in need of an organ. Patients travel to these countries because wait times are minimal or they have been unsuccessful in their home country to find a match. On the surface this may not seem such a bad practice. A person in need of a life saving transplant is able to obtain an organ without having to wait on the organ transplant list. But what is the cost of a short waiting list? The cost is these organs are obtained from the poor. Organs are being harvested and donors paid minimal amounts or these organs are being harvested from executed prisoners as discussed in the previous blog. The focus of these blog is primarily on India and their practice of victimizing the poor.  

According to Labonte et al (2010), when using the internet search terms of; hospital, international patients and medical tourism contact information for thirty-one hospitals in India and twenty-nine hospitals in China were discovered. Questionnaires for these hospitals were in English, Arabic, French, Chinese Russian and German. When I have visited a hospital the forms are either in English or Spanish which is due English being the native language and Spanish being the language spoken by a large portion of those living in America. It is hard to believe there is a large population of a person of French or Russian decent living in India. India is catering to medical tourist at the expense of their poor. India has the largest proportion of medical travelers coming from the USA, Canada and Britain. India has more medical tourist than China, Jordan and the United Arab Emirates combined. (Labonte et al 2010). Why is it that India has more medical tourism then China, Jordan and the United Arab Emirates combined? India makes it extremely easy for the medical tourist to enter the country, so easy that they even have a special medical visa which is valid for the duration of the medical treatment. In all of countries a person must apply for a visitor visa and if they extend their stay they must keep renewing the visa. (Labonte et al 2010).

According to Anuj (2008), Organ hunters will visit the slums of India promising those living in poverty if they donate an organ they will become rich. They promise the patients on average $2500 for a kidney, sometimes three times that much. After the organ has been butchered out of the donor they are usually given only half of the original $2500 and left with a lifetime of pain from a botched surgery. A kidney recipient will pay on average $25,000 for the surgery. With only $1250 going to the donor, the doctors and organ hunters obtain a large profit. Often times the donor is placed into further debt because they are likely to miss work from the chronic pain. Medical tourism is only going to continue to grow in India. In 2005 150,000 patients were treated in India. By 2012 medical tourism in India is likely to generate two billion US dollars (Labonte et al 2010).

According to American.edu, with pressure from the west India passed The Transplantation of Human Organs Act which only allowed for immediate relatives to donate an organ or if the donor had suffered a brain-stem death. This act is ineffective because it is up to each individual state to enforce legislation and only three (Maharashtra, Goa, and Himachal Pradesh) have actually enforced the law.  With no agreement between the federal and state level it is unlikely there will be any change in the foreseeable future. According to American.edu, selling an organ is only punishable by up to seven years incarceration and $300 fine. Just because the crime is punishable by up to seven years does not mean a person will actually be sentenced to such a term. One kidney can receive up to $25,000. If a person is only being fined $300 that really not much of an incentive to stop when greed is associated.  To make maters even worse organ selling is only punishable in the three states that have adopted the The Transplantation of Human Organs Act. Those who practice organ harvesting know they just need to operate anywhere else in the country except for the three states of Maharashtra, Goa, and Himachal Pradesh.

            While researching this blog some have argued that in order to decrease the number of people victimized by organ harvesting the government needs to allow for the selling of human organs. With the government running the program it will stop the black market that has been created and leave the poor to not being victimized. While this sounds good in theory, protect the poor from the rich, it is unethical. A person living in poverty should not have to sell a part of them to afford to feed their families. Hearing the story of people who had agreed to have a kidney donated only to have been butchered and left with chronic pain is shameful. The government of India needs to look at how to change their countries social situation so they do not have citizens who are even contemplating selling an organ to provide for their family. Instead of protecting the poor from the rich, protect the poor from poverty.

Chopra, Anuj.(2008)  "Harvesting Kidneys From the Poor for Rich Patients." U.S. News & World Report 144.5: 33-34.

Labonte, Ronald & Zuxun Lu & Mohd Jamal Alsharif (2010) ‘Patients Beyond Borders: A Study of Medical Toursists in Four Countries.’ Global Social Policy 10/315

TED Case Studies India Kidney Trade, May 02, 2011 from http://www1.american.edu/TED/KIDNEY.HTM

China's Inhumane Organ Procurement Practice

China leads the world in less than ethical organ procurement. China is dependent upon the execution of prisoners to support their booming organ donation business. According to Biggens et al 2009, 95% of the organ donors in China are executed prisoners.

The Chinese government has released several documents concerning the use of executed prisoners as organ donors. According to Lenning (2007), in 1979 China published Rules Concerning the Dissection of Corpses. This was the first documentation by the Chinese government confirming the uses of organ donation from executed prisoners. China has some of the harshest penalties in the world. An act of theft can constitute capital punishment. (American.edu) In 1984 China passed Rules Concerning the Utilization of Corpses or Organs for the Corpses of Executed Prisoners. This allowed for organs of executed prisoners to be harvested if the body was not claimed by a family member, if the family has given consent, or if the prisoner volunteered to donate. (American.edu) One prisoner serving a seven year sentence witnessed, on several different occasions, prisoners who were having blood samples taken and being medically screened for organ donation the night before their execution. (American.edu) The proclamation On the Use of Dead bodies or Organs from Condemned Criminals states theuse of organs from condemned criminals should be strictly confidential, there is no time frame specified that a family must claim the body, after organ procurement the deceased is to be cremated and the family members may then pick up the ashes. (Lenning 2007). With the laws governing organ procurement being so vague it is unlikely that a family would even know if their loved one had been an organ donor. There is no required time frame that a body is officially unclaimed. If the government wishes, they could begin organ procurement shortly after execution, cremate the remains and the family is none the wiser.

Documentation from the Chinese government shows that between 2,000 to 3,000 human organs, from approximately 4,500 executed prisoners, are procured each year. Through the 1990’s China executed more people than the rest of the world combined. (American.edu) At a rate of 4500 executed prisoners a year, it is not surprising that China surpasses all other countries in executions.

Why does the Chinese government allow for such lax organ donation standards? Organ donation is big money. A liver can sell for $25,000, a kidney for $20,000 and corneas and pancreases for $5,000 a pair. (American.edu) With 2,000 to 3,000 human organs being harvested a year, China is gaining millions of dollars in profit. Since the Chinese government is not putting a stop to the unethical organ procurement procedures why has there not been an international movement to stop China? According to American.edu, there are no international laws which can be enforced upon the Chinese government and no organization that can make the Chinese government comply with international human rights decree. Since there is not an international law and no agency which can enforce an investigation into the Chinese process of organ donation there is no way to force the Chinese government into compliance.

It is interesting that China has such a high rate of organ transplantation when such a thing is taboo in Chinese culture. Buddhism and Confucianism dominate the nation’s religious values. ‘Chinese religious traditions dictate that bodies are to be kept whole after death, meaning voluntary donations are rare, if they occur at all. Chinese are so dedicated to this notion of keeping dead bodies intact that the autopsy rate is virtually zero.’(Lenning 2007) Wang et al (2010) argues that ‘an important Confucian requirement that one should protect one’s body and attempt not to damage it because one’s body, from the Confucian view, is received from one’s parents and ancestors to whom one should keep filial. Wang et al (2010) has mentioned that inmates in the past were coerced to donate their organs by being treated better while in prison. Another explanation for China’s high rate of organ donation is that according to American.edu, the family is responsible to compensate the government for the cost of incarceration, the bullet used to kill the offender as well as cremation costs. It is unlikely that a family can afford neither these fees nor wanting the shame of having a family member in prison. It is becomes unlikely a family member will claim the body which leaves the Chinese government ‘legally’ allowed to procure the organs.

What can be done? International law needs to be created that creates regulations on organ donation. There must be an agency which investigates and enforces policy.

Biggins, S. W., Bambha, K., Terrault, N., Inadomi, J., Roberts, J. P., & Bass, N. (2009). Transplant tourism to China: the impact on domestic patient-care decisions. Clinical Transplantation, 23(6), 831-838.

Lenning, Emily. "Execution for Body Parts: A Case of State Crime." Contemporary Justice Review 10.2 (2007): 173-191. Academic Search Premier. EBSCO. Web. 3 May 2011.

Wang, M., & Wang, X. (2010). Organ Donation by Capital Prisoners in China: Reflections in Confucian Ethics. Journal of Medicine & Philosophy, 35(2), 197-212. doi:10.1093/jmp/jhq008

Illegal Human Organ Trade from Executed Prisoners in China, May 03, 2011 from, http://www1.american.edu/ted/prisonorgans.htm