The Clinton era was about breaking down all FDR left social capitalism making way for extreme wealth and extreme poverty global 1% wealth and empire----Hillary was assigned the duty to do this to our best in the world and world history----PUBLIC HEALTH CARE SYSTEM----ending Medicare, Medicaid, privatizing all public health structures filling Federal Health and Human Services with corporate and Wall Street executives who then filled our public health system with fraud, corruption, dysfunction. It was the 1990s under the Clintons that health industry frauds rose to $200-400 billion each year. Posing left social the Clintons sent more to these programs at the same time they ramped up the frauds and corruption----moving those trillions of dollars from our MEDICARE AND MEDICAID TRUSTS----to building global health systems.
Today they are saying these Medicare and Medicaid Trusts no longer have funds for baby boomers because of these actions by Clintons. Bush then simply sat back and allowed all the Robber Baron frauds to occur and Obama created the same frauds to do the same. It was the Affordable Care Act that actually ends Federal Medicare and Medicaid creating that tiered health structure of 99% receiving only preventative health care and expanding globally for the global 1% and their 2% global health tourism and telemedicine.
This is what Clinton global 1% Wall Street players have been doing these few decades all the while thinking they were GLOBAL PLAYERS. SHOW THEM THE MONEY AND THEY DID ANYTHING GLOBAL WALL STREET TOLD THEM-----
Hillary worked hard to move all public health funding providing the best health care to 99% of citizens----to these GLOBAL CORPORATE EXECUTIVES.
Bernie Sanders ran on a platform of saving MEDICARE -----while he was actually the same far-right wing global 1% neo-liberal now using the term SINGLE-PAYER UNIVERSAL----pushing the same access to health care as the WORLD BANK/WORLD HEALTH/UNITED NATIONS-----
ONE WORLD HEALTH CARE IS THE SINGLE-PAYER.
Below we see the results of Hillary's health care reform from the 1990s-----just as Bill's banking reforms with global Wall Street-----extreme wealth with corporate executives and global administrative structures taking what USED TO BE FUNDS FOR STRONG HEALTH CARE FOR ALL AMERICANS.
Venture capital's bold move into population health
By Dave Barkholz | January 7, 2017
Rahul Jain got the entrepreneurial bug when a medical school friend and former classmate found it difficult to take seven medications a day to battle a blood disorder.
If his friend couldn't manage that regimen, how could seniors taking even more pills—often with no supervision—manage their daily load, thought Jain, a Duke University economics graduate. An idea for a new business was born.
His research quickly discovered improper medication adherence causes 125,000 deaths and wastes $100 billion annually in avoidable hospitalizations. Jain joined forces with his friend Nick Valilis and others to create TowerView Health, a low-tech prescription management service.
The 2-year-old business attracted $2 million in seed money last year to launch the company.
Jain expects more venture capital to flow into his start-up early this year to finance an expected expansion beyond the nearly 1,000 patients that insurers have lined up to use the service.
“We'll be looking for more funding in the spring,” said Jain, whose four founders were just named to the Forbes “30 Under 30” list.
Raul Jain joined forces with a friend and others to create TowerView Heatlh, a low-tech prescription management service.
Maintaining medication adherence for chronically ill patients is a crucial part of the population health management strategies being adopted by healthcare systems across the U.S. Staying on their meds helps keep patients out of hospitals, which in turn helps health systems and other providers meet the reimbursement criteria in their new value-based payment contracts.
That's why start-ups like TowerView that offer practical solutions for managing populations are attracting serious investor interest. Global population health management as an industry is expected to grow from $11.1 billion in 2015 to $31.6 billion by 2020, according to a January 2016 report by the research firm MarketsandMarkets.
Venture capital firms are chasing that growth. Rock Health, which tracks healthcare venture funding, reported last week that nearly $200 million was invested in population health management start-ups last year, making it one of the top six fields in healthcare attracting new money. Overall investment fell slightly to $4.2 billion in 2016, down from a record $4.6 billion invested the previous year.
MH TAKEAWAYS Population health management is now one of the top six fields in healthcare attracting new money from venture capital firms, thanks in large part to the aging of the baby boomer population.
The term population health has different meanings in different settings. Most major health systems and insurers see it as managing the healthcare of large groups of people, often the chronically ill, to ensure they are getting care at the right time in the appropriate setting. To do that, hundreds of companies have sprung up or started divisions to provide the data analytics and software tools to help hospitals, physicians and insurers manage that care.
Dreamit, a Philadelphia-based accelerator that invests in promising start-ups and introduces them to venture capitalists, is bullish on population health players, said Karen Griffith Gryga, partner and chief investment officer. Of 80-plus companies in its healthcare portfolio, which is Dreamit's largest segment, one-third are involved in population health and 25% of its total investment is in population-health start-ups, Griffith Gryga said.
She said a healthcare industry that uses some of the world's most-sophisticated technology to diagnose and treat illnesses is “decades behind” in using data and analytic tools to assist clinicians with managing populations.
Moreover, the move from fee-for-service to putting providers at financial risk for care is only going to work well for those that can put data to work to help maintain patient health. “Opportunities are huge for the industry,” Griffith Gryga said.
Venture capitalists are investors who bet early on promising companies and are generally willing to wait several years for a return on their investment. They typically take an equity position in a company of 6% or more in exchange for a few million dollars to commercialize a product or service.
That first big breakthrough in financing is getting harder to come by, though, Griffith Gryga said. There are so many companies with promising technology that just 11% of companies today desiring to graduate from the seed-money stage can attract a multimillion-dollar investment, she said. That compares with one in four companies two years ago.
To help companies in its early-stage portfolio reach venture capital investors, Dreamit often takes their key personnel on road shows to make their case to potential funders, Griffith Gryga said.
Those introductions are crucial for TowerView, Jain said. His firm received $50,000 from Dreamit in 2014 and was put into a 13-week accelerator program that included business advice and a series of road shows.
Dreamit took no equity at the time, instead getting notes that allowed it to buy future equity at a discount, he said. That can run from 10% to 20% of what other investors are paying. Dreamit has since invested another $150,000 in TowerView.
TowerView's product is a relatively low-tech approach to getting patients to take their medicine on time, Griffith Gryga said. “It isn't brain surgery,” she said.
The company arranges with a patient's pharmacy to receive a 28-slot medication tray of their daily medications that lasts a week. The pre-sorted tray is then put in a cellular-connected pillbox that senses when a patient misses their medications and sends a text, phone and in-box reminder to patients, loved ones and case managers. TowerView also handles the prescription refills.
In a 2015 randomized controlled trial conducted by Penn Medicine in Philadelphia, a test group of patients achieved 99% adherence compared to 70% before the patients enrolled in the program. The trial was funded by Independence Blue Cross in Philadelphia.
THESE ARE NOT DEVELOPED NATION CLINICAL TRIALS-----THESE ARE FAST AND EASY GLOBAL CORPORATE TRIALS KNOWN TO CREATE DATA HEALTH CORPORATIONS WANT.
Adherence was measured by prescription refill rates, the same way that the CMS measures medication adherence, Jain said. Those results enabled TowerView to win eight contracts with Medicare Advantage and managed Medicaid plans, Jain said.
With more than 25 million Americans 65 and older taking at least five medications per day, the opportunities for small companies selling medication adherence technologies is already vast. The aging baby boomer generation is expected to drive that number to more than 30 million ultra-high medication users within 10 years.
Caring for elderly patients in less expensive settings—another key to successful population health management strategies—is also on the radar screen of private equity firms. In May, private equity giant Welsh, Carson, Anderson & Stowe led a group that paid $196 million to buy home senior-care company InnovAge.
Welsh Carson was attracted to the company, which was not-for-profit at the time, because of its focus on a CMS-designated plan for frail seniors to keep them in their homes called the Program of All-Inclusive Care for the Elderly, or PACE, said Tom Scully, Welsh Carson general partner who served as CMS administrator between 2001 and 2004. PACE is a capitated, holistic way of managing that population that includes everything from transportation and home nursing to adult day care and meals. “I've always loved PACE,” Scully said.
His firm outbid other suitors with the plan to help CEO Maureen Hewitt build the company far beyond its center in Denver and satellite operations in Albuquerque and San Bernardino, Calif. InnovAge's client base averages 80 years old and is 85% women. The company touched 93,000 lives in 2015.
Welsh Carson hasn't set a timeframe for when it plans to get a return on the investment, Scully said. But with the growth of the senior population and the market for PACE around the country, he said an initial public offering in four years or so wouldn't be out of the question.
Dr. Betty Rabinowitz, CEO of EagleDream Health in Rochester, N.Y., said population health is crowded with start-ups, all of which are looking for ways to prove themselves and grow. EagleDream provides data analytics and software that allow clinicians and practice managers to track patient admissions and discharges, identify high-risk patients in their populations and compare cost, quality and clinical variations between providers in their networks.
Customers include the University of Rochester (N.Y.) Medical Center, the Greater Macomb PHO physician network in suburban Detroit and the Massachusetts Health Quality Partners, Rabinowitz said. EagleDream stayed close to home raising its money for growth. It is completing a
$6 million equity placement funded by more than 50 individuals who now own about one-third of the company.
Rabinowitz said the company will use that funding to grow and hopefully separate itself from the pack. “It's almost like the wild west,” she said.
OH, THAT'S ALWAYS GOOD FOR QUALITY SERVICE AND PROGRAMS---ESPECIALLY LIFE AND DEATH HEALTH CARE.
___________________________
The idea that global Wall Street is moving from FEE-FOR-SERVICE TO what they are touting as ACO managed care to bring better service to the consumer is LAUGHABLE. This policy goal is consolidating the health care industry just so it can SOAK THE CONSUMER WITH HEALTH CARE COSTS in just a few decades. It will do this as with other industries----by pushing all small and regional businesses out of business especially all those pay-to-play health businesses Clinton neo-liberals through some millions at while privatizing away public health. Remember, the global MERCHANTS OF VENICE always make the 99% feel they are participating in an empire economy ----with no intention of allowing them to gain wealth or market share. The Clinton's found those 5% to the 1% players willing to dismantle our public agencies throwing what was loose change to the billions of dollars moved to global 1% corporations.
STARTUPS IS SIMPLY THAT SAME TERM-----THEY GO NOWHERE.
Fee-for-service worked fine when there was oversight and accountability and it was what made our public health structure CAPITALIST....SOCIAL DEMOCRATIC----and this is to what we want to return as soon as we GET RID OF GLOBAL WALL STREET PLAYERS.
'Moreover, the move from fee-for-service to putting providers at financial risk for care is only going to work well for those that can put data to work to help maintain patient health.
“Opportunities are huge for the industry,” Griffith Gryga said'.
Nowhere are health industry profits SOARING than in transplant tourism-------since Affordable CAre Act DEREGULATES the health care industry allowing it to be PREDATORY as global Wall Street banks-----and since WE THE PEOPLE are now human capital ----not citizens with rights----our bodies become modes of profit for global Wall Street health systems. This has been a CRIMES AGAINST HUMANITY issue overseas in FOREIGN ECONOMIC ZONES these several decades and has been shown to exit here in the US through CLINTON/BUSH/OBAMA------with predation soaring under OBAMA because of Affordable Care Act policies.
THE ARTICLE BELOW IS LONG BUT PLEASE GLANCE THROUGH----WE WILL FOCUS ON THIS HEALTH CARE ISSUE FOR THE WEEK.
Ethical Controversies in Organ Transplantation
E.F. Ehtuish1[1] Surgery Department Tripoli Central Hospital &National Organ Transplantation Program, Libya
1. Introduction
Since the 1st successful kidney transplant in 1954 done between two identical twins [Merrill et al 1958] organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Clinical organ transplantation has been recognized as one of the most gripping medical advances of the century as it provides a way of giving the gift of life to patients with terminal failure of vital organs, which requires the participation of other fellow human beings and of society by donating organs from deceased or living individuals [Ehtuish et al 2006 & Hariharan et al 2000]. The gap between the demand for organ transplantation and the supply of donor organs is growing [The economist 2008].The waiting list of the United Network for Organ Sharing has grown from 21,975 names in 2000 to 32,722 in 2008 Fig. (1).
Figure 1.The gap between the demand for organ transplantation and the supply of donor organs (UNOS) publications
The scarcity of organs has dire consequences. And an average of 19 people dies each day waiting for a transplant that never comes [United Network for Organ Sharing (UNOS) 1999]. The World Health Organization WHO global observatory showed that in 2009 about 100,900 people receive a lifesaving organ transplant, representing only less than 10% of the global needs Fig. (2). the entire issue has raised serious ethical concerns and the debate over them rages unabated. As further advances are made in such areas as cloning [Savules et al 1999], the ethical debate should grow more intense. The increasing incidence of vital organ failure and the inadequate supply of organs, especially from cadavers, have created a wide gap between organ supply and organ demand, which has resulted in very long waiting times to receive an organ as well as an increasing number of deaths while waiting. These events have raised many ethical, moral and societ al issues regarding supply, the methods of organ allocation, and the use of living donors including minors. It has also led to the practice of organ sale by entrepreneurs for financial gains in some parts of the world through exploitation of the poor, for the benefit of the wealthy the ethical questions are complicated by an outgoing debate over the definitions of certain key terms such as life, death, human, and body. One example is the definition of brain death [Delmonico et al 1973]. People have been confused over the issue because of the highly public cases of people recovering from comas even after many years. The distinction between the idea of brain death and coma becomes a matter that must be clearly defined. A family that is asked to donate body organs from dead relative on the basis of brain death must be confident that there is no hope of recovering. Other ethical issues of organ donation are considered bioethical an important one is the idea of cloning. The technology that would allow the cloning of genetically matched clones for the purpose of body harvesting another issue is known as xenotransplantation which involves the harvesting of certain compatible animal organs for use in humans. A whole new plethora of ethical issues surround this idea due to fear from animals and the diseases might transmitted form them, or to protect them, even animal rights groups have joined in these debates. There is no question that body donation and organ donation will remain a hot topic for many years to come. Organ transplantation in general, and kidney transplants in particular, are fraught with ethical issues and dilemmas worldwide, about which there is ongoing debate, especially because of the shortage of organs The ethical questions associated with transplantation are many [Abouna 2008]. Is the human body a commodity?
How should decisions be made about who should receive scarce organs? Who should pay for transplants? Should someone who has received one organ transplant be given a second transplant? Or should people who have not had a transplant be given priority over those who have already had one? Should one person receive several organs or should several people each receive one? Should one person have a second transplant when the first one fail or should a different person be given a first chance at new organ? Should people who have young children be given an organ transplant over a single person? Should young people be given an organ transplant over an elderly person? Should age and whether or not a person has children even matter? Should organs be given to people who have abused their bodies (smoking and drinking etc, ) or only to people whose organs are damaged by disease? Should hands or other appendages, which are not essential to life, be transplanted? Who can “donate” the organs of people who cannot give informed consent to the process? Should money now spent on transplantation be put to other uses? Is it possible to prevent the coercion of some donors? Should suicidal individuals be given an organ transplant? What if they attempted suicide in the past but are not currently contemplating suicide? Should people who can’t afford expensive anti-rejection drugs be passed over for a transplant? Should people who don’t have Insurance and can’t pay for a transplant be allowed to go on the National waiting list? Should condemned prisoners receive organ transplants? What if they are serving a life sentence without parole? Should country lawmakers be involved in transplantation? When should courts be involved in these questions?
The questions go on and on; the answers are never simple. Knowing that there are more people who need organs than there are organs available, how would you answer these questions? Are your answers based on a belief of equal access or maximum benefit distribution?
2. What is organ transplantation?
An organ transplant is a surgical operation involves removing of an organ from one person (donor) and transferring it to another (recipient), keeping the native organs like Kidneys or removing them like Livers and Hearts. The need to obtain informed consent from both persons (and their surrogate decision-makers) is compulsory. This is in keeping with the ethical principle of respect for persons and is expressed in many ethical guidelines today.
3. Important milestones in the history of organ transplantation
The sources of organs for transplantation, i.e., living donor (related and nonrelated), cadaveric donor, and brain-dead patients. In countries where transplantation is well established, organs are sourced from living and cadaveric donors using different strategies, i.e., an opt-in (explicit consent), opt-out (presumed consent), and donation after brain death, donation after controlled cardiac death, and extended criteria for deceased donors.
Figure 3.
4.1. Living organ donation
Four categories of donation by living persons can be distinguished: Living Related Organ Donation “blood or emotional”: directed donation to a loved one; Altruistic Organ Donation: non-directed donation, in which the donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list; Living Non-Related Organ Donation: directed donation to a stranger, whereby donors choose to give to a specific person with whom they have no prior emotional connection; and Cross donation where a living donor wants to donate to his blood or emotional relative an organ but blood groups does not match, there is a complete mismatch or cross matching is positive. Two families or more can cross donate if matches exist. Each type of donation prompts distinct ethical concerns. Living Related Organ Donation is presumed to be the most ethical form of organ donation [Spittal A 1997]. One can argue that the psychological and non-specific benefits to the donor are real, particularly when a close relative is returned to normal health. There can, however, be no doubt that the physical consequences of living donation are entirely detrimental to the donor. Motives behind the 1st degree living renal donation are understandable and one may assume that the living donation between relatives carries the same altruistic motives. In related organ donation, the donor saves the life and attains the wellbeing of its immediate relative by accepting a physical injury and debilitation to itself. While many related donors fall neatly into this altruistic categorization, unfortunately, there are many examples where the related donors have attained physical, emotional or financial toll from the recipient. With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so to feel coerced. In these cases, transplantation programs are typically willing to identify a plausible medical excuse, so that the person can bow out gracefully. Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves. In cases like these, simply obtaining the informed consent of the relative is insufficient; physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large. Non directed donation raises different ethical concerns. The radical altruism that motivates a person to make a potentially life threatening sacrifice for a stranger calls for careful scrutiny [Garwood et al 2007].
Transplantation teams have an obligation to assess potential donors in all these dimensions and prohibit donations that arouse serious concern. Directed donation to stranger raises similar ethical questions with a few additional wrinkles. This type of donation usually occurs when a patient advertises for an organ publicly, on television or billboards or over the Internet. Such advertising is not illegal, but it has been strongly discouraged by the transplantation community. Two central objections are that the practice is unfair and that it threatens the view that an organ is a “gift of life,” not a commodity to be bought and sold. Some argue that just as we have a right to donate to the charities of our choice, so should we be able to choose to whom to give our organs. In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs — rather than those most in need. This strikes some ethicists as unfair. Unlike monetary gifts, they argue, organ transplantation requires the involvement of social structures and institutions, such as transplantation teams and hospitals. Hence, the argument goes, these donations are legitimately subject to societ al requirements of fairness, and transplantation centers should refuse to permit the allocation of organs on the basis of anything but morally relevant criteria [Hull et al 1997].
The most ethically problematic cases are those in which the recipient is chosen on the basis of race, religion, or ethnic group [Epstein 2007]. A person with organ damage or organ failure may look for a living donor to donate an organ, allowing the patient to bypass the national waiting pool to receive a cadaveric organ.
4.1.1. Directed versus anonymous donationCurrently there is some debate whether altruistic donation should be anonymous or the donor should choose the recipient that he wishes to donate the organ to [Epstein et al 2009]. Donation could be criticized ethically that it unfairly favors some potential recipients by allowing them to jump to the top of
the waiting list; however, many transplant surgeons and ethicists believe that this is a very special kind of advantage when a good Samaritan donates one of his organs to a friend or colleague who is on the waiting list. For this not only helps the recipient, but actually also helps those who are on the waiting list who will move up the ladder and will have a better chance of having a cadaveric organ.
4.1.2. Benefits to living donation [Abouna 1998]
4.1.3. Drawbacks of living donation [Landolt et al 2001]
WHO publications
Other critics seek to discourage living donation because they think extending life through costly and physically taxing medical procedures is not the purpose of health systems. Although there are some who object to the practice of living donation, this potential source of organs is currently a major focus as a way to reduce the shortage of organs. Increasing the number of living donors could occur through a variety of strategies from education and civic duty promotion to the sale and purchase of organs Fig. (4).
Figure 4.International Registry of Organ Donation
4.1.4. Justification of transplantation from living donorsLiving related donation, emotional related or altruistic are very justifiable on humanistic grounds and they are ethically and medically acceptable, providing that donor evaluation both medical and psychological is carried out in accordance with accepted protocols and that a fully informed consent is given by the donor. Also, the rate of donor complications after kidney donation is extremely small. The reported mortality rate after kidney donation is 1 in 10,000 [Delmonico et al 2008].
On the side of the donor, there are many psychological and spiritual benefits, and most donors express an increased sense of pride and satisfaction and the joy of giving a gift of life to a relative, a friend or to another fellow human being. Another justification is that the success rate of living donor kidney transplantation is considerably higher than that of cadavers [Hunsicker 1999]. The expected patient survival rate and graft function at 5 years in 2007 is 99 and 96%, respectively, with living donors and 96 and 91% with cadaver donors, which is much better than 1998 statistics and that is most probably due to the recent introduction of more effective immunosuppression medications Fig. (5 & 6).
In living donor transplantation it must be shown that the benefits to both donor and recipient outweigh the risks associated with donation and transplantation.
4.1.5. The decision to donate organs within the familyMany decisions to be living donors will be made within a family context - whether blood relations or less commonly, spouses, or in-laws - and involve the needs of specific members of that family. Very often, in living donation, there will be a host of pressures and family complexities to take into account. These may affect the extent to which a decision to donate or not to donate is genuinely free. Understanding some of these complexities and family dynamics can assist greatly in reaching a decision that is genuinely voluntary. It is important to distinguish between different kinds of pressure that a person faced with the decision about living donation may feel Avoidable pressures or Unavoidable pressures [Spital A 1996]. The decision to be a living donor should be based on adequate information and understanding, an informed decision is one based on information relevant to the making of that decision. Of course, in assisting a potential donor to make his or her decision about donation, doctors have an ethical and legal duty to warn about material risks in a treatment [Danovitch 2007]. Material risks are those that most people would want to know and also those that would be significant for a particular individual. It follows that a donor, before deciding about donation, should ask the appropriate medical practitioner to disclose the risks of the intended procedure and of its short and long term effects.
4.1.6. Psychological issues in live donationThis includes information and understanding about possible emotional and psychological consequences of making a decision one way or the other, for the potential recipient, the potential donor, the relationship between these two people, and for other family members. These questions can only be answered within the context of understanding a particular family and/or the particular individuals involved whatever the outcome, certain issues may take some time to resolve.
Tissue typing and other medical checks may identify only one suitable donor in a family, which can lead to great pressure being put on that person. There may be more than one suitable donor and in these cases there can be complex pressures again as a choice is made between these people. As examples of such pressures, focus may fall on one of the suitable people for various reasons, perhaps without sufficient thought. In other cases there may be one person who is extremely eager to donate and so perhaps too willing to overlook possible difficulties that may be encountered. Often, such very willing people may need even more careful counseling to ensure that their decision is sound.
Living donation offers the recipient immediate hope. Because the results are generally favorable, the mood of the recipient, family and donor are usually optimistic. Against this background, other issues need to be considered [Jarvis 1995]:
Chances of survival of recipient:
It is argued by some that it is preferable to donate to recipients who are not critically ill, because choosing recipients with higher chances of survival better balances the risk to the donor. In addition, when such recipients are chosen, there is less need to make a decision under pressure and the additional time allows thorough medical and psychological evaluation of the proposed donor.
Changes in donor/recipient relationship:
The exceptional nature of what has happened and what both the donor and recipient have shared may be mutually enhancing. After a donation, there is often increased contact between a donor and the recipient where they are known to each other. Our experience suggests that reaction to being identified as a donor is very positive [Mathieson 1999].
Feeling if the transplant fails:
If the donation does fail, the donor may have feelings of guilt or inadequacy or feelings of anger, sadness, or that the donated organs or tissues have been wasted, and that the discomforts he or she has suffered have been made for nothing.
Feelings of ‘ownership’ towards the recipient:
Living donors can feel closer to recipients and have expressed attitudes of ownership about the state of health and activities of the recipient. They may feel that they have a right to ensure that the recipient is taking good care of his or her health and therefore of the donated organ or tissue. Conversely, the recipient may identify with the donor and feel that part of the donor is living in them. Ultimately such feelings may not be in the best interest of either party.
Recipient feelings of guilt if the donation has harmful effects on the donor:
A recipient may feel guilty and responsible if the donor suffers from his or her donation.
Consequences of not donating:
A decision not to donate can have a major impact on relationships within a family. The recipient’s illness is often life-threatening and death may occur before or after transplantation. It is therefore important that the family, including prospective donors, do not have unrealistic expectations for the recipient nor underestimate the difficulties for the donor. A decision not to donate might be entirely appropriate for the individual, but still have profound effects on family relationships if the proposed recipient dies. It is very important to consider whether such factors amount to undue pressure on a potential donor
4.2. Deceased organ donation
Organs for transplantation which obtained from living donors unfortunately, have so far been unable to keep up with demand. As a result, there are a large and steadily increasing number of potential recipients awaiting transplantation, some of whom will die before an organ can be found. This scarcity of organs for transplantation can only be met from the cadavers Fig. (7). Cadaveric source is beneficial in another way that it provides multi-organ donation. To utilize cadaveric organs effectively, it needs legal formalities and most of the countries have passed cadaveric law [Alashek, Ehtuish et al 2009].
4.2.1. Strategies to promote cadaveric organ donations and self sufficiencya. Education
Educational efforts focus on increasing the number of people who consent to be an organ donor before they die. And educating families when they are considering giving consent for their deceased loved one’s organs. Social responsibility and the idea of “the gift of life” should be popularized
b. Mandated choice
Under this strategy, every individual would have to indicate his wishes regarding organ transplantation, perhaps on driver’s licenses. When a person dies, the hospital must comply with their written wishes regardless of what their family may want. The positive aspect of this strategy is that it strongly enforces the concept of individual autonomy of the organ donor. A mandated choice policy would require an enormous level of trust in the medical system. People must be able to trust their health care providers to care for them no matter what their organ donation wishes
c. Presumed consent
This method of procuring organs is in fact the policy of many European nations. In countries with presumed consent, their citizens’ organs are taken after they die, unless a person specifically requests to not donate while still living. Advocates of a presumed consent approach might say that it is every person’s civic duty to donate their organs once they no longer need them (i.e. after death) to those who do. People against presumed consent would argue that to implement this policy, the general public would have to be educated and well-informed about organ donation, which would be difficult to adequately achieve. Doubters of the presumed consent approach might also argue that requiring people to opt out of donating their organs requires them to take action and this might unfairly burden some people. The countries having presumed consent principles like Spain and Canada shows higher donation rate 40-50 per million population [Miranda et al 1998 & Rithalia et al 2009].
d. Incentives
Incentives take many forms [Beier et al 2008]. Some of the most frequently debated incentive strategies are:
Proponents say that since the person will be dead and unable to receive the recognition, that this would not be a coercive action. Some ethicists believe that many of the incentives above, while not attached directly to cash money, are still coercive and unfair. They believe that some people will be swayed to donate, in spite of their better judgment, if an incentive is attractive enough. They further argue that a gesture may seem small and a mere token to one person, but others might interpret it quite differently. A final anti-incentives argument offered by some ethicists discourages the practice of incentivizing organ donation [Jasper et al 1999]. They believe that society should instead re-culture its thinking to embrace a communitarian spirit of giving and altruism where people actively want to donate their organs
4.2.2. Maximizing donation form deceased donorsIn order to maximize the donation from deceased donors it is important to consider the following:
It is another issue that needs considerate discussion. Living donors provide the best outcome for children undergoing renal transplantation. Most of these donors are parents. When parents are unable to donate, siblings are often considered. But what if the siblings are also children? Should they be permitted to donate? They are below 18 years of age and not able to consent and they might be pushed or convinced to donate. And what about those who are mentally subnormal and their families wants to use them as donors?
Sometimes there are reports that children have been kidnapped, only to re- appear later lacking one kidney, or that they simply disappear and are subsequently killed to have all their transplantable organs removed for profit. However, the issue is covered in a broader sense by more general provisions. There are endless rumors surrounding this area. Members of various organizations who travel in the suspected countries say that the trafficking in children who are sold for transplantation is well known, but it is too difficult and very dangerous to catch the people involved [Spital A 1997],
4.4. Executed prisoners as donors
Several authors and ethicists have recently commented on the current practice in some countries of the use of organs from executed prisoners. While all societies strongly condemn the arbitrary use of taking organs from executed prisoners, which is a common practice in some countries, where organs are taken and given to various institutions for transplantation or even sold to other countries. It is suggested that it will be ethically permissible to allow a prisoner on death row to donate an organ to a relative or a friend. [Miller 1999].
One argument in favor of taking organs from prisoners, who are put to death, is that it is the execution that is ethically unsound and not the organ removal. Indeed, in light of the severe organ shortage, some ethicists could make the argument that to not use the organs for transplantation is wasteful. Some ethicist, put forth the argument that obtaining organs from condemned prisoners is allowable if the prisoner or their next of kin consents to donation, as long as organ donation is not the means by which the prisoner is killed because that violates the principle that a cadaveric donor be dead prior to donation. Some could argue that organ retrieval from executed prisoners is morally justifiable only if a “presumed consent” donation practice was in place. Many, if not most, bioethicists consider taking organs from condemned prisoners a morally objectionable practice. And immoral [Cameron et al 1999].
4.5. Alternative organ sources
Some potential non-traditional sources of organs are:
4.5.1. Animal organs – “xenotransplantation”Animals are a potential source of donated organs. Experiments with baboon hearts and pig liver transplants have received extensive media attention in the past. One cautionary argument in opposition to the use of animal organs concerns the possibility of transferring animal bacteria and viruses to humans. Some argue that xenotransplantation is the only potential way of addressing this shortage. As immunological barriers to xenotransplantation are better understood, those hurdles are being addressed through genetic engineering of donor animals and the development of new drugs therapies [Starzl et al 1964 & Grant et al 2001]. The focus of ethical attention has changed from the moral correctness of using animals for research/therapy to an increasingly appreciated danger of the establishment and spread of xenozoonses in recipients, their contacts and the general public. There are a number of reasons for not using subhuman primates for xenotransplantation, including their closeness to humans, the likelihood of passing on infections, their availability (gorillas, chimpanzees), their slow breeding and the expense of breeding them under specified pathogen free conditions. The pig, although domesticated and familiar, is too distant to evoke the same feeling as we have for primates, has the correct size organs, is probably less likely to pass infections, breeds rapidly and is not endangered; moreover, millions of them are eaten every year. Although drawing ethical conclusions is difficult at the stage of knowledge and debate, it seems acceptable to manipulate pigs genetically and to proceed to using their organs for xenotransplantation trials when infection control measures and the scientific base justify it [Bukler et al 1999 & Sim et al 1999]. The use of pigs in Muslim countries would be more controversial and disruptive although it is acceptable by Islamic religion in case of a real need and when there is no alternative [Rahman 1998]. In this case the question of informed consent is likely to be ambiguous and awkward. It might end up more of a binding legal contract than consent, as we understand it now. Xenotransplantation is also unlikely to cost less than or significantly alleviate the shortage of cadaveric organs in the short term. The international dimension of the risk of infection is becoming obvious, but there has so far been no effort to convene an international forum to agree on universally acceptable guidelines However, before xenotransplantation can be fully implemented, both the scientific/medical communities and the general public must seriously consider and attempt to resolve many complex ethical, social and economic issues that it presents [Platt 1999].
4.5.2. Artificial organsArtificial organs are yet another potential option.
The ethical issues involved in artificial organs often revert to questions about the cost and effectiveness of artificial organs. People who receive artificial organ transplants might require further transplanting if there is a problem with the device.
4.5.3. Organs from fetusesThe ethics of using tissues and organs from fetuses have been a matter of enormous discussion. Aborted fetuses are a proposed source of organs. Debates address whether it is morally appropriate to use organs from a fetus aborted late in a pregnancy for transplantation that could save the life of another infant. Many people believe that this practice would encourage late-term abortions, which some individuals and groups find morally objectionable. Another objection comes from people who fear that encouraging the use of aborted fet al organs would encourage “organ farming,” or the practice of conceiving a child with the intention of aborting it for its organs[Golmakani et al 2005]., but the use of spontaneously aborted fetus or anencephalic newborn could be encouraged. Although there is ethical debate concerning the possible use of organs of anencephalic babies for transplant. Some have argued that because of the absence of neocortex these are ‘nonpersons ‘and are ‘brain-dead’ and thus, such infants should be available for organ donation if this is the wish of the parents. However, as brain stem function is present in these infants, the ‘whole of the brain’ or ‘brain stem’ requirement for certification of brain death precludes removal of organs until cardiorespiratory death occurs.
4.5.4. Stem cells –“The future”Stem cells are cells that can specialize into many different cells found in the human body. Researchers have great hopes that stem cells can one day be used to grow entire organs, or at least groups of specialized cells [Bartholomew et al 2001 & Eradini 2002]. Some of the very recent developments in transplantation over the past decade have been the use of stem cells from bone marrow, cord blood, and from fet al and adult tissue, including somatic cells and neural cells. These cells have the great potential for differentiation and proliferation into other types of body cells including neuronal, hepatic, hemopoietic and muscular and thus help many patients with organ failure after their transplantation into the patients. These stem cells have also been shown to induce immunological tolerance and chimerism when they are transplanted into recipients of vital organ grafts and their rejection of a transplanted organ such as bone marrow, kidney, heart, liver, is prevented [Fandrich 2002]. A new hope is emerging now with the possibility of preserving the architecture of an organ i.e. preserving capsule, vascular structures and draining system and removing the destroyed or fibrosed cells and replace them with new cell mass produced by stem cells like removing all non-functioning Hepatocytes and replacing them with a new Hepatocyte cell mass, The ethical objections concerning stem cells have focused primarily on their source. While stem cells can be found in the adult human body, the seemingly most potent stem cells come from the first few cells of a human embryo. When the stem cells are removed, the embryo is destroyed. Some people find this practice morally objectionable and would like to put a stop to research and medical procedures that destroy human embryos in the process.
5. Life & death
With the development of mechanical ventilators, new drugs, and other forms of treatment, it became possible to artificially maintain circulatory and respiratory functions, even after the brain had stopped functioning. In the past four decades many countries amended their death statutes to include a definition of death by the complete and irreversible cessation of all brain functions. Since that time almost all cadaveric organs have been recovered from patients who have been declared "brain dead." Veatch has never been comfortable with the term "brain death," preferring instead "brain-oriented definition of death." Since the 1970s he has argued that the entire brain does not have to be dead for the individual as a whole to be dead. Instead, he advocates a "‘higher-brain-oriented definition’ of death—in other words, one is dead when there is irreversible loss of all ‘higher’ brain functions" he further proposes creating a new definition of death law that incorporates the notion that one need only have an irreversible loss of consciousness as opposed to an irreversible loss of all brain functions [Veatch 2008]. Veatch’s proposal is clearly controversial. It suggests a violation of an ethical boundary most clinicians are currently unwilling to cross. Perhaps he is correct that such a change is inevitable and that the "definition of death at the conceptual level is a religious/philosophical/social policy choice rather than a question of medical science".There was clear leadership from individuals such as pioneering transplant surgeon, Dr. David Hume; Dr. Hume wrote “there is only one definition of death, irreversible brain damage. Cessation of heart beat does not constitute death unless it has caused irreversible brain damage there must be no spontaneous respirations” [Delmonico 2010]. These observations were later corroborated by Dr. William Sweet published in the New England of Medicine when he wrote “it is clear that a person is not dead unless his brain is dead [Sweet 1978]. The time-honored criteria of stoppage of heart beat in circulation are long enough for the brain to die”. Dr. Sam Shemie has clarified the paradigm for donation and death by emphasizing on the “required absence of circulation” and by underscoring the vital functions of the brain as an essential criterion of life [Shemie 2007]. “Where the extracorporeal machines of transplantation can support or replace the function of organs such as the heart, lung, liver or kidney, the brain is the only organ that cannot be supported by medical technology”. On the other hand Byrne and others have rejected brain death as constituting death of the person contending the “cessation of the entire brain function, whether irreversible or not, is not necessarily linked to total destruction of the brain or the death of the person”. Byrne, apparently, bases his opinion regarding death as philosophically constituting a separation of the soul from the body [Byrne 1979]. However, applying that personal philosophy to the diagnosis of death defies a legal and medical standard, and an ethical and practical sensibility. No one knows when the soul may separate from the body at the time of death. However, the legal and medical definition of death is clear in terms of neurological and circulatory function. It becomes unethical to impose futile clinical treatments to a comatose individual, if the function of the entire brain is irreversibly lost. What would opponents of the brain death determination do with a patient on a ventilator with such a clinical condition have them maintained indefinitely in such a state? To propose the brain death criteria as constituting death was the central issue that confronted the Harvard Committee in 1967 [Ad Hoc 1968]. No one knows when the soul separates from the body, but a precise time of death must be specified for obvious legal, medical and social reasons, so that futile treatment can be concluded (without further obligation or responsibility to provide resuscitative or supportive technologies) and proper disposition of the body with burial and estate and property transfer, etc can be exercised. For many years, Truog has also objected to the determination of death by neurologic evaluation and by circulatory function. He wrote in the New England Journal of Medicine that “arguments about why these patients should be considered dead have never been fully convincing [Truog 1997]. The definition of brain death requires a complete absence of all functions of the entire brain yet many of these patients retaining essential neurologic function, such as regulated secretion of hypothalamic hormones”. The rebuttal to this assertion has been given by Shemie [Shemie et al 2006] who claimed that “the release of antidiuretic hormone (ADH) from the hypothalamus is not considered to be essential neurologic function. Brain death is determined by an absence of consciousness, receptivity and responsiveness, spontaneous movement, spontaneous breathing and absence of brainstem reflexes”. Brain death does not require every brain cell to be nonviable but the criteria require an irreversible loss of neurologic function of a patient interminably supported by a mechanical respirator. For Truog and others however, these patients are not considered dead because they indeed can be supported indefinitely beyond the acute phase of their illness. It is well known however that despite the irreversible loss of brain function the remainder of the body can be maintained by mechanical support; for example, even by patients who become brain-dead during pregnancy yet successfully have their fetuses brought to term. The clinical condition still constitutes the death of the mother and a viable fetus buys continued mechanical support until birth. Again in the New England Journal of Medicine. Truog and Veatch [Veatch 2008 & Truog et al 2008 & Life 9 November 1962] have asserted the donation after cardiac death (DCD) is not acceptable; that is, the recovery of organs after the determination of death by circulatory and respiratory criteria. Troug suggests that recovery of the heart following DCD is “paradoxical” because the hearts of patients who have been declared dead on the basis of the irreversible loss of cardiac function have in fact been transplanted and successfully functioned in the chest of another”. Veatch is similarly not convinced that the donor is dead and stated that “if someone is pronounced dead on the basis of irreversible loss of heart function, after all. It would not be possible for heart function to be restored in another body. Both Veatch and Truog misinterpret the uniform declaration of death act UDDA which precisely stated that it applies to an individual who had sustained irreversible cessation of circulatory and respiratory functions. It is not a matter of the cessation of heartbeat or cardiac function per se but an irreversible cessation of circulation in the donor. The consequence of the absence of circulation is upon the function of the brain results in an irreversible loss or neurologic function – the UDDA definition of death [Ad Hoc committee 1968 & President Commission 1981 & Delmonico et al 1999].
Bernat has written that circulation – not heartbeat – is the critical function that must be lost using circulatory-respiratory tests to determine death [Bernat 2008]. For example, we do not declare patients dead who are on heart lung machines during cardiac surgery, on ECMO awaiting heart transplantation (even if they never receive a heart), or carrying artificial hearts because, despite absence of heartbeat, their circulation remains continuously maintained. That is why the death standard requires absence of circulation. “Whether the asystolic heart is subsequently left alone, removed and not restarted or removed and restarted in another patient is irrelevant to the circulatory status of the just-declared dead patient [Norton 1992]. Removing and restarting the heart elsewhere simply has no impact on the previous death determination because that patient remains permanently without circulation in exactly the same way as if the non-beating had been left in place”. And as an everyday example after slaughtering the rooster it jumps higher and stronger as never than done in its life, this movement doesn’t indicate that he is still alive and it continues bleeding strongly indicating that the heart is still functioning, and on the opposite side the heart beating may stop spontaneously, known as cardiac arrest and attempts of rescue continue, in many cases the restitution succeed. The heart start beating again and life gets back to its normal state, moreover doctors can stop the heart for hours during the operation of the open heart, however the blood circulation does not stop, not even for seconds, therefore the heart beating does not mean life and the stoppage of heart beating does not necessarily mean death. Irreversible loss of consciousness may be due to partial or total brain injury [Shewmon 1998]. For the determination of brain death, irreversible coma must be due to injury to the brain so severe as to cause loss of brain functions
Death is when blood stop reaching the brain causing a permanent harm to the brain and leading to a permanent loss of all its functions including the brainstem functions and to diagnose death it is necessary to prove the cessation of the functions of the brain, and then brain commences disintegration and its known that many cells from a dead person remain alive after the declaration of his death. Therefore we find that the muscular cells responds to electrical stimulations and some cells within the liver continue transforming the glucose to glycogen, so cells do not die all at once, however they differ in their timing of death and perish after death of the person. We can extend the life of these cells if they are put in saline solution, especially with the flow by means of a pump hence allowing the use of organs and cell of the dead person for another patient needing them, the death is a process and not an event.
Brain death can be defined as follows: When the brain is damaged, and its activities completely cease, brain death is present, even if it is possible for the patient to be kept breathing and his heart is beating with artificial respiration and medications; even if the heart and liver are functioning that is not live it is just artificial. The consideration of legality of brain death as “true death” was first considered in the early 1960’s; with the 1968 Harvard report becoming the “standard” definition of brain death. the majority of countries and international professional associations have accepted it.
5.1. Islamic opinion
The majority of Muslim jurisprudents consider organ transplantation to be permissible on the basis of principles that needs of the living outweigh those of the dead. Saving a life is of paramount value in Islam as the following verse from the Quran illustrates “And if any one sustains life, it would be as if he sustained the life of all mankind” [Ebrahim 1995 & Ebrahim 1998 & Van Bommel 1999 & Al Faqih 1991]. The Islamic jurisprudence Assembly Council in its meeting in Saudi Arabia on Feb 6-11, 1988 ratified resolution number 26.1.41 declared the following fatwa the permissibility of proxy consent: “Transplantation of an organ of the dead to a living human being whose life or essential function of the body would rely on the donated organ is allowed, provided that the dead (before his death) or his heirs permit it. Shiite scholars have made similar rulings. The majority of Shiite jurisprudents confirm organ transplantation especially when human life is at stake.[Moqaddam 2000 & Ghods et al 2006 & Zargooshi 2008].
Ordinarily, the dead have a right in Islam to the sanctity and wholeness of their body, but as we have already noted, the need to save a life overrides this injunction as it has a prima facie importance in the mundane affairs of mankind. While saving a life is of paramount importance in Islam, the family of the deceased must consent and there are in no way obliged to consent to organ donation even if it involves the death of another person who is alive but gravely ill. It has been reasoned that the “ownership” of organs, like that of property, is relative and subjective because God is the ultimate “owner” of the universe having created it. Therefore, it would be permissible to donate them because God had placed great value on saving a life.
5.2. Church opinion
In the address of pope John Paul II to the Transplantation Congress in Rome in 2000, regarding the determination of death, he said …”it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of the unitary and integrated whole that is the personal self”. And that “it is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio respiratory signs to the so-called neurological criterion. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity” [Abouna 1984 & Pope John Paul II 2000].
6. Brain death is death
6.1. Misuse of terminology
Patients who fulfill the brain function criterion for death are commonly said to be ‘brain dead’. This term, unfortunately, suggests that there are two ways of being dead, being ‘brain dead’ and being ‘really dead’. The term ‘brain death’ is also used, incorrectly, in other contexts to describe much lesser degrees of neurological dysfunction than it strictly implies. This misuse of the term is to be found in the medical and related professions as much as in the general public. It has lead to confusion surrounding the idea of a brain function criterion and its relation to ‘brain death’. It may be that it is too late to reclaim the term for its legitimate use. Whenever it is used, it is important that it is sufficiently qualified to ensure that its meaning is clear, and professional medical bodies may have a role to play in encouraging correct application of the term.
6.2. Explaining brain function criterion to the family of the deceased donors
Even apart from confusion over the use of the term ‘brain death’ it can be very difficult for families to fully understand the reality of death based on a brain function criterion. To casual observation, patients fulfilling the brain function criterion for death appear to be sleeping rather than dead. The skin is warm. The chest rises and falls with mechanical ventilation. The heart and the kidneys continue to function. There are even reports that pregnancy may be maintained in patients fulfilling the brain function criterion for death. This ambiguity is reflected in the way medical and paramedical staff relates to the beating-heart cadaver in the period before organ donation. Nurses will often talk to such a cadaver as they carry out their nursing care as if the body retained the ability to hear. Acceptance of death by the brain function criterion in the context of organ donation asks much more of a family than does the same diagnosis with a view to cessation of treatment. Community education programs might go part way in helping families understand the issues involved. Detailed explanations with appropriate written material should be provided. Practitioners dealing with families should be trained in the process of explaining the brain function criterion and in grief counseling in general. Families should be provided with the opportunity to ask relevant questions and to have their questions answered in a genuinely sympathetic environment. Sufficient time should be provided to ensure that families really understand the brain function criterion before the issue of organ donation is broached. Families should then be allowed whatever time and assistance are necessary to make a decision concerning organ donation and then to deal with the particular grieving problems over the ensuing days and weeks. They should be offered the opportunity to view the body after the retrieval process has occurred when it has the appearance of being dead [Shemie et al 2006 & Delmonico et al 1999 & Norton 1992].
6.3. Deciding to donate or not to donate organs after death
The main reason why people may consider donating organs is because of the very great benefit that this can bring to others. Organ transplantation may be a lifesaving treatment for patients with liver or heart disease, and it may be the only hope of treatment there is. For kidney patients, having a transplant can mean being able to cease, and this can bring a great improvement in health and lifestyle. For instance, it may enable a kidney patient to return to the workforce, or to work longer hours, and it can even mean that a woman can now have a baby. The transplantation of a cornea can give someone back his or her sight [Ehtuish et al 2006 & Abouna 1998 & Hunsicker 1999 & Alashek et al 2009 & Cohen et al 1995]. Transplantation is generally a very successful procedure. The success rates of transplantations vary, but in all cases these have increased considerably since transplantation first began (Fig. 4b). It can be difficult in medical science to predict which procedures will become more successful and eventually routine. However, kidney transplantation is now considered to be accepted medical treatment and this is likely to happen in other areas of transplantation. Some people decide not to donate organs because they are not confident that donation would be in accordance with their dead relative’s wishes. Some people think that transplantation is a very costly procedure from which relatively few people benefit. If you believe that your family may gain some comfort from donation, this may be a reason to consider it for yourself. On the other hand, if you feel that your family may be upset about donation, you may decide against it. This shows the importance of discussing donation with your family. You need also to bear in mind that the people who donate organs are mostly those who have died suddenly and unexpectedly and they are often quite young. For the families of these patients, death may be especially traumatic. When deciding about donation for yourself before death, you may begin by thinking of how you would feel if you were in the position of needing lifesaving organ or tissue transplantation. In making your decision, you also may feel, for instance, that you no longer need your body, and would like to feel that you had done something to help others. Or you may feel that it is important that your body remains intact for burial or cremation. If you belong to a religious faith, you may want to consider how organ donation and transplantation is understood from that religious point of view. Indeed you may wish to consult a religious advisor on the appropriateness of organ donation in your particular circumstances.
6.4. Making a decision when a relative has died
Deciding about organ donation on behalf of a loved relative who has just died may be a very difficult decision to make. Often the relative’s death will have been the result of a traumatic event such as a car accident or a head injury. This makes the death an especially sad one for family and friends, means that people are asked to make a serious decision at a difficult, stressful and emotional time. You may feel shocked, bewildered, angry, and numb [Norton 1992]. But, for practical reasons, if organ donation is to occur, it must take place within a certain time period: so there will be only a limited time in which to make this decision. The difficult circumstances in which the decision has to be made make it all the more important that you are well-informed and that you feel confident that you have considered the matter as fully as you wish. Families are greatly assisted in their decision-making at a time of crisis if they have previously discussed organ and tissue donation and the wishes of individuals are known. There are three scenarios that need to be considered: (1) Your relative dies having made known his or her wish to donate organs after death: in this case the family is consulted in order to clarify what the person’s wishes were in relation to organ donation and to see whether the family has any objections to the deceased’s wishes being acted on. Donation will not proceed in the face of objection from families. If you know that your relative wished to donate his or her organs and/or tissues, this may provide you with a substantial reason for you to consent to the request for donation. Islamic religion respect the intestate and wishes of the person before he died and the relatives are obliged to implement the intestate that is clear in many verses in Quran. (2) Your relative dies having made known to you his or her wish not to donate organs: in this case, made this known to hospital staff and organ donation will not be discussed further. (3) Your relative dies and either had no views about organ donation (as in the case of a young child) or had not made his or her views known to you: in this case the hospital authorities will consult the family to find out whether anything is known about the deceased person’s wishes and/or to find out whether the family will consent to donation on behalf of their deceased relative. One thing that you may like to do in this situation is to make a judgment based on your knowledge of that person. What was his or her attitude to transplantation: had he or she ever shown any sign of being in favor or against it? What were his or her beliefs and feelings about the body and about how it should be treated after death? Was he or she the kind of person who would want to help others? Would he or she have been likely to have discussed organ donation with someone outside the family? It is professional practice not to pressure people in any way. The decision that you have to make is not a purely rational or ‘head’ decision but also an emotional or ‘heart’ decision. You may need time to come to terms a little more with the emotional significance of events, may be to accept that your relative really is dead. You may wish for time to imagine how you may feel afterwards, whatever decision you make; and how others in your family may feel. You may feel you need time alone, or time with just your family [Evans 1993 & Courtney et al 2009].
6.5. Some key questions you might consider in case of organ donation
Do I think that donating organs and/or tissues for transplantation (or other purposes) is a worthwhile cause? How would I feel if I needed a transplanted organ? How does organ donation fit with my religious, spiritual and moral beliefs? How would I feel if a friend or relative needed an organ? What do my other family members think about organ donation? Have I made my wishes about organ donation known to my family? If I decide I want to donate organs, how will this affect my family? Am I satisfied that I understand the concept of ‘brain death’ as a way of determining death? Do I feel that I could trust the medical staff involved if I were ever in a situation to be a potential organ donor? How do I think of my body after death? Are there some organs I would like to donate, and not others? Will my family try to carry out my wishes? Will counseling be available for my family if they need it? Am I satisfied that respect will be shown to my body? Are there other people I would like to consult? [Miranda et al 1998 & Jasper et al 1999 & Cameron et al 1999 & Cohen et al 1995]
7. Entry of patients to transplantation programs
Decision-making becomes necessary at two stages of the process of organ and tissue allocation. The first stage deals with those considerations which should be taken into account in deciding on the identity of the individual patients to whom offers of transplants are to be made. Decisions of this type, by reason of the technical details involved, will remain a responsibility of medical personnel. Entry to, and exclusion from, a transplantation program both raise ethical issues.
Entry to a program is offered following assessment of patients by the program personnel. Exclusion criteria include age restrictions, abnormalities in other organ systems, previous history of malignant disease and other medical considerations. In making decisions about which patients are to be admitted to a program, there is merit in more than one medical practitioner being involved.
The second stage of decision-making relates to whether an individual chooses to become a transplant recipient. This is a decision to be made by the patients in the light of advice received from their medical attendants and consultation with their families. Acceptance of the offer requires an informed decision on the part of a patient and/or their family. Prior to this decision, a patient should receive a full description of what is entailed in being in the program, what procedures can be expected and their possible risks and benefits. On the other hand, if a patient is excluded from a transplantation program, he or she is entitled to know why? [Turcotte et al 1989].
In an attempt to ensure that transplanted kidneys have the best outcome possible for individual patients, concurrent medical conditions that introduce a potential risk following transplantation should be managed before acceptance on to the waiting list, If a pre-existing condition is likely to be affected adversely by the ongoing immunosuppression required after transplantation (for example, immunosuppression increases the risk of recurrence of cancer and of persistence of chronic infection) a patient may be excluded from transplantation in his or her own interest. Though some may think it is unfair to deny a patient the opportunity to receive a transplanted kidney because of renal disease which could recur in the graft, others might consider it unreasonable to inflict repeated transplantation when there is a high risk of rejection. In rare circumstances, the kidney allocation system may be suspended to provide an organ for transplantation to a critically ill patient. To ensure fairness in allocation, the selection criteria and weighting of different criteria are subject to repeated review by personnel from all institutions involved in renal transplantation.
7.1. Factors influencing entry to, and ranking in, a transplantation program
The allocation of kidneys occurs under circumstances not paralleled in the case of other organs because candidates for transplantation are drawn exclusively from patients already within a dialysis program. This introduces the difficulty that, whereas selection to receive a kidney is determined by clearly defined and promulgated criteria that are uniformly applicable nationally, selection to enter dialysis programs is affected by a variety of sets of guidelines. In some cases uniform criteria for entry to dialysis are being formulated. However, in other instances, individual clinics have their own guidelines, not all of which are readily available. This lack of transparency precludes ethical assessment of the procedures employed and this should occasion concern: it is an ethical issue in itself. As kidneys can be preserved safely by simple cold storage for at least twenty-four hours, the results of a blood T-cell cross match and tissue matching can be available before transplantation is undertaken. Because of the length of waiting lists, several potential recipients are commonly equally well matched with each presenting donor. Allocation of kidneys should be organized on a national basis so that recipients with the closest tissue matching with the donor are selected to receive the organs. This provides the best chance of success. Currently, kidneys are raised by allocation of transplant resources allocated to potential recipients according to the best available tissue match. If there are no suitably matched potential recipients on the national waiting list, the length of time on dialysis usually determines the recipient. Factors such as recipient age, period on dialysis, pre-sensitization to tissue antigens, presence of diabetes mellitus and the previous receipt of a transplant are likely to be taken into account.
The concept of distributive justice – how to fairly divide resources – arises around organ transplantation. Distributive justice theory states that there is not one “right” way to distribute organs, but rather many ways a person could justify giving an organ to one
Particular individual over someone else. Equal access criteria include [UNOS 2001]:
Successful transplants are measured by the number of life years gained. Life years are the number of years that a person will live with a successful organ transplant that they would not have lived otherwise. This philosophy allows organ procurement organizations to take into account several things when distributing organs that the equal access philosophy does not – like giving a second organ transplant to someone who’s already had one or factoring in the probability of a successful medical outcome.
Three primary arguments oppose using the maximum benefit distribution criteria. First, predicting medical success is difficult because a successful outcome can vary. Is success the number of years a patient lives after a transplant? Or is success the number of years a transplanted organ functions? Is success the level of rehabilitation and quality of life the patient experiences afterward? These questions pose challenges to those attempting to allocate organs using medical success prediction criteria. The second argument against maximum benefit distribution is that distributing organs in this way could leave the door open for bias, lying, favoritism and other unfair practices more so than other forms of distribution due to the subjective nature of these criteria. Third, some ethicists argue against using age and maximizing life years as criteria for distributing organs because it devalues the remaining life of an older person awaiting a transplant. Regardless of how old someone is, if that person does not receive a transplant they will still be losing “the rest of his or her life,” which is valuable to everyone.
9. Organ trafficking
Organs trading
The transfer, traveling, hosting, receiving living or deceased persons, or their organs, through threat, by force or any other forms of oppression or kidnapping or fraud, or deceit, or misuse of power or position, mis-receipt by a third party of money or subsidies submitted to oppress the contingent donor and use him as an organ donor.
Commercialization of organs
It is the policy or conduct by which the organ is dealt with as if it is a trade goods, including their purchase, sale or use for material gain.
Travel for organs transplantation
It is the travel of organs, donors, recipients or professionals of organs transplantation over the international borders for purpose of organs transplantation.
9.1. Methods and means used for organ trafficking and transplant tourism
The donor, recipient and surgeon may be of the same country. The agreement may be done before they get to the surgeon. The donor and recipient may travel to the country of the surgeon. The patient may travel to the donor country and vice-versa. The donor may be from one country, the patient from another country and the surgeon from third country, and all may travel to a fourth country to perform the transplantation
[Bramstedt 2007] Fig (8 & 9). This needs organizers and coordinators, until the matter arrived to the existence of organized gangs aiming for benefit and do not care of the donor or the patient. They are standing on extortion principle and earning profits on the account of poor people and those in need. The matter arrived to even stealing organs, yet to kidnap children and women and even men in order to get their organs for selling them to whom pays more [Fasting et al 1998].
9.2. Organ sale
Paying people to donate their kidneys is one of the most contentious ethical issues being debated at the moment. The most common arguments against this practice include:
Figure 10.Kidney bazar
The drawback is that physical harm comes to one person for the benefit of another. However, this is considered an acceptable side effect because of the rule of choosing between the lesser of two maladies, i.e. one person dies and one lives, or, two people live, both with physical deformities. It is not surprising, therefore, that this practice of trading in human organs has alarmed the medical profession, the public and many governments and it has rightly been condemned by all major religions, and by most transplant societies. Organ sale has serious negative impact on all aspects and on everyone involved in the process of transplantation, including the donor, the recipient, the local transplant program, the medical profession and the moral and ethical values of the society. Most ethicists believe that organ sale is an affront not only to altruism, but also to basic human dignity as opposed to a utilitarian approach to the important issue of transplantation for the following main reasons: (a) Organ sale promotes coercion and exploitation of the poor. (b) It promotes poor quality of care to the donor and particularly to the recipient as a result of poor standards of donor selection and inadequate screening for transmissible disease. (c) It benefits ruthless entrepreneurs, greedy doctors who care for their egos and financial gain. It is also against the patient’s right for autonomy. It is contrary to accepted moral and ethical beliefs of most societies, including the major religions of Islam, Christianity, and Judaism. It diminishes the current benefit of altruistic donation by living donors and the families of cadaveric donors. It makes human organs a commodity for profit and sale thus inviting corruption and an unjust and unfair system of organ access and distribution and it predisposes to criminal tendencies of selling, kidnapping or killing children and women for organ sale, which has been reported [Spital 1997 & Danovitch et al 2006]. Some proponents of organ sale claim that well-controlled organ purchase does have several major advantages: by making more organs available it can reduce the waiting time for organs, reduce the number of deaths among waiting list patients as well as reduce the overall cost of treatment of patients with end-stage kidney disease. Some professionals in the transplant community believe that it will be much more productive as well as protective from sale of organs by vendors, at least in the developing countries where cadaver organs are not available, if the practice of organ sale is regulated by an independent organization. They argue that the feeling of repugnance of organ sale for the rich and the healthy should not justify removing the only hope for the destitute and dying. Cameron and Hoffenberg [Cameron et al 1999 & Ghods et al 2006 & Friedman 2006 & Laurance 2008] have recommended that organs be paid for through nationally established organ sharing networks to ensure the quality of care received by donors and to promote the equity of distribution which will involve the ethical and medical problems that exist with organ sale. Radcliffe-Richards et al. [Radcliffe et al 1998] have emphasized that current exploitation of donors and lack of informed consent through organ purchase are due to poverty and lack of education, which do not justify banning organ sale. They suggest that a national organization be established to regulate the sale of organs or provide educational and appropriate consultation to patients to enable them to have informed consent and even a ‘guardian’ for the donor. Also this organization will regulate and control organ vending, proper selection, payment of fees and provision of necessary care which will prevent the current exploitation, the risk of removing organs, both for the donor and the recipient, and provide screening and counseling, together with reliable payment and financial incentives [Friedman E 2006 & Friedman Al 2006 & Surman et al 2008]. They believe that this will not affect cadaveric donation, since payment can also be made to the family of the deceased. Some have proposed a market for organ donation or sale. The proponents of this model propose a legitimate governmental or nonprofit nongovernmental organization to take charge for the responsibility of compensating the donor, without any direct contact between donors and recipients. This would eliminate profit-seeking middlemen and organ brokers. While in certain instances, this practice has led to elimination of the waiting list [Matas 2008], evidence for negative impact of kidney donation for the donors have been reported. The best is to avoid people and their organs of being a commodity in the market weather it is an open black market or an organized and controlled market. In addition to direct payment, various other forms of compensation such as life and health insurance, medal of honor, reimbursement for travel expenses, compensation for time out of work, or a tax credit have been proposed. The potential problem with this model is that if it is not well organized, it will open the door to an organ market, where the organs are sold to the highest bidder, benefiting the rich and disadvantaging the poor [Chapman 2008 & Godlee 2008 & Thomas 2000]. Concern has also been raised that this will reduce altruistic kidney donation and discourage deceased multi-organ donation. However, some believe that it does not preclude increased donation, and others have shown that it has not inhibited the establishment of deceased donor transplantation programs. Opponents to any form of compensation and an organ market cite the concern that the poor will be viewed as mere providers of spare parts and will live with fewer organs, adding to this their list of disadvantages. According to this viewpoint, the market will be driven by poverty and the poor will be a disadvantage compared to the ealthier, feeling a disproportionately higher pressure to sell their organs Fig (11). On a global scale this could translate into people from rich nations travelling to poor countries to buy organs. There is the concern that the market could potentially lead to demeaning bodies to “articles of trade”. Degrading human relationships, and particularly damaging the altruistic bond. There is also the concern about the occasional coercion of a spouse by an addicted spouse into selling an organ to pay for the addiction.
With related donor transplantation, altruism is the expected driving force; however, regarding unrelated donors, several valid question have been raised. Why should the unrelated donors not be at least partially rewarded for their donation? Why should they be expected to undergo the surgery and live with one less organ for the rest of their lives? Are the other parties involved (physicians, surgeons, nurses, etc,) providing their services only altruistically? Why should the only individuals sacrificing their bodies not be appropriately acknowledged? Although current laws in most countries and guidelines by WHO and professional societies prohibit the sales of organs, it has been debated that provision of financial incentive seems not only fair, but may also encourage donation and subsequently benefit the patients on the waiting list [Novelli et al 2007 & Satel et al 2008 & Kranenburg et al 2008]. The main opponents of providing financial incentives have voiced concern over “devaluing” the body to a mere commodity and the potential for commercialization. Some would argue that the body is a property and, in fact, the most valuable commodity that an individual possesses. They would contend that the owner of this property has a right to sell part of it for his/her better good.
There is little doubt that commercialization of organ donation is fraught with drawbacks, dangers and potential immoral consequences. On the other hand, it is clear that efforts to increase the rate of organ donation through education have failed and sole moral incentives have not worked [Delmonico et al 2008 & Colakgin et al 1998 & Prasad et al 2006]. Organs are currently limited by supply, and in the hope of expanding the available organs, it seems prudent to provide incentives not only to encourage donation, but also in order to express appreciation. In the process, we should be cognizant of the fact that we might be sacrificing some good for the sake of other potentially more meritorious goods, weighing the ethical and morals risks of one against the other. The obligation of society is to establish safeguards to protect all parties involved, as well as the humane inter-relationship between donor and recipient. In this regard, the method of acknowledging the good deeds of donors is of paramount importance.
It is clear that we need to look for feasible, ethical alternatives to the current model. This is not limited to whether or not donors should be compensated. Now that living unrelated transplant (LURT) has become an ever increasing reality Fig (12). Society and the transplant community should devise safeguards to scrutinize the process [Matas 2007 & Chapman 2008 & Godlee 2008 & Novelli et al 2007 & Satel et al 2008 & Kranenburg et al 2008 & Leung 2006].
10. The struggle against international organ trafficking
The antimarket campaign could change things. To be able to do so, however, it needs to embrace a strategy combining new discursive and practical elements.
The campaign against transplant commercialism could be coherent and possibly successful only if it explained that the suffering-preventing capacity of a kidney disease-free and poverty-free world is considerably greater than that of any regulated market in organs [Danovitch et al 2008 & Turner 2008].
10.1. WHO guiding principles for cell, tissue and organ transplantation
WHO has condemned the commercialization of organs in several occasions, starting from the decision of the General assembly No. 40.13 in year 1987 and No. 42.5 in year 1989, and requested the countries to consolidate efforts to implement the decision, then the decision No. 44.25 for the year 1991 which has adopted the first draft of the WHO guiding principles regarding the human cells, tissues and organs transplantation, and which has contoured the methodological and ethical standard framework.
Among the most important recommendations issued by the general assembly, are those issued in its fifty-seventh session (decision 57.18) in may 2004, where the organization has required from the member countries the necessity of existence of an actual supervision on the organ transplantation, and promotion of both living and deceased donation, and to take the necessary measures to protect the poorest and exposed to the organs transplantation tourism. In year 2008, the guiding principles of the WHO have been updated regarding the human cells, tissues and organs transplantation [WHO 2008]. They were adopted by the executive council in its session held in November 2008 these guidelines are.
A group of meetings were held by the WHO joined number of scientists and international and national organizations in order study the challenges facing human cells, tissues and organ transplantation. Open consultations were done in Karachi, Geneva and Madrid, different experts were invited The purpose of all such consultations is to determine the problem about such a matter and also to extract preparatory ideas in order to make them implemented and to encourage countries to have national or regional strategies for self sufficiency by promoting both living and deceased donation and to cooperate towards organ trafficking free world. They urge the need for an international binding treaty to regulate transplantation and to combat organ trafficking [Carmi 1996]. Fig (13)
Figure 13.
10.3. Amsterdam forum on the care of the kidney donor: Data and medical Guidelines
Kidney and transplant surgeons met in Amsterdam. The Netherland, from April 1-4, 2004 for the international forum on the care of the live kidney donor. Forum participants included over 100 experts and leaders in Transplantation representing more than 40 countries from around the world. The Forum analyzed the sentinel events associated with live kidney donation; the data emphasized the extremely low Operative mortality rates and the long-term safety of this procedure. Forum participants affirmed the necessity for live donors to receive complete medical and psychosocial evaluation prior to donation. A great detail of discussion focused on prevention of transmissible infectious diseases through live kidney transplantation [Delmonico et al 2007].
10.4. Lisbon conference for the care of kidney transplantation recipients in February 2006
An international conference about the care of the kidney transplantation recipients, held in Lisbon, Portugal, February 2nd-4th 2006, with the cooperation between the WHO and different international and national societies of organs transplantation. The conference has joined more than 100 experts and leaders in organ transplantation. It represents more than 40 countries from all over the world. The conference aimed to determine the main issues and to set recommendations to improve the outcome of kidney transplantation all over the world [The Consensus Statement of the Amsterdam Forum 2004].
10.5. Asian campaign against organs commercialization
A meeting was held in Taipei – January 2008, About the immoral and unfair practices related to the organs transplantation in Asia by local citizens and by others from other areas. The recommendation of the Asian campaign stressed the importance of collective measures against organ trafficking [Bagheri 2005].
10.6. Istanbul declaration
An international summit was held in Istanbul on May 2nd 2008, joining more than 150 representatives for medical professional, governmental and non governmental organizations, and transplant societies from 78 countries and 20 international organizations, The meeting was organized by The Transplantation Society (TTS) and the International Society of Nephrology (ISN). The recommendations of Istanbul Declaration have added very important dimensions to the international standards of organ transplantation and emphasized the encouragement of living and deceased donation and stressed on the living donors care and to view their act as a championship as they are sharing in the Gift of life and the necessity to evaluate the donors medically and psychologically before and after donation [Steering Committee of the Istanbul Summit 2008]. The declaration was centered on Organ commercialism, which targets vulnerable populations (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) in resource-poor countries, has been condemned by international bodies such as the World Health Organization for decades. Yet in recent years, as a consequence of the increasing ease of Internet communication and the willingness of patients in rich countries to travel and purchase organs, organ trafficking and transplant tourism have grown into global problems.
The Istanbul Declaration proclaims that the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad. Moreover, transplant tourists risk physical harm by unregulated and illegal transplantation. Participants in the Istanbul Summit concluded that transplant commercialism, which targets the vulnerable, transplant tourism, and organ trafficking should be prohibited. And they also urged their fellow transplant professionals, individually and through their organizations, to put an end to these unethical activities and foster safe, accountable practices that meet the needs of transplant recipients while protecting donors.
Countries from which transplant tourists originate, as well as those to which they travel to obtain transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop national self-sufficiency in organ donation. The Declaration should reinforce the resolve of governments and international organizations to develop laws and guidelines to bring an end to wrongful practices. “The legacy of transplantation is threatened by organ trafficking and transplant tourism. The Declaration of Istanbul aims to combat these activities and to preserve the nobility of organ donation. The success of transplantation as a life-saving treatment does not require—nor justify—victimizing the world's poor as the source of organs for the rich” [Epstein 2008]
10.7. Madrid conference March 23th-25th, 2010
A conference was held in Madrid. It has concentrated about the self-sufficiency of organs for each country or region. The conference has recommended the necessity to set national plans and strategies to promote the donation of organs from deceased and living persons, arriving to the self-sufficiency and to fight, struggle and limit organ trafficking and transplant tourism.
10.8. Global leadership symposium on organs donationDuring the period May 10th-13th, 2010, the global leadership symposium on organs donation was held in California. It was attended by a lot of workers in the promotion of organs donation and a number of the international experts in the organs donation and transplantation and ethicists from several countries to more support the organs donation and fight organ trafficking.
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OH, but in global Wall Street health systems it does justify victimizing the world's poor as a source of tissue and organs for the rich-------it does here in BALTIMORE.....again, if you are a race and class citizen not caring if these CRIMES AGAINST HUMANITY come to the US----one better wake up to the fact that our children and grandchildren will be those 99% extreme poverty ---if their skin or blood type are right watch out! There is a global 1% and their 2% looking for that BODY PART. This was the goal of Clinton/Bush/Obama's privatization and deregulation of our strongest in the world public interest health care and the media has us listening to garbage about a Trump saying mean things to a disabled person.
'The success of transplantation as a life-saving treatment does not require—nor justify—victimizing the world's poor as the source of organs for the rich” [Epstein 2008]'
The hundreds of billions of dollars stolen in fraud from our Federal health structures were used to expand health corporations globally----global Johns Hopkins was the worst of offenders in this. Bringing Western health industry technology to Foreign Economic Zones not a bad thing if it brought US standards of care and human rights but as with everything in Foreign Economic Zones overseas----the point of US corporate expansion overseas was to ignore all Western laws and morals. Asian and Latin American nations having Foreign Economic Zones have been battling these few decades the most profitable of health care procedures-----TISSUE AND ORGAN TRANSPLANT PREDATION. The Asian market didn't just occur while GOOD GLOBAL WALL STREET PLAYERS tried to stop this-----it was driven by global Wall Street players corporations getting rich.
We have cases of illegal tissue and organ harvesting RIGHT HERE IN BALTIMORE-----and indeed it is crimes against humanity.
An organ is sold every hour, WHO warns: Brutal black market on the rise again thanks to diseases of affluence
By Damien Gayle
Published: 00:52 EST, 28 May 2012 | Updated: 04:07 EST, 28 May 2012
Desperate: An Indian woman shows the scar from where she sold her kidney in a black market transplant op
An organ is sold once an hour, the World Health Organisation has warned, amid fears that the illegal trade is again on the rise.
The U.N. public health body estimates that 10,000 organs are now traded every year, with figures soaring off the back of a huge rise in black market kidney transplants.
Wealthy patients are paying up to £128,500 for a kidney to gangs, often in China, India and Pakistan, who harvest the organs from desperate people for as little as £3,200.
Eastern Europe also has a huge market for illegal organ donation and last month the Salvation Army revealed it had rescued a woman brought to the UK to have her organs harvested.
With kidneys believed to make up 75 per cent of the black market in organs, experts believe the rise of diseases of affluence - like diabetes, high blood pressure and heart problems - is spurring the trade.
The disparity of wealth between rich countries and poor also means there is no shortage of willing customers who can pay a premium - and desperate sellers who need the cash.
Dr Luc Noel, a WHO official, told The Guardian: 'The stakes are so big, the profit that can be made so huge, that the temptation is out there.'
The WHO does not know how many of the 106,879 known transplant operations in 2010 were performed with illegally harvested organs, but Dr Noel believes the figure could be as high as 10 per cent.
A lack of law enforcement in some countries, and an inadequate legal framework in others meant that the traffickers urging poor people to part with an organ have it too easy, said Dr Noel.
A medical source with knowledge of the situation in China told the Guardian anonymously that rich foreigners mainly from the Middle East and Asia are the usual customers.
'The stakes are so big, the profit that can be made so huge, that the temptation is out there' Dr Luc Noel, WHO official'
While commercial transplantation is now forbidden by law in China, that's difficult to enforce; there's been a resurgence here in the last two or three years,' he said.
He added that some of China's military hospitals are even believed to be carrying out the operations.
Jim Feehally, professor of renal medicine at University Hospitals of Leicester NHS Trust, said that the key issue was one of exploitation, with poor donors often left with no medical care to recover from the brutal operations.
'The people who gain are the rich transplant patients who can afford to buy a kidney, the doctors and hospital administrators, and the middlemen, the traffickers,' he said. 'It's absolutely wrong, morally wrong.'
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THE AFFORDABLE CARE ACT is that deregulation and globalization of health care that brings this morality to our US health care structures and the global Wall Street CLINTON/BUSH/OBAMA 5% TO THE 1% KNOW THIS. That was the primary objective of ACA----deregulating, consolidation, dismantling of all oversight and accountability so US cities deemed Foreign Economic Zones could have global health corporations and medical research operate in the US as it has overseas-----lying, cheating, stealing, no morals, no ethics----far-right wing PRAGMATIC NILISM-----do anything for profit.
US academics have watched this past decade as cases in the US of illegal tissue and organ harvesting often by our own local public health departments working in tandem with global health corporations. Sadly it is those once best in public interest health institutions----our public university and private university medical schools and hospitals that have been corporatized under CLINTON/BUSH/OBAMA that are now part of this problem. If a US city has a BALTIMORE PUBLIC HEALTH OR MARYLAND DEPARTMENT OF HEALTH AND HUMAN SERVICES that is corporate------working to expand health industries and profits-------those public health agencies are not providing oversight and accountability for public interest ----they are SEEING NO EVIL----HEARING NO EVIL----SPEAKING NO EVIL regarding how health industry profits are being made.
Keep in mind most former US corporations have been gutted, sent into bankruptcy, rebuilt by being enfolded into global 1% corporations and these several years this consolidation is now mostly tying all global corporations to GLOBAL HEDGE FUNDS------our local senior care facilities are tied to GLOBAL HEDGE FUNDS-----wonder what profit-making policies come with SENIOR CARE?
Profits Soaring After Disgrace at Cohen’s Hedge Fund
By
Matthew Goldstein
July 29, 2014 5:41 pm July 29, 2014 5:41 pm
PhotoSteven A. Cohen, the founder of the family office Point72 Asset Management, at a New York Knicks game last year.Credit Justin Lane/European Pressphoto Agency
Updated, 8:38 p.m. | Three months after his once-powerful hedge fund entered a guilty plea to insider trading charges, Steven A. Cohen is doing quite well.
This summer, Mr. Cohen and his family rented a yacht off the Greek islands for a vacation. An avid art collector, Mr. Cohen attended Art Basel in Switzerland in June. And last weekend, he and his wife, Alexandra, were guests at a charitable event at the Hamptons home of the comedian Jerry Seinfeld and his wife, Jessica.
Most of all, Mr. Cohen, 58, is continuing to do what he has done best for more than two decades: make an astounding amount of money from trading stocks and bonds.
His renamed firm, Point72 Asset Management, which manages $9 billion to $10 billion of his personal fortune, is proving to be nearly as profitable as his former hedge fund.
Over the first six months of this year, the firm generated a profit of nearly $1 billion, said two people briefed on the matter. In 2013, SAC Capital Advisors’ last year as a hedge fund, Mr. Cohen personally made about $2.3 billion.
Funds play health care mergers; sell media companies and large financial institutions
By FactSet Insight | Aug 19, 2014
The 50 largest hedge funds significantly increased their equity exposure (+9.8%) in Q2 2014 in the wake of M&A activity in the Health Care sector. Four of the top ten equity additions were health care stocks involved in significant merger discussions—Allergan, Actavis, Covidien, and Questcor Pharmaceuticals.
Allergan, which was in the midst of acquisition negotiations with Valeant Pharmaceuticals International during the second quarter, was the funds’ top purchase by far. The market value purchased in the global health care company amounted to nearly three times that of the next most popular purchase ($7.4 billion versus $2.8 billion for Apple), and the stock’s exposure in the portfolio of the fifty largest hedge funds grew nearly 600%. The largest contributor to this trend was Pershing Square Capital Management, which took a 10% stake that amounted to nearly two-thirds the aggregate hedge fund portfolio’s increased exposure in the stock. Other funds that made significant purchases in the biopharmaceutical company included Paulson & Co., Mason Capital Management, and OZ Management.
The next largest purchase was Apple. The funds’ managed to show impressive quarter-over-quarter growth in the stock (+27%) despite a high ownership baseline (Apple was the second largest holding in the aggregate portfolio at the end of Q1). By the end of Q2, Apple was the largest holding in the aggregate portfolio, and its exposure comprised 1.6% of all equity holdings. However, Apple has been a stock that has shown a lot of turnover in the portfolio, and more funds listed Apple as their largest quarterly equity sale (4) than those that listed it as their biggest purchase in Q2 (3).
Actavis received the third largest increase in exposure at $2.2 billion, which represented 23% growth from Q1. The integrated pharmaceutical company was also affected by its widespread popularity, and consequently surpassed Apple to become the most widely held of any stock in the portfolio (29 funds hold Actavis compared to 28 for Apple). In addition, Actavis is the largest holding of four funds, which matches the number of funds that are anchored by Apple. Shortly after the end of the second quarter, Actavis closed the acquisition of Forest Laboratories.
On the other end of the spectrum, individual funds sold large interests in International Paper, Micron Technology, and several large financial institutions and media companies in Q2. International Paper received outflows from many funds in the wake of continued underperformance over the past year. Micron Technology, on the other hand, was the second largest sale of all equities despite outperforming the S&P 500 by significant margins. Top shareholders Greenlight Capital and Discovery Capital Management have been paring exposure to the semiconductor company over the last six months.
In addition, systematically important financial institutions (as designated by the Financial Stability Board) on the list of the top fifty equity holdings were pared in Q2. The exposure of JPMorgan Chase, Citigroup, and AIG in the aggregate hedge fund portfolio fell 15%, 5%, and 8%, respectively.
Another interesting trend in Q2 was the funds’ bets towards cable providers and away from media content companies. The funds added exposure to Comcast (+12%), Time Warner Cable (+10%), and Charter Communications (+10%), but Twenty-First Century Fox, Walt Disney Company, and Time Warner Inc. were among the funds’ three largest sales. Shortly after the end of the second quarter, Twenty-First Century Fox announced an unsuccessful bid to acquire Time Warner Inc. (the offer was cancelled on August 5th). Meanwhile, Netflix showed a 9% increase in exposure in the fund portfolio.
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For several decades of transplant medicine and advancement there have been very STRICT HUMAN RIGHTS/PATIENT RIGHTS and equity in how this process unfolds. Since access to health care was open to all there was no pressures to DONATE ORGANS OR TISSUES if it was against a personal, religious, or family belief. Pragmatic nilism------that far-right wing anything for profit philosophy says------hey, we're saying a human life here----you have two kidneys---two eyes-----you have a big liver that can be taken to half-----GIVE IT UP for that global 1% and their 2% ----
GOD WANTS IT THAT WAY SAY PRAGMATIC NILISTS.
Our US regulations, laws, morals and ethics protected against these kinds of abuses. Organ transplant was done by list---first come first serve whether you were poor or rich. Donation was encouraged not required ------a patient was not held captive to receiving ordinary hospital treatments to donating tissue or organs.
THAT IS WHAT HAS BEEN HAPPENING ACROSS THE US AND IT IS NOW GROWING AND GROWING ---AS ARE THE BLACK MARKET ORGAN HARVESTING SEEN IN DEVELOPING NATIONS WITH FOREIGN ECONOMIC ZONES.
What was a great opportunity to help another WE THE PEOPLE----has now become predatory and slowly mandatory excluding 99% of citizens not able to afford the right health plan or pay the costs of procedures. If you have a plan that will allow this today-----watch out as these health insurance plans start excluding MOST ORDINARY HOSPITAL CARE.
We want to emphasize---this article states doctors should make these transplant decisions not the courts----but ACO MANAGED CARE HEALTH SYSTEM CORPORATIONS are taking that control from our doctors and giving that power to global health organizations filled with corporate executives-----
Organ transplant decisions should be made by doctors, not courts
June 13, 2013|By Carla Hall
Sarah Murnaghan, center, celebrates the 100th day of her stay in Children's… (Handout )It’s wonderful that the 10-year old suburban Philadelphia girl in need of a lung transplant whose plight became national news was finally able to get one on Wednesday. “God is great! He moved the mountain!” exclaimed Sarah Murnaghan’s mother, Janet Ruddock Murnaghan, on her Facebook page.
Actually, it was her parents who took her case to court and a federal judge who moved the mountain. The judge ordered that Sarah, as well as an 11-year-old boy waiting for lungs at the same hospital, be allowed to compete for them on an equal basis with adults.
Transplantation always entails an extraordinary mix of heartache and joy. Someone must die and donate organs, so someone else gets a chance to survive. Meanwhile, people waiting for organs often die while people ahead of them on the list get organs and live.
Everyone on an organ waiting list is desperate and everyone deserves a chance. But how those chances are doled out is a complicated process, particularly with lung transplants. People waiting for lungs are grouped according to age—children under 12, adolescents, and adults—and get priority for lungs from donors in their age group. As Alan Zarembo reported in the Los Angeles Times, the rationale behind the rankings takes into account difference in lung size, different medical criteria, death rates, and survival rates.
We don’t let people buy organs and we don’t let someone’s race or religion dictate where they stand in line for them. Nor should we let the civil courts--or the court of public opinion--subvert medical decisions. As painful as it might have been, the judge should not have intervened. That doesn’t mean that people shouldn’t be thrilled that young Sarah did get an organ. We should be heartened when anyone has a successful transplant.
The methodology behind a transplant waiting list can change. (In fact, until 2005, the lung transplant list was simply first-come, first-served.) And national organ network officials are now studying whether the lung transplant list should be adjusted again. That’s fine. But who gets an organ and when must remain a decision made by medical experts.
The real way to fix this problem, of course, is to have more people designate themselves as organ donors. I confess that I am not a donor. But we should all consider it.
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We do not want to scare people from donating tissue and organs---we do want to SHOUT----THE SYSTEM IS CORRUPTED and dangerous to 99% of US citizens. It starts when the state government---Federal government decides they have control over an individual's body once they die----brain dead or no. In the past a person dies whether homeless or nameless----they were buried in POTTER CEMETERIES----then these people had their bodies donated to science------medical schools could use homeless, unidentified people as cadavers. Today, this has now moved to the tissue and organ donation circuit----and one does not have to be a rocket scientist to understand where all this leads. As far-right CLINTON/BUSH/OBAMA dismantle all our social safety net programs -----homeless shelters being closed---more and more people pushed into poverty----we are seeing policies in place that grow the predatory nature of organ and tissue harvesting and profiteering.
One needs to read these headlines ORGAN DONATIONS ON THE RISE to understand we have more people in the US dying on our streets---more low-income citizens shooting one another or police killing citizens whose lives end in our emergency rooms before they or their families have that chance to say I WANT TO BE THAT DONOR----WE WANT OUR LOVED ONE TO BE THAT DONOR. This is one step away from what has been overseas organized criminal organ harvesting for profit. Whether our public health department through deregulation weakens protections for our global health systems or whether global health systems receive organs or tissues collected illegally----
IT IS THE MOST PROFITABLE GROWTH INDUSTRY IN HEALTH CARE.
This article written in 2003 just after the Clintons spent 8 years deregulating health care---dismantling oversight and accountability ----opening the door to hundreds of billions of dollars in health industry frauds and corruption.
By Bootie Cosgrove-Mather AP August 14, 2003, 1:37 PM
Organ Donations On The Rise
organ donor card
AP CBS NEWS
Families agree to donate organs from brain-dead patients more than half the time, but that is far from enough to meet the growing need for transplants, new research shows.
Even if organs were harvested from all the potential brain-dead donors for transplants, there wouldn't be enough to go around, the researchers concluded after reviewing hospital records from around the nation.
They estimated the number of organ donor candidates each year at between 10,500 and 13,800 from the nation's 1 million hospital deaths. Previous estimates varied as high as 26,000.
There are 82,000 people on the nation's waiting list for transplants.
"It's a game of small numbers and every opportunity needs to be maximized," said Ellen Sheehy, who led the study for the Association of Organ Procurement Organizations, which represents organ banks.
The findings appear in Thursday's New England Journal of Medicine.
Thirty-six of the nation's 59 organ banks participated in the study. They checked hospital records for all patients who died in intensive care units from 1997 to 1999 to see how many met the criteria for organ donations and how many became donors.
Most transplanted organs come from patients who die because their brain stops functioning, although the number of living donors - especially for kidneys - has sharply increased.
Overall, 54 percent of families agreed to donate their loved one's organs, an increase from a consent rate of 48 percent in a 1990 study, and 42 percent actually became donors.
"One of the questions is, `Is the glass half full or half empty?"' said Sheehy. "While I think everyone agrees that there's still room to improve, the idea is not that we're going to get to 100 percent."
She said polling suggests that 75 percent of Americans would donate their organs.
The researchers also reported that consent wasn't sought for 16 percent of the patients they deemed potential donors. That has recently improved, Sheehy said, because of 1998 Medicare regulations requiring hospitals to alert organ banks of all deaths for evaluation.
There were lower rates of consent for older patients, nonwhites and those who died of causes other than trauma.
The researchers suggested that efforts to improve consent rates should be concentrated at larger hospitals since most of the candidates were found at those with 150 beds or more. One government program is compiling the best techniques from the most successful hospitals to share.
"We have to identify those people. We have to get everybody to say yes. But even then it's not going to solve the problem," said Dr. J. Harold Helderman of Vanderbilt University Medical School, who was the co-author of an accompanying editorial.
He said alternative sources of organs, including animals, have to be explored along with ways to keep people off transplant lists with better treatment for disease and anti-rejection drugs.
One potential way of increasing donations is for hospitals to follow the wishes of the patient, even if their family says no. Although some states allow it, hospitals are reluctant to do it and antagonize the family, Helderman said. That's why it is important for families to discuss organ donation and whether they'd want to be a donor, he said.
"If we're perceived as stealing organs out of patients against their family's wishes, people are not going to be organ donors," he said.
In addition to donor cards or driver's license notations, some states have started donor registries that organ banks can check. Many of the registries are too new to determine their impact on donations, said Carol O'Neill of the organ banks' association.
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During this time the UK and Scotland by extension have dismantled its UNIVERSAL PUBLIC HEALTH CARE SYSTEM-----and today it is as global corporate and profit-driven as today's US health system-----seems people didn't have that urge to donate when all the health care they needed was UNIVERSALLY ATTAINED. We will look first at the history and current organ harvesting problems done illegally around the globe and then we will look at how pressures to access ordinary hospital procedures and not being able to pay PUSH CITIZENS into donating their organs or a loved ones......
WHAT ARE THE ETHICS ON THIS? WE HAVEN'T HAD THAT DISCUSSION BECAUSE THERE ARE NO ETHICS IN GLOBAL WALL STREET FOREIGN ECONOMIC ZONES.
Remember, this tissue and organ donation today no longer goes to that citizen in our community or across the nation-----global health tourism and systems are searching for consumers all over the world.
Someone reminded me when sharing this conversation that WW 2 was famous for medical experimentation and procedures designated CRIMES AGAINST HUMANITY----because all medical ethics were supposedly suspended during times of war.
NUMBER OF ORGAN DONORS RISES BY NEARLY 100% IN SIX YEARS
New statistics show that 341 organ transplants were carried out from deceased organ donors in 2013/14; an increase of around 62 per cent since 2007/8. Similarly in this period, there has been a 96 per cent increase in the number of people in Scotland who have donated their organs after death.
In 2013-14, in hospitals across Scotland, 106 individuals and their families made the selfless decision to donate and, in doing so, transformed the lives of people on transplant waiting lists across the country.
As of 31st March 2014, 2,110,881 people living in Scotland had made their organ donation wishes known by joining the UK Organ Donor Register. This represents 40 per cent of the Scottish population and compares well against the UK average of 32 per cent.
Last year the Scottish Government published A Donation and Transplantation Plan for Scotland 2013-2020 which sets out the ways in which it hopes to improve donation and transplantation in Scotland. The plan builds on the very good progress made under the auspices of the Organ Donation Taskforce between 2008 and 2013.
Public Health Minister Michael Matheson said: “First and foremost I want to offer my thanks to every donor and every donor’s family in Scotland who have demonstrated such kindness and benevolence in the face of tragic and difficult circumstances. It is our responsibility to ensure that people’s organ donation wishes are respected and to ensure that we make every donation count.
“Over the last few years we have made important strides in raising awareness of the importance of organ donation in Scotland and have been encouraging more and more people to make their wishes known. The staff working in the NHS do a fantastic job of ensuring that those wishes are respected and as a result more and more people are able to get the life-changing transplant they require.
"It’s important to remember however that around 600 people in Scotland are still waiting for an organ and we must be doing all we can to give them hope. I’d like to take this opportunity to encourage everyone to make their organ donation wishes known to their loved ones and to join the NHS Organ Donor Register.”
By 2020 the Scottish Government aims to increase deceased donation rates to 26 per million of population. This figure currently stands at 20 per million of population, up from 17.9 in 2012/13.
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The rise world-wide in organ and tissue trafficing occurred because CLINTON/BUSH/OBAMA created conditions for US health corporations to go overseas to operate and expand developed nation health care knowing there were no human rights standards---no structures to protect patients or citizens-----what CLINTON/BUSH/OBAMA saw was a global market bringing more profits to global 1% Wall Street. That is it.
It was US health professionals and corporations bringing and overseeing health industry growth in Foreign Economic Zones----they built the hospitals----trained medical personelle---and know what? These professional medical personelle came with no history of morals and ethics around health care-----they came with only a history of doing anything for profit----and this drove the global expansion of
CRIMES AGAINST HUMANITY-----ORGAN AND TISSUE TRAFFICING AND BLACK MARKET.
As all this is happening overseas driven by global US corporations and executives in the US CLINTON/BUSH/OBAMA were filling our US Federal, state, and local public health agencies with global Wall Street players-----people willing to HEAR NO EVIL---SEE NO EVIL----SPEAK NO EVIL-----and VOILA------we see human capital not citizens having no rights if they are poor these few decades---and that definition of human capital having no rights is climbing our economic ladder soon to include 99% of Americans.
Baltimore is ground zero for weakening the ethics and morals around tissue and organ harvesting-------we do not want to see this grow.
Deliberately pushing more and more people into poverty and then telling them they no longer have access to health care----especially when we have decades of PRE-PAID MEDICARE AND MEDICAID----decades of Federal taxes paying for all the medical infrastructure, medical discoveries, medical procedures----this is why health care in the US has served ALL CITIZENS.
April 28, 2014 2
The Rise of Black-Market Organ Trafficking
By Michelle Beshears, professor of criminal justice at American Military University
According to the Department of Health and Human Service (DHHS) more than 2,000 names are added to the national waiting list for organ donations every month, which already has a waiting list of over 100,000 patients.
The need far outweighs the current supply of legally obtained organs. In fact, it is estimated that approximately 18 people die each day while waiting for an organ transplant in the United States alone. However, the issue of supply and demand for organs is not limited to the U.S. This is an international problem that stems from the fact that there are just not enough donors to supply people in dire need of a life-saving organ transplant.
The laws in the United States (as well as many countries around the globe) prohibit the sale of organs. However, these laws seem to only fuel profiteers in the black market organ trade. Many patients are willing to turn to the black market and pay big money for a life-saving organ. Why not?
In reality, the law provides little deterrent to a patient who will likely die without the organ. And, for those impoverished people around the world who are in desperate need for money, they see the selling of their organs as the answer to their prayers.
However, in reality, the real profiteers in these situations are the brokers. In many cases the organ donor is paid very little for their organ compared to what the broker makes. In addition, the facility and the professional and para-professional personnel who are involved in the harvesting of the organs make a lot of money as well.
In the United States, the National Organ Transplant Act of 1984, Pub. L. 98-507, forbids any sale of organs that affects interstate commerce with a penalty of five years imprisonment and/or a $50,000 fine. In 2000, the Trafficking Victims Protection Act, Pub. L. 106-386, was first passed and was reauthorized in 2008. However, organ trafficking is not specifically included because the Act’s primary focus is the illicit trade in sex and in illegal immigration.
The truth is that even though the U.S. Code characterizes trafficking as ‘‘a transnational crime with national implications,’’ (22 U.S.C. § 7101(b)(24) (2010)), it is rare that trafficking is prosecuted in domestic courts. This is largely due to the fact that in most cases prosecutors do not desire to prosecute the recipients or the sellers. The belief is that in most cases people selling their organs are coerced and forced to do so. However, in reality, they are often compelled to do so by their destitute circumstances. Many of the sellers are so poor that they see this as their only way to earn much needed financial resources to survive.
However, the current supply shortage of organs may extend beyond an issue of the wealthy taking advantage of the poor and impoverished. There have been recent reports of human trafficking and possible organ harvesting from unwilling victims in Mexico, the UK and China:
This leads to the question of what can be done to help stop incidents of human trafficking for the purpose of illegal organ trade and/or the exploitation of impoverished people around the world?
The truth is, unless something is done the issue of a shortage of organs around the world is not going to disappear and so the market for the illegal trading of organs will continue to thrive.
Should international law enforcement agencies take a tougher stance on current standing laws? Should laws be repealed to allow for the legalization of organ trade? Is there anything more that could be done to encourage the willingness of the public to donate freely, thus eliminating the large disparity currently seen in supply and demand?
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The Affordable Care Act funds what is called END OF LIFE COUNSELING-----and indeed as this article states our medical staff are counseling for donations of tissues and organs. Before profit-driven health care when all citizens needing transplants were able to get them----these kinds of counseling structures existed. Now, we have global ACO managed health systems driven by profit owned by hedge funds with personnel trained to encourage people to donate. PROFITEERING on transplants is huge----the doctors and hospital systems doing these transplants are charging more and more and more at the same time WE THE PEOPLE are told it is our moral obligation to save the life of someone in UPPER MONGOLIA.
The waiting lists that used to exist in the US were indeed long------think about these same waiting lists today with all this health care reform making it harder for most Americans to get basic hospital care----are they really still on these transplant lists because I am reading many people have been pushed off----denied -----
The amount of Federal funding to build organ transplant transport infrastructure to US global health system tourist destinations is huge-----while the actual ability of US citizens to access transplant process is in steady decline because that funding has been cut and redirected.
Tissue donation rises as nurses focus on bereavement support
18 August 2009 By Clare Lomas
A pioneering service that provides hospital staff with 24-hour access to a bereavement and donation officer has helped to dramatically increase the number of tissue donations at a Lancashire trust.
The nurse-led service at the Royal Bolton Hospital was introduced in 2005 as part of a package of measures to help address the low rates of organ and tissue donation.
This included combining the hospital’s bereavement and donation services, setting up a corneal retrieval service, and employing four extra nurses to offer round-the-clock support to hospital staff and families of the deceased.
Tissue donation rates, such as corneas, had been relatively low at the hospital, ranging from just six in 2002 to 37 in 2005. However, following implementation of the new service, this figure leapt to 234 by 2007.
The trust looks set to achieve even greater success in tissue donation, with every ward at the hospital recording at least one tissue donor over the last 12 months. Latest figures also show 108 cornea donations already between April and early August this year.
Additionally, a trigger system introduced in 2007 – which automatically refers all potential organ donors to the regional transplant donor coordinators – resulted in 31 referrals and nine successful multi-organ donations by the end of 2008.
The team have also made amendments to the end-of-life care pathway for dying patients to make sure staff include donation in end-of-life care, and they also provide training for all hospital staff, including monthly teaching sessions.
‘The aim of the service is to change the culture around donation, and to make it a normal part of end-of-life care,’ said Fiona Murphy, lead bereavement and donor coordinator at the Royal Bolton Hospital.
‘All choices around death and dying have to be made in a timely manner, and it is vital that patients and families have clear, concise information to be able to make informed decisions,’ she added.
‘It is about giving control to families in an uncontrollable situation, and providing the same high level of care for patients and their families regardless of whether or not they donate,’ Ms Murphy told Nursing Times.
Organ donation rates in the UK are among the lowest in Europe. In 2006, the government established the Organ Donation Task Force to help identify obstacles to organ donation and plug the gap between supply and demand.
Last year, the taskforce published a set of recommendations to help meet a target of increasing organ donation in the UK by 50% over five years, including encouraging hospital trusts to develop local initiatives.
However, if organ donation rates do not increase, the government is considering changing the law on organ donation to one of ‘presumed consent’, where it will be assumed that organs and tissues can be used unless people ‘opt out’.
‘Providing everybody with the information they need to make an informed choice about donation is a real alternative to presumed consent,’ said Ms Murphy. ‘It may not work in all settings, but it has really worked for us in Bolton,’ she added.
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The American people must be aware of this--------global health tourism comes with patients from overseas----mostly the 1% and their 2% being marketed and brought to US Foreign Economic Zones on the promise of transplant tissue and organ availability------this creates the mechanism in a global Wall Street governance to have that tissue and organ availability---ergo ethics and morals around collection DECLINE OR DISAPPEAR.
Second, what used to be called a long wait list for American citizens needing transplants of all kinds no longer means that----long wait lists can mean a global citizen has contracted with a US Foreign Economic Zone global health system for a transplant need. Meanwhile, a US citizen needing that transplant today may very well be told they need to travel to Thailand---or India for that transplant. Now, knowing Asian organ trafficing is driven by these developing nation transplant corporations----HOW DOES AN AMERICAN TRAVEL TO DEVELOPING NATIONS TO GET WHAT USED TO BE TRANSPLANT WAITING LISTS HERE IN THE US?
Of course the US has always had waiting lists for transplantation and yes, many US citizen have decided to go overseas to Foreign Economic Zones to get that transplant faster-----the point is this----the pressures around the globe are now driven by a 99% of global citizens not having the money for life-saving procedures and what extent people will go to get those treatments.
The morals and ethics have never been clear in a developed nation like the US------they do not exist overseas------and now US cities deemed Foreign Economic Zones are MOVING FORWARD to operate as they do overseas.
Ethics and Organ Transplantation
Heidi WilliamsA paper prepared for "Ethics in the Health Care Professions," an undergraduate class in the Religious Studies Department of Santa Clara University
In February 2003, 17-year-old Jesica Santillan received a heart-lung transplant at Duke University Hospital that went badly awry because, by mistake, doctors used donor organs from a patient with a different blood type. The botched operation and subsequent unsuccessful retransplant opened a discussion in the media, in internet chat rooms, and in ethicists' circles regarding how we, in the United States, allocate the scarce commodity of organs for transplant. How do we go about allocating a future for people who will die without a transplant? How do we go about denying it? When so many are waiting for their shot at a life worth living, is it fair to grant multiple organs or multiple transplants to a person whose chance for survival is slim to none? And though we, as compassionate human beings, want to help everyone, how far should our benevolence extend beyond our borders? Are we responsible for seeing that the needy who come to America for help receive their chance, or are we morally responsible to our own citizens only?
Rationing scarce resources presents an ethical challenge. I believe that since available organs are so scarce, it is imperative that the utility of donated organs be maximized. In this paper, I suggest that organ allocation be rooted in distributive justice, which demands that equals be treated equally and unequals be treated unequally. I will explore this formal principle and the substantive criteria of equality, need and efficacy (maximum survivability) as they relate to the just allocation of organs for transplant. I will apply these principles of justice to Jésica's case to show that while her first transplant was warranted, her second was not. And, finally, I will conclude that Jésica Santillán's case should serve as an example of what's wrong with our current system of organ allocation.
First, let's address equality as it applies to justice. All other things being equal, who holds a claim to the organs available for transplant in the United States—just citizens, or illegal immigrants, too? A recent Chicago news source cited the tragedy of "American taxpayers and their children who died last year waiting for the transplant that Duke University Hospital chose to give to a citizen of a foreign nation" (Bailey, 2). This article went on to state that our system "rewards illegal aliens for entering the United States to access our health care system, thus condemning some of the American taxpayers who pay for that system to premature deaths. Few could deny the sheer unfairness of such a situation" (Bailey, 2). But how true are these statements? Are organs allocated in a way that promotes inequality for American citizens? An ethicist's first responsibility is to look at the facts, and the facts in this instance tell a different story.
According to the United Network for Organ Sharing (UNOS), American citizens are more likely to receive organs of non-citizens than vice versa; "As a percentage, every year, U.S. citizens receive more organs than they donate" (Vedantam, 2). Also, UNOS limits the number of transplants allotted to non-citizens to no more than five percent of available organs; however, no limits on donations are made (Vedantam, 2). These facts indicate that Americans are benefiting from the organ donations of non-citizens, receiving more than an equal share.
Another question arises when we speak of justice regarding this issue: what does our society owe to illegal immigrants in light of the benefits we receive from their participation in our economic and social life? In his article, "Parties to the Social Contract? Justice and Health Care for Undocumented Immigrants," Kenneth DeVille explains the idea of the social contract as "individuals [who] create civil societies by joining together for their mutual benefit and protection" (306). According to DeVille, citizenship is not necessarily the best, nor the only, method of determining who is party to this contract. He notes, "In many cases, immigrants are socially, culturally and economically integrated members of our civil society…liv[ing] under the same laws as citizens…pay[ing] many of the same taxes" (307). He goes on to note the ambiguity of an American system that halfheartedly enforces immigration and work laws while "benefiting from, and in some cases exploiting, immigrant labor" (307). He makes the point that the social contract demands extending social goods to members of society who participate significantly within that society. Our economy relies on the low cost labor of illegal immigrants to keep produce prices down. We allow hordes of workers to do the backbreaking jobs we disdain, turning a blind eye to aliens working in our fields. If we, as citizens, benefit from their exploitation, we have a duty to honor our side of the social contract and allow them access to our services. In my opinion, UNOS has acted fairly in safeguarding equality of organ allocation by taking into consideration the moral mandate we have as human beings to care for one another. By allowing up to five percent of the organs within its system to be allocated to non-citizens, they are identifying the common bond between members of the worldwide community while respecting and carefully guarding the resources of the American community.
Equal opportunity to tap into the system of organ allocation is just one component of distributive justice surrounding organ allocation. As Ronald Munson points out in Intervention and Reflection, "we do not always expect that being treated justly will work to our direct advantage" (37). But in a situation where resources are scarce and not everyone who needs help will receive it, it is important that allocation be fair. In selecting a system of allocation, it would be wise to choose one "that favored those most likely to benefit from a transplant. Rational planners [behind the veil of ignorance], ignorant as to whether or not they will ever need a transplant or retransplant, would increase their own chances of benefiting from a transplant by setting up a system that, all else equal, distributed scarce organs to those most likely to gain long-term survival from a transplant" (Ubel, et al, 270). Maximizing utility just makes sense, so we need to determine which of the neediest candidates are most likely to have the highest success rate. The basic principle of justice that dictates similar cases be treated similarly, conversely allows for different treatment when cases are dissimilar. It is these dissimilarities that have the most effect on maximizing the utility (or the life) of a donated organ. The first criterion to be looked at is need.
In Transplantation Ethics, Robert Veatch outlines an interesting way of assessing need. He calls it the "over-a-lifetime perspective" (340). This approach takes into consideration a person's entire life when determining who is worst off. A 17-year-old and an 80-year-old both dying of heart failure are equally bad off, but this perspective allows that the person who has had 63 more years of life is better off, so the 17 year old is neediest (Veatch, 341). Veatch writes, "from this over-a-lifetime perspective, justice requires that we target organs for these younger persons who are so poorly off that they will not make it to old age without being given special priority. The younger the age of the person, the higher the claim" (341). This methodology furthers the goal of utilizing organs to their maximum potential.
Of course, it would be foolish to base allocation simply on the age of the neediest patients; efficacy, or expected survivability, must also be considered. Presently, our system of allocation gives priority to those who are the sickest or most in need of a transplant. But sometimes those who are the sickest and in the most immediate need will not receive the same benefit from the transplant as someone whose medical condition is currently more stable. Robert Veatch notes, "They may be so sick that they have a higher chance of dying regardless of treatment" (295). I believe there is a moral obligation, due to the scarcity of organs, to maximize the potential longevity of donated organs and place them where they are most likely to do the most good (bring the most health) over the longest period of time.
This brings us to the question of retransplantation. Years of collecting data show that "retransplant recipients at similar levels of urgency do significantly worse than primary transplant recipients, a difference that increases with each successive transplant" (Ubel, et al, 272). Though I don't believe those who have already received a transplant should be prohibited from receiving another, careful and objective consideration should be given to these cases. Reasons for the organ failure and current condition of the patient must be evaluated to determine if the retransplant candidate will maximize the utility of the organ. Preference in the allocation of scarce organs should be given to the patient whose chances of long-term survival are best.
Now that we have a model for organ allocation based on the principles of distributive justice, we turn to Jésica Santillán's case to determine if her transplants were warranted. Starting with her first transplant, let's review the facts. Jésica and her family entered the United States illegally from Mexico several years ago. Doctors in Mexico were not equipped to diagnose nor treat their daughter's rare heart condition of cardiomyopathy which prevents the heart from pumping blood efficiently and eventually leads to death, so, desperate to obtain medical help for their daughter, the Santilláns paid $5,000 to be smuggled into the country (Bailey, 1). Once in the United States, the family settled with relatives in a trailer near Duke University Hospital and their story was publicized in a local newspaper. A wealthy businessman took up the girl's plight, raising money for her medical care and lobbying successfully to get Jésica on Duke's transplant list. Meanwhile, her father had found construction work and her mother was employed as a janitor at a nearby college (Bailey, 1).
After being listed with UNOS in January 2002 for heart transplant, Jésica's condition deteriorated, and in May 2002 she was listed for heart/lung transplant (Fulkerson, 1). At 17 years old, Jésica weighed only eighty pounds and was just five feet tall. Her small size made finding an organ match more difficult. When a heart/lung block was offered to Duke's pediatric unit, the two potential recipients who had been identified by UNOS were unsuitable. In a tragic communication breach, the organs from a type-A donor were awarded to Jésica, whose type-O blood could only lead to acute organ rejection (Adler, 21). Five hours into the transplant surgery, when the organs had already been exchanged, the mistake was discovered. Powerful anti-rejection drugs were administered and UNOS was notified that Jésica was "in critical need of another transplant" (Duke, 1).
Let's stop here and apply the substantive criteria of equality, need and efficacy of a distributive justice model of allocation to Jessica's first transplant. Regarding equality, Jésica had a right to receive an organ transplant based on the UNOS guidelines allowing up to five percent of non-citizens to receive organs. Beyond that, her parents were also employed, contributing members of society-a party to the social contract. Jésica also fulfilled the requirement of need-without a transplant, she would die, and using Veatch's "over-a-lifetime perspective," she was a particularly deserving candidate-her youth gave her a higher claim. In the area of efficacy, Jésica looked to be suitable as well. Her age and current condition gave physicians every indication that the odds of her long-term survival were good. According to a distributive justice model, Jésica's first transplant was warranted. Continuing with the facts, we turn to the second transplant.
As a result of organ failure following the first transplant, Jésica was placed on life support and within two weeks a second set of organs was allotted to her. Before accepting the organs, doctors evaluated her brain activity and surmised she had not suffered irreversible brain damage; therefore, a second transplant was performed (Duke, 1). Though this heart/lung block was functioning well, the trauma of the first organ rejection, paired with being on life support for nearly two weeks caused irreparable brain damage, and two days after the retransplant "all brain function had ceased" (Adler, 24).
Applying the principles of distributive justice to the second transplant scenario presents a different outcome. Though Jésica still deserved an equal opportunity based on her illegal immigrant status, she was no longer equally entitled to a second set of organs because her odds of survival (and, thus, the odds of maximizing the utility of the organs) were greatly diminished.
Her need was sufficient to push her to the top of the list (Kher and Cuadros, 1). Her young age again made her an attractive candidate, but the expectation of her survival rate was now drastically changed, thereby minimizing the efficacy of the procedure. Duke's staff determined the results of Jésica's brain scan the day before the retransplant were inconclusive though they showed "some minor stroke damage and some bleeding on the brain" (Kirkpatrick, 1). In their urgency to save Jésica's life, the doctors discounted the ill effect of being on life support for nearly two weeks. Mark D. Fox, M.D., UNOS Ethics Committee Chairman, said that determining whether or not someone is too ill to receive a transplant is problematic in medical ethics because "the physician is always going to do what's best for the patient" (Kirkpatrick, 1). While that action supports a goal of maximizing the patient's chance for survival, it does not guarantee maximizing the utility of a scarce organ. If Jésica's condition before the first transplant had been the same as it was before the second, she never would have been a candidate; therefore, her second transplant was unwarranted.
Maximizing utility calls for hard choices but upholds justice by "contribut[ing] to giving people opportunities for equality of outcome" (Veatch, 295). The sad fact is that Jésica's second transplant deprived at least one and perhaps three people from receiving organs they also needed to survive. In a desperate effort to "control damage after its earlier transplant mistake" sound judgment was clouded and valuable organs were wasted (Kirkpatrick, 1). In "Rationing Failure: The Ethical Lessons of the Retransplantation of Scarce Vital Organs," the authors write,
Health care workers cannot always be expected to recognize when it is
time to forgo heroic lifesaving measures. Indeed, their traditional role
as patient advocates would seem to compel them to ignore the odds and
do whatever they can to help their patients…However, when such heroic
measures require scarce resources that could be better used to help others,
their good intentions can be unjust (272).
The tragedy of Jésica Santillán's death should be a call to physicians, transplant boards, and UNOS officials to consider allocation criteria outside the Intensive Care Unit where emotions are likely to misguide decision-making. Doctors should not be made to feel they are abandoning their patients during their greatest hour of need, but they should also not be allowed to drain the resource pool when the outcome is unlikely to be good. UNOS should implement a strict policy of organ allocation based on equality, need, and efficacy.
Obviously, I've placed myself behind the "veil of ignorance" in order to reach this proposal. If it were my daughter, my husband, my sister, or my friend who needed the transplant, I would be all for solely using the principle of need to determine allocation. But that's precisely the point: we must have a policy in place that moves decision-making from the more visceral, gut-feeling approach to a rational decision based on projected outcome that is more appropriate for maximizing the utility of our scarce resources. Heartbreaking, yes, but just.
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When we hear organ donation is climbing in black citizens who historically did not donate----we need to think of this. We have 300 deaths in Baltimore each year from gun violence----we have had 100s more deaths from police interactions. We have 100s of deaths each year of homeless citizens----that is a great deal of citizens coming to our emergency rooms and medical examiner's offices-----often having no insurance, not identified----often poor black citizens-----and that is one reason black tissue and organ donation is UP. We can create societal structures designed to feel a predatory, global Wall Street driven economy----and we will if we keep MOVING FORWARD TO ONE WORLD ONE GOVERNANCE US CITIES AS FOREIGN ECONOMIC ZONES.
Below we see one incident of growing homelessness----Portland has one of the biggest populations of displaced many being WHITE citizens-----this is not about race, gender, creed---it will come to ALL CITIZENS-----we must keep our developed nation regulated, public interest, morals and ethics structures tied to PUBLIC HEALTH CARE.
Portland Woman Who Died of Hypothermia Was Evicted for Being Late on $338 in Rent
(Catie Cooper)
By Tarra Martin |
1 day ago
Karen Batts, 52, who died from hypothermia Saturday in a parking garage, was evicted from a downtown Portland apartment building in October for being overdue on paying $338 in monthly rent.
Portland police confirmed this morning Batts died from hypothermia. She was seen removing her clothes in the parking garage—at 730 Southwest 10th Avenue—shortly after 2 pm on Saturday, in the midst of a Portland snowstorm.
The Oregonian first reported today that Batts had been evicted.
A review of Multnomah County eviction court records by WW shows that Batts had been living in an apartment building at 333 SW Oak Street designed to provide affordable housing for seniors and people with disabilities.
But on October 21, 2016, Cascade Management, Inc. and Northwest Housing Alternatives, LLC, evicted Batts from the building they manage. The court records say only that she was evicted for being at least seven days late with the $338 rent for August.
The landlords sent Batts a 72-hour notice on Sept. 9, saying she owed $338 plus a $5 late fee. She does not appear to have paid that amount between Sept. 9 and Oct. 6, when an eviction complaint was filed with the court.
Batts did not appear at the scheduled Oct. 14 hearing, so the court found in favor of the plaintiffs by default. Multnomah County Circuit Judge Michael C. Zusman signed the order for her to leave the apartment by Oct. 21. (Disclosure: Zusman is a contributor to WW. He is not related to WW Editor Mark Zusman.)
Cascade Management and Northwest Housing Alternatives did not immediately return requests for comment.
Batts was believed to be homeless when she died. The SmartPark garage where she died is eight blocks from the apartment where she had lived.
UPDATE, 4:31 pm: Reed Andrews, a reporter with WW's news partner KATU-TV, spoke with Martha McLennan, the executive director of Northwest Housing Alternatives.
McLennan says Batts had been a tenant since 2007—but says her behavior changed in the spring.
"There were a variety of lease violations that were either damage of property or late payments, also incidents against staff and other tenants," McLennan tells KATU. "It's a terrible tragedy to have a situation where someone ends up alone and without resources."
McLennan tells WW that Northwest Housing Alternatives tried to get help for Batts before evicting her.
"We hate these sorts of situations," McLennan says. "But unfortunately, when someone decline services there's not much you can do. And I can say there were dozens of attempts to help."
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As costs of transplants in US soar because of global profit-driven health care systems and health tourism more and more Americans are being sold on traveling overseas where often the medical facilities are owned by the same global hedge funds. Yes, this is creating the growing organ trafficing and illegal harvesting situation. Let's ask this----if it is considered a crime against humanity to harvest organs from prisoners----is it not the same to harvest from our US city homeless---low-income killed? Of course--MORE SO.
As MOVING FORWARD to US citied deemed FOREIGN ECONOMIC ZONES occurs more people than already exist will be jailed as POLITICAL PRISONERS---what exists in China will very easily come to the US.
It is the PROFITEERING on transplant medicine driving global citizens whether patient or organ trafficer. The problem falls on MEDICAL DOCTORS AND PROFITEERING GLOBAL HEALTH SYSTEMS-----it is all pragmatic nilism.
It is the PROFITEERING on transplant medicine driving global citizens whether patient or organ trafficer. The problem falls on MEDICAL DOCTORS AND PROFITEERING GLOBAL HEALTH SYSTEMS-----it is all pragmatic nilism.
It's safe to assume prisoners dying in US prisons having lost touch with family are seeing themselves as TOTAL BODY DONORS.
Patients seeking transplants turn to China / Rights activists fear organs are taken from executed prisoners
By Vanessa Hua
Published 4:00 am, Monday, April 17, 2006
The San Mateo father of six learned in May 2005 that he had liver cancer. Chemotherapy seemed to knock out the tumors, but in January a scan turned up nine more and he was taken off the transplant list. Too risky, his doctors said. The cancer would probably return in the new organ, the doctors told De Leon, 50, a construction superintendent who cried when he learned of his prognosis.
He wanted to be around for his youngest children, who are 3 and 5 years old, and help put them through college. But the cancer would also probably return after the treatments his doctors were recommending -- so he decided to go outside the U.S. health care system.
De Leon researched overseas transplant centers on the Web, chose Yeson International Healthcare in bustling Shanghai and began a blog. The liver he received last month came from a 20-year-old, doctors told him.
Hundreds of Americans and other foreigners are now finding their last, best chance for survival with organ transplants in China, where businesses are opening to meet international demand. Roughly 17,000 Americans needed liver transplants in 2004; only 6,100 patients received them, based on availability, their risk of dying in surgery, their chances for long-term survival and other factors. It is unknown how many Americans are now going to China, India, the Philippines and other developing countries for transplants they cannot get in this country.
American doctors caution their patients against going overseas for transplants because the organs may not be screened for infectious diseases and the quality of care after surgery is questionable. Human rights activists raise ethical concerns about China in particular, saying transplant doctors there who cater to foreigners may be harvesting organs from executed prisoners without their permission, just for financial gain.
De Leon said his donor could have been in a car accident or was brain dead for another reason.
"I checked on the laws there," he said, noting that donors and their families would have been required to sign waivers.
"They didn't shoot someone so I could have a liver," said De Leon, who praised the quality of care at the hospital in Shanghai. The facility had new medical equipment, but the rooms were worn, with chipped paint and crank-up beds and often no remote control for the television, De Leon said. Most members of the staff did not speak English, so he used hand gestures to communicate.
New regulations going into effect in July will explicitly forbid the buying and selling of organs in China and require donors to give written permission for their organs to be transplanted, although Chinese Embassy spokesman Chu Maoming in Washington, D.C., said organs already are harvested ethically.
"The organs come from ordinary citizens who voluntarily give them," Chu said.
Critics of the new regulations say that they still fail to address the source of organs, the administration of organ donations or the definition of "brain dead" -- and that they apply only to live donors.
Chinese officials have confirmed that executed prisoners have been among the sources of organs for transplants, according to the U.S. State Department's annual human rights report released in March. The report questions whether anyone obtained meaningful or voluntary consent from the prisoners or their relatives before the organs were harvested.
So far, watchdogs haven't been able to determine how many transplants Chinese doctors have conducted on foreign patients because the Chinese government does not release such figures.
The human rights group Amnesty International estimated in 2004 that at least 3,400 people were executed in China and 6,000 sentenced to death. The totals could be much higher; Chinese authorities keep national statistics on death sentences and executions secret. Amnesty has repeatedly reported the harvesting of organs from executed prisoners and called for the Chinese government to forbid the practice if prisoners haven't given free and informed consent.
Adherents of Falun Gong, the spiritual movement banned in China, have accused the government of harvesting organs from thousands of the movement's followers in Liaoning province, charges that the U.S. State Department has urged the Chinese government to investigate.
Harry Wu, a human rights activist and founder of the China Information Center in Virginia, notes that Chinese, by culture and tradition, want to die whole. "They don't have a concept to donate body parts to other people," Wu said.
This deep reluctance, the high number of executions and the thriving transplant business add up to one conclusion, he said: "The death penalty is the base of (China's transplant) program."
In contrast, federal prisoners on death row in the United States are not allowed to donate their organs because it is assumed their incarceration impairs their freedom to consent. For prisoners on state death rows, the laws vary. In any case, many prisoners are medically unsuitable to donate organs because they carry transmissible illnesses such as HIV or hepatitis.
Going to China for organ transplants is "reprehensible," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.
"I understand people are desperate and want organs," Caplan said. "But there is a problem of dirty hands. It's not like there's a national assistance program of Chinese organs to the needy of the world. It's the rich who go and say, 'I'm going to look the other way.' "
In September, Daniel Farley of Sebastopol also received a liver transplant at Yeson in Shanghai, a booming commercial and cultural center in China. He grappled with the knowledge that the organs could have come from an executed prisoner.
"I'm a fairly liberal guy, and it's not the greatest thing to think about," said Farley, 57. "But when you're faced with a certainty -- and (the donors) have a certainty -- it's easier to take. Either someone was sentenced to die or it was their time."
However, the organs should be suspect because their origin often remains a mystery, doctors say.
"What was the health of the donors?" asked Robert Gish, division chief of hepatology and complex gastroenterology at the California Pacific Medical Center in San Francisco. "It's not as well defined as in the United States. It's also not clear, the circumstance of a donor's death."
Yeson International Healthcare, which provided both De Leon's and Farley's transplants, was one of the first in China to offer such services to foreigners, said Tony Lee, the company's senior medical consultant. Founded in 2000, Yeson now serves about 20 Westerners and up to 100 patients from Taiwan each year, he said.
"People come here because they're desperate, and we offer them a chance of living," Lee said in a telephone interview. "That's why they come here, because of something we have here and nowhere else is offering."
Yeson contracts with a hospital in Shanghai, which in turn handles the donation process with a government agency, said Lee, adding that the company follows Chinese regulations.
"We do the service part," Lee said.
The China International Organ Transplant Center, founded in 2003, also in Shanghai, performs more than 100 kidney transplants and more than 20 liver transplants each year, according to its Web site, which is written in English, Russian, Korean, Japanese and Chinese.
A kidney transplant at China International costs $62,000, a liver $98,000 to $130,000, a lung transplant $150,000 to $170,000 and a new heart $130,000 to $160,000.
A month after his transplant, De Leon said he feels great, though he has some numbness at the stitches across his abdomen.
He still has a high risk of recurrence of liver cancer, his doctors say. "We'll look after Eric and see how he does," said Nathan Bass, medical director of liver transplants at UC San Francisco. "Hopefully he'll be one of the lucky ones."
De Leon plans to take off another month or two before going back to work on remodeling projects in high-rise buildings. He also wants to write a book of advice for people going to China for transplants. Several patients and their families already have contacted him after coming across his blog.
"We want to help if we can," De Leon said. "What else can you do? People are dying."
Transplant tales: to China and backEric De Leon and his wife, Lori, wrote about his experience in China undergoing a $110,000 liver transplant in March, which they financed with a loan on their San Mateo home. Following are some of the entries from their Web log at newfilter.blogspot.com:
March 2: Well we made it to Shanghai after a long 13 1/2 hour flight. ... The coordinator Tony met us at the airport and escorted us to the hotel. We started our first full day by meeting with Dr. Fan the leading Transplant Surgeon. ...Then the rest of our day was full of Tests, Tests, and more Tests.
March 14: Well hopefully this is it. We received a call today saying that they had an organ match ... FINALLY!! Of course the screening still needs to be done.
March 15: One of the surgeons inquired on if we wanted to see the liver they removed from Eric. I told him yes. We went down to the surgery floor and the surgeon brought a large bowl with a huge roast. Really, Eric's liver was huge. The doctor said his liver was twice the size of a normal liver. This size was due to the Hep C and the cancer. The average liver weighs around 3 pounds Eric's was all of 6 pounds ...
March 17: The doctor told Eric that he was very lucky. He received a 20-year-old liver. Young and healthy. Hmmm ... Maybe that's why Eric is feeling so good already! He's already bored out of his mind. Partly due to the fact that he hasn't been able to sleep much. Plus he's a little paranoid. He thinks the nurses are screwing around with him. Tony said the paranoia is normal and is actually one of the side effects of the anti-rejection medicine. I think it might also have a little to do with the fact that there is a bit of a language barrier.
March 31: The normal meal Eric receives consists of 2 bowls of rice, and a banana. Along with that he also receives a dish of meat. ... Today's menu, for example, consisted of the following. Breakfast: meat bun and milk or fried shredded pork and pickled green noodles with egg. Lunch: braised weever with brown sauce (does anyone know what that is?), salted egg with minced pork, or stewed shredded eel and bamboo shoots. Supper: Gingeli and sliced fish. ...
April 3: It is now day number 19 since Eric's liver transplant. He is doing fantastic! Looking at him in the picture with the leading liver surgeon here at the hospital, who would ever think that he had just undergone such a life-saving operation? Eric is being released today and not a day too soon. We are being told continuously that he has recovered remarkably fast.
Today they are saying these Medicare and Medicaid Trusts no longer have funds for baby boomers because of these actions by Clintons. Bush then simply sat back and allowed all the Robber Baron frauds to occur and Obama created the same frauds to do the same. It was the Affordable Care Act that actually ends Federal Medicare and Medicaid creating that tiered health structure of 99% receiving only preventative health care and expanding globally for the global 1% and their 2% global health tourism and telemedicine.
This is what Clinton global 1% Wall Street players have been doing these few decades all the while thinking they were GLOBAL PLAYERS. SHOW THEM THE MONEY AND THEY DID ANYTHING GLOBAL WALL STREET TOLD THEM-----
Hillary worked hard to move all public health funding providing the best health care to 99% of citizens----to these GLOBAL CORPORATE EXECUTIVES.
Bernie Sanders ran on a platform of saving MEDICARE -----while he was actually the same far-right wing global 1% neo-liberal now using the term SINGLE-PAYER UNIVERSAL----pushing the same access to health care as the WORLD BANK/WORLD HEALTH/UNITED NATIONS-----
ONE WORLD HEALTH CARE IS THE SINGLE-PAYER.
Below we see the results of Hillary's health care reform from the 1990s-----just as Bill's banking reforms with global Wall Street-----extreme wealth with corporate executives and global administrative structures taking what USED TO BE FUNDS FOR STRONG HEALTH CARE FOR ALL AMERICANS.
Venture capital's bold move into population health
By Dave Barkholz | January 7, 2017
Rahul Jain got the entrepreneurial bug when a medical school friend and former classmate found it difficult to take seven medications a day to battle a blood disorder.
If his friend couldn't manage that regimen, how could seniors taking even more pills—often with no supervision—manage their daily load, thought Jain, a Duke University economics graduate. An idea for a new business was born.
His research quickly discovered improper medication adherence causes 125,000 deaths and wastes $100 billion annually in avoidable hospitalizations. Jain joined forces with his friend Nick Valilis and others to create TowerView Health, a low-tech prescription management service.
The 2-year-old business attracted $2 million in seed money last year to launch the company.
Jain expects more venture capital to flow into his start-up early this year to finance an expected expansion beyond the nearly 1,000 patients that insurers have lined up to use the service.
“We'll be looking for more funding in the spring,” said Jain, whose four founders were just named to the Forbes “30 Under 30” list.
Raul Jain joined forces with a friend and others to create TowerView Heatlh, a low-tech prescription management service.
Maintaining medication adherence for chronically ill patients is a crucial part of the population health management strategies being adopted by healthcare systems across the U.S. Staying on their meds helps keep patients out of hospitals, which in turn helps health systems and other providers meet the reimbursement criteria in their new value-based payment contracts.
That's why start-ups like TowerView that offer practical solutions for managing populations are attracting serious investor interest. Global population health management as an industry is expected to grow from $11.1 billion in 2015 to $31.6 billion by 2020, according to a January 2016 report by the research firm MarketsandMarkets.
Venture capital firms are chasing that growth. Rock Health, which tracks healthcare venture funding, reported last week that nearly $200 million was invested in population health management start-ups last year, making it one of the top six fields in healthcare attracting new money. Overall investment fell slightly to $4.2 billion in 2016, down from a record $4.6 billion invested the previous year.
MH TAKEAWAYS Population health management is now one of the top six fields in healthcare attracting new money from venture capital firms, thanks in large part to the aging of the baby boomer population.
The term population health has different meanings in different settings. Most major health systems and insurers see it as managing the healthcare of large groups of people, often the chronically ill, to ensure they are getting care at the right time in the appropriate setting. To do that, hundreds of companies have sprung up or started divisions to provide the data analytics and software tools to help hospitals, physicians and insurers manage that care.
Dreamit, a Philadelphia-based accelerator that invests in promising start-ups and introduces them to venture capitalists, is bullish on population health players, said Karen Griffith Gryga, partner and chief investment officer. Of 80-plus companies in its healthcare portfolio, which is Dreamit's largest segment, one-third are involved in population health and 25% of its total investment is in population-health start-ups, Griffith Gryga said.
She said a healthcare industry that uses some of the world's most-sophisticated technology to diagnose and treat illnesses is “decades behind” in using data and analytic tools to assist clinicians with managing populations.
Moreover, the move from fee-for-service to putting providers at financial risk for care is only going to work well for those that can put data to work to help maintain patient health. “Opportunities are huge for the industry,” Griffith Gryga said.
Venture capitalists are investors who bet early on promising companies and are generally willing to wait several years for a return on their investment. They typically take an equity position in a company of 6% or more in exchange for a few million dollars to commercialize a product or service.
That first big breakthrough in financing is getting harder to come by, though, Griffith Gryga said. There are so many companies with promising technology that just 11% of companies today desiring to graduate from the seed-money stage can attract a multimillion-dollar investment, she said. That compares with one in four companies two years ago.
To help companies in its early-stage portfolio reach venture capital investors, Dreamit often takes their key personnel on road shows to make their case to potential funders, Griffith Gryga said.
Those introductions are crucial for TowerView, Jain said. His firm received $50,000 from Dreamit in 2014 and was put into a 13-week accelerator program that included business advice and a series of road shows.
Dreamit took no equity at the time, instead getting notes that allowed it to buy future equity at a discount, he said. That can run from 10% to 20% of what other investors are paying. Dreamit has since invested another $150,000 in TowerView.
TowerView's product is a relatively low-tech approach to getting patients to take their medicine on time, Griffith Gryga said. “It isn't brain surgery,” she said.
The company arranges with a patient's pharmacy to receive a 28-slot medication tray of their daily medications that lasts a week. The pre-sorted tray is then put in a cellular-connected pillbox that senses when a patient misses their medications and sends a text, phone and in-box reminder to patients, loved ones and case managers. TowerView also handles the prescription refills.
In a 2015 randomized controlled trial conducted by Penn Medicine in Philadelphia, a test group of patients achieved 99% adherence compared to 70% before the patients enrolled in the program. The trial was funded by Independence Blue Cross in Philadelphia.
THESE ARE NOT DEVELOPED NATION CLINICAL TRIALS-----THESE ARE FAST AND EASY GLOBAL CORPORATE TRIALS KNOWN TO CREATE DATA HEALTH CORPORATIONS WANT.
Adherence was measured by prescription refill rates, the same way that the CMS measures medication adherence, Jain said. Those results enabled TowerView to win eight contracts with Medicare Advantage and managed Medicaid plans, Jain said.
With more than 25 million Americans 65 and older taking at least five medications per day, the opportunities for small companies selling medication adherence technologies is already vast. The aging baby boomer generation is expected to drive that number to more than 30 million ultra-high medication users within 10 years.
Caring for elderly patients in less expensive settings—another key to successful population health management strategies—is also on the radar screen of private equity firms. In May, private equity giant Welsh, Carson, Anderson & Stowe led a group that paid $196 million to buy home senior-care company InnovAge.
Welsh Carson was attracted to the company, which was not-for-profit at the time, because of its focus on a CMS-designated plan for frail seniors to keep them in their homes called the Program of All-Inclusive Care for the Elderly, or PACE, said Tom Scully, Welsh Carson general partner who served as CMS administrator between 2001 and 2004. PACE is a capitated, holistic way of managing that population that includes everything from transportation and home nursing to adult day care and meals. “I've always loved PACE,” Scully said.
His firm outbid other suitors with the plan to help CEO Maureen Hewitt build the company far beyond its center in Denver and satellite operations in Albuquerque and San Bernardino, Calif. InnovAge's client base averages 80 years old and is 85% women. The company touched 93,000 lives in 2015.
Welsh Carson hasn't set a timeframe for when it plans to get a return on the investment, Scully said. But with the growth of the senior population and the market for PACE around the country, he said an initial public offering in four years or so wouldn't be out of the question.
Dr. Betty Rabinowitz, CEO of EagleDream Health in Rochester, N.Y., said population health is crowded with start-ups, all of which are looking for ways to prove themselves and grow. EagleDream provides data analytics and software that allow clinicians and practice managers to track patient admissions and discharges, identify high-risk patients in their populations and compare cost, quality and clinical variations between providers in their networks.
Customers include the University of Rochester (N.Y.) Medical Center, the Greater Macomb PHO physician network in suburban Detroit and the Massachusetts Health Quality Partners, Rabinowitz said. EagleDream stayed close to home raising its money for growth. It is completing a
$6 million equity placement funded by more than 50 individuals who now own about one-third of the company.
Rabinowitz said the company will use that funding to grow and hopefully separate itself from the pack. “It's almost like the wild west,” she said.
OH, THAT'S ALWAYS GOOD FOR QUALITY SERVICE AND PROGRAMS---ESPECIALLY LIFE AND DEATH HEALTH CARE.
___________________________
The idea that global Wall Street is moving from FEE-FOR-SERVICE TO what they are touting as ACO managed care to bring better service to the consumer is LAUGHABLE. This policy goal is consolidating the health care industry just so it can SOAK THE CONSUMER WITH HEALTH CARE COSTS in just a few decades. It will do this as with other industries----by pushing all small and regional businesses out of business especially all those pay-to-play health businesses Clinton neo-liberals through some millions at while privatizing away public health. Remember, the global MERCHANTS OF VENICE always make the 99% feel they are participating in an empire economy ----with no intention of allowing them to gain wealth or market share. The Clinton's found those 5% to the 1% players willing to dismantle our public agencies throwing what was loose change to the billions of dollars moved to global 1% corporations.
STARTUPS IS SIMPLY THAT SAME TERM-----THEY GO NOWHERE.
Fee-for-service worked fine when there was oversight and accountability and it was what made our public health structure CAPITALIST....SOCIAL DEMOCRATIC----and this is to what we want to return as soon as we GET RID OF GLOBAL WALL STREET PLAYERS.
'Moreover, the move from fee-for-service to putting providers at financial risk for care is only going to work well for those that can put data to work to help maintain patient health.
“Opportunities are huge for the industry,” Griffith Gryga said'.
Nowhere are health industry profits SOARING than in transplant tourism-------since Affordable CAre Act DEREGULATES the health care industry allowing it to be PREDATORY as global Wall Street banks-----and since WE THE PEOPLE are now human capital ----not citizens with rights----our bodies become modes of profit for global Wall Street health systems. This has been a CRIMES AGAINST HUMANITY issue overseas in FOREIGN ECONOMIC ZONES these several decades and has been shown to exit here in the US through CLINTON/BUSH/OBAMA------with predation soaring under OBAMA because of Affordable Care Act policies.
THE ARTICLE BELOW IS LONG BUT PLEASE GLANCE THROUGH----WE WILL FOCUS ON THIS HEALTH CARE ISSUE FOR THE WEEK.
Ethical Controversies in Organ Transplantation
E.F. Ehtuish1[1] Surgery Department Tripoli Central Hospital &National Organ Transplantation Program, Libya
1. Introduction
Since the 1st successful kidney transplant in 1954 done between two identical twins [Merrill et al 1958] organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Clinical organ transplantation has been recognized as one of the most gripping medical advances of the century as it provides a way of giving the gift of life to patients with terminal failure of vital organs, which requires the participation of other fellow human beings and of society by donating organs from deceased or living individuals [Ehtuish et al 2006 & Hariharan et al 2000]. The gap between the demand for organ transplantation and the supply of donor organs is growing [The economist 2008].The waiting list of the United Network for Organ Sharing has grown from 21,975 names in 2000 to 32,722 in 2008 Fig. (1).
Figure 1.The gap between the demand for organ transplantation and the supply of donor organs (UNOS) publications
The scarcity of organs has dire consequences. And an average of 19 people dies each day waiting for a transplant that never comes [United Network for Organ Sharing (UNOS) 1999]. The World Health Organization WHO global observatory showed that in 2009 about 100,900 people receive a lifesaving organ transplant, representing only less than 10% of the global needs Fig. (2). the entire issue has raised serious ethical concerns and the debate over them rages unabated. As further advances are made in such areas as cloning [Savules et al 1999], the ethical debate should grow more intense. The increasing incidence of vital organ failure and the inadequate supply of organs, especially from cadavers, have created a wide gap between organ supply and organ demand, which has resulted in very long waiting times to receive an organ as well as an increasing number of deaths while waiting. These events have raised many ethical, moral and societ al issues regarding supply, the methods of organ allocation, and the use of living donors including minors. It has also led to the practice of organ sale by entrepreneurs for financial gains in some parts of the world through exploitation of the poor, for the benefit of the wealthy the ethical questions are complicated by an outgoing debate over the definitions of certain key terms such as life, death, human, and body. One example is the definition of brain death [Delmonico et al 1973]. People have been confused over the issue because of the highly public cases of people recovering from comas even after many years. The distinction between the idea of brain death and coma becomes a matter that must be clearly defined. A family that is asked to donate body organs from dead relative on the basis of brain death must be confident that there is no hope of recovering. Other ethical issues of organ donation are considered bioethical an important one is the idea of cloning. The technology that would allow the cloning of genetically matched clones for the purpose of body harvesting another issue is known as xenotransplantation which involves the harvesting of certain compatible animal organs for use in humans. A whole new plethora of ethical issues surround this idea due to fear from animals and the diseases might transmitted form them, or to protect them, even animal rights groups have joined in these debates. There is no question that body donation and organ donation will remain a hot topic for many years to come. Organ transplantation in general, and kidney transplants in particular, are fraught with ethical issues and dilemmas worldwide, about which there is ongoing debate, especially because of the shortage of organs The ethical questions associated with transplantation are many [Abouna 2008]. Is the human body a commodity?
How should decisions be made about who should receive scarce organs? Who should pay for transplants? Should someone who has received one organ transplant be given a second transplant? Or should people who have not had a transplant be given priority over those who have already had one? Should one person receive several organs or should several people each receive one? Should one person have a second transplant when the first one fail or should a different person be given a first chance at new organ? Should people who have young children be given an organ transplant over a single person? Should young people be given an organ transplant over an elderly person? Should age and whether or not a person has children even matter? Should organs be given to people who have abused their bodies (smoking and drinking etc, ) or only to people whose organs are damaged by disease? Should hands or other appendages, which are not essential to life, be transplanted? Who can “donate” the organs of people who cannot give informed consent to the process? Should money now spent on transplantation be put to other uses? Is it possible to prevent the coercion of some donors? Should suicidal individuals be given an organ transplant? What if they attempted suicide in the past but are not currently contemplating suicide? Should people who can’t afford expensive anti-rejection drugs be passed over for a transplant? Should people who don’t have Insurance and can’t pay for a transplant be allowed to go on the National waiting list? Should condemned prisoners receive organ transplants? What if they are serving a life sentence without parole? Should country lawmakers be involved in transplantation? When should courts be involved in these questions?
The questions go on and on; the answers are never simple. Knowing that there are more people who need organs than there are organs available, how would you answer these questions? Are your answers based on a belief of equal access or maximum benefit distribution?
2. What is organ transplantation?
An organ transplant is a surgical operation involves removing of an organ from one person (donor) and transferring it to another (recipient), keeping the native organs like Kidneys or removing them like Livers and Hearts. The need to obtain informed consent from both persons (and their surrogate decision-makers) is compulsory. This is in keeping with the ethical principle of respect for persons and is expressed in many ethical guidelines today.
3. Important milestones in the history of organ transplantation
- 1950 – 1954 The first successful kidney transplant. A kidney is taken from one identical brother and transplanted in another, where it worked for 8 years.
- 1960 - 1962 The first successful cadaveric transplant used deceased donor kidney. The kidney worked for almost 2 years.
- 1966 First successful liver transplant. The liver worked for over one year.
- 1967 First successful heart transplant. The heart worked for 2 1/2 weeks.
- 1980 – 1981 First successful heart-lung transplant. The organs worked for 5 years.
- 1982 First artificial heart transplant.
- 1983 Cyclosporine, an immunosuppressant drug, was approved by the FDA.
- 1986 A baboon heart was transplanted into Baby Faye and worked for 20days.
- 1989 The first successful living-related liver transplant.
- 1990 – 1996 The first “split liver” transplant was performed where one cadaveric liver was split into several pieces to transplant into more than one person.
- 2000 First culture of human embryonic stem cells.
The sources of organs for transplantation, i.e., living donor (related and nonrelated), cadaveric donor, and brain-dead patients. In countries where transplantation is well established, organs are sourced from living and cadaveric donors using different strategies, i.e., an opt-in (explicit consent), opt-out (presumed consent), and donation after brain death, donation after controlled cardiac death, and extended criteria for deceased donors.
Figure 3.
4.1. Living organ donation
Four categories of donation by living persons can be distinguished: Living Related Organ Donation “blood or emotional”: directed donation to a loved one; Altruistic Organ Donation: non-directed donation, in which the donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list; Living Non-Related Organ Donation: directed donation to a stranger, whereby donors choose to give to a specific person with whom they have no prior emotional connection; and Cross donation where a living donor wants to donate to his blood or emotional relative an organ but blood groups does not match, there is a complete mismatch or cross matching is positive. Two families or more can cross donate if matches exist. Each type of donation prompts distinct ethical concerns. Living Related Organ Donation is presumed to be the most ethical form of organ donation [Spittal A 1997]. One can argue that the psychological and non-specific benefits to the donor are real, particularly when a close relative is returned to normal health. There can, however, be no doubt that the physical consequences of living donation are entirely detrimental to the donor. Motives behind the 1st degree living renal donation are understandable and one may assume that the living donation between relatives carries the same altruistic motives. In related organ donation, the donor saves the life and attains the wellbeing of its immediate relative by accepting a physical injury and debilitation to itself. While many related donors fall neatly into this altruistic categorization, unfortunately, there are many examples where the related donors have attained physical, emotional or financial toll from the recipient. With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so to feel coerced. In these cases, transplantation programs are typically willing to identify a plausible medical excuse, so that the person can bow out gracefully. Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves. In cases like these, simply obtaining the informed consent of the relative is insufficient; physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large. Non directed donation raises different ethical concerns. The radical altruism that motivates a person to make a potentially life threatening sacrifice for a stranger calls for careful scrutiny [Garwood et al 2007].
Transplantation teams have an obligation to assess potential donors in all these dimensions and prohibit donations that arouse serious concern. Directed donation to stranger raises similar ethical questions with a few additional wrinkles. This type of donation usually occurs when a patient advertises for an organ publicly, on television or billboards or over the Internet. Such advertising is not illegal, but it has been strongly discouraged by the transplantation community. Two central objections are that the practice is unfair and that it threatens the view that an organ is a “gift of life,” not a commodity to be bought and sold. Some argue that just as we have a right to donate to the charities of our choice, so should we be able to choose to whom to give our organs. In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs — rather than those most in need. This strikes some ethicists as unfair. Unlike monetary gifts, they argue, organ transplantation requires the involvement of social structures and institutions, such as transplantation teams and hospitals. Hence, the argument goes, these donations are legitimately subject to societ al requirements of fairness, and transplantation centers should refuse to permit the allocation of organs on the basis of anything but morally relevant criteria [Hull et al 1997].
The most ethically problematic cases are those in which the recipient is chosen on the basis of race, religion, or ethnic group [Epstein 2007]. A person with organ damage or organ failure may look for a living donor to donate an organ, allowing the patient to bypass the national waiting pool to receive a cadaveric organ.
4.1.1. Directed versus anonymous donationCurrently there is some debate whether altruistic donation should be anonymous or the donor should choose the recipient that he wishes to donate the organ to [Epstein et al 2009]. Donation could be criticized ethically that it unfairly favors some potential recipients by allowing them to jump to the top of
the waiting list; however, many transplant surgeons and ethicists believe that this is a very special kind of advantage when a good Samaritan donates one of his organs to a friend or colleague who is on the waiting list. For this not only helps the recipient, but actually also helps those who are on the waiting list who will move up the ladder and will have a better chance of having a cadaveric organ.
4.1.2. Benefits to living donation [Abouna 1998]
- The operation can be pre-arranged so, the hot and cold ischemia will be minimized which will have a good impact on the transplantation outcome.
- There are often better matches between donors and recipients with living donation, because many donors are genetically related to the recipient.
- Psychological benefits for both the donors and recipients.
4.1.3. Drawbacks of living donation [Landolt et al 2001]
- Health consequences: Pain, discomfort, infection, bleeding and potential future health complications.
- Psychological consequences: Family pressure, guilt or resentment.
- Pressure: Family members may feel pressured to donate when they have a sick family member or loved one.
- No donor advocate: While the patients have advocates, like the transplant surgeon or medical team (who are there to advise the patient and work in favor of his or her best interests) donors do not have such an advocate and can be faced with an overwhelming and complicated process with no one to turn to for guidance or advice.
WHO publications
Other critics seek to discourage living donation because they think extending life through costly and physically taxing medical procedures is not the purpose of health systems. Although there are some who object to the practice of living donation, this potential source of organs is currently a major focus as a way to reduce the shortage of organs. Increasing the number of living donors could occur through a variety of strategies from education and civic duty promotion to the sale and purchase of organs Fig. (4).
Figure 4.International Registry of Organ Donation
4.1.4. Justification of transplantation from living donorsLiving related donation, emotional related or altruistic are very justifiable on humanistic grounds and they are ethically and medically acceptable, providing that donor evaluation both medical and psychological is carried out in accordance with accepted protocols and that a fully informed consent is given by the donor. Also, the rate of donor complications after kidney donation is extremely small. The reported mortality rate after kidney donation is 1 in 10,000 [Delmonico et al 2008].
On the side of the donor, there are many psychological and spiritual benefits, and most donors express an increased sense of pride and satisfaction and the joy of giving a gift of life to a relative, a friend or to another fellow human being. Another justification is that the success rate of living donor kidney transplantation is considerably higher than that of cadavers [Hunsicker 1999]. The expected patient survival rate and graft function at 5 years in 2007 is 99 and 96%, respectively, with living donors and 96 and 91% with cadaver donors, which is much better than 1998 statistics and that is most probably due to the recent introduction of more effective immunosuppression medications Fig. (5 & 6).
In living donor transplantation it must be shown that the benefits to both donor and recipient outweigh the risks associated with donation and transplantation.
4.1.5. The decision to donate organs within the familyMany decisions to be living donors will be made within a family context - whether blood relations or less commonly, spouses, or in-laws - and involve the needs of specific members of that family. Very often, in living donation, there will be a host of pressures and family complexities to take into account. These may affect the extent to which a decision to donate or not to donate is genuinely free. Understanding some of these complexities and family dynamics can assist greatly in reaching a decision that is genuinely voluntary. It is important to distinguish between different kinds of pressure that a person faced with the decision about living donation may feel Avoidable pressures or Unavoidable pressures [Spital A 1996]. The decision to be a living donor should be based on adequate information and understanding, an informed decision is one based on information relevant to the making of that decision. Of course, in assisting a potential donor to make his or her decision about donation, doctors have an ethical and legal duty to warn about material risks in a treatment [Danovitch 2007]. Material risks are those that most people would want to know and also those that would be significant for a particular individual. It follows that a donor, before deciding about donation, should ask the appropriate medical practitioner to disclose the risks of the intended procedure and of its short and long term effects.
4.1.6. Psychological issues in live donationThis includes information and understanding about possible emotional and psychological consequences of making a decision one way or the other, for the potential recipient, the potential donor, the relationship between these two people, and for other family members. These questions can only be answered within the context of understanding a particular family and/or the particular individuals involved whatever the outcome, certain issues may take some time to resolve.
Tissue typing and other medical checks may identify only one suitable donor in a family, which can lead to great pressure being put on that person. There may be more than one suitable donor and in these cases there can be complex pressures again as a choice is made between these people. As examples of such pressures, focus may fall on one of the suitable people for various reasons, perhaps without sufficient thought. In other cases there may be one person who is extremely eager to donate and so perhaps too willing to overlook possible difficulties that may be encountered. Often, such very willing people may need even more careful counseling to ensure that their decision is sound.
Living donation offers the recipient immediate hope. Because the results are generally favorable, the mood of the recipient, family and donor are usually optimistic. Against this background, other issues need to be considered [Jarvis 1995]:
Chances of survival of recipient:
It is argued by some that it is preferable to donate to recipients who are not critically ill, because choosing recipients with higher chances of survival better balances the risk to the donor. In addition, when such recipients are chosen, there is less need to make a decision under pressure and the additional time allows thorough medical and psychological evaluation of the proposed donor.
Changes in donor/recipient relationship:
The exceptional nature of what has happened and what both the donor and recipient have shared may be mutually enhancing. After a donation, there is often increased contact between a donor and the recipient where they are known to each other. Our experience suggests that reaction to being identified as a donor is very positive [Mathieson 1999].
Feeling if the transplant fails:
If the donation does fail, the donor may have feelings of guilt or inadequacy or feelings of anger, sadness, or that the donated organs or tissues have been wasted, and that the discomforts he or she has suffered have been made for nothing.
Feelings of ‘ownership’ towards the recipient:
Living donors can feel closer to recipients and have expressed attitudes of ownership about the state of health and activities of the recipient. They may feel that they have a right to ensure that the recipient is taking good care of his or her health and therefore of the donated organ or tissue. Conversely, the recipient may identify with the donor and feel that part of the donor is living in them. Ultimately such feelings may not be in the best interest of either party.
Recipient feelings of guilt if the donation has harmful effects on the donor:
A recipient may feel guilty and responsible if the donor suffers from his or her donation.
Consequences of not donating:
A decision not to donate can have a major impact on relationships within a family. The recipient’s illness is often life-threatening and death may occur before or after transplantation. It is therefore important that the family, including prospective donors, do not have unrealistic expectations for the recipient nor underestimate the difficulties for the donor. A decision not to donate might be entirely appropriate for the individual, but still have profound effects on family relationships if the proposed recipient dies. It is very important to consider whether such factors amount to undue pressure on a potential donor
4.2. Deceased organ donation
Organs for transplantation which obtained from living donors unfortunately, have so far been unable to keep up with demand. As a result, there are a large and steadily increasing number of potential recipients awaiting transplantation, some of whom will die before an organ can be found. This scarcity of organs for transplantation can only be met from the cadavers Fig. (7). Cadaveric source is beneficial in another way that it provides multi-organ donation. To utilize cadaveric organs effectively, it needs legal formalities and most of the countries have passed cadaveric law [Alashek, Ehtuish et al 2009].
4.2.1. Strategies to promote cadaveric organ donations and self sufficiencya. Education
Educational efforts focus on increasing the number of people who consent to be an organ donor before they die. And educating families when they are considering giving consent for their deceased loved one’s organs. Social responsibility and the idea of “the gift of life” should be popularized
b. Mandated choice
Under this strategy, every individual would have to indicate his wishes regarding organ transplantation, perhaps on driver’s licenses. When a person dies, the hospital must comply with their written wishes regardless of what their family may want. The positive aspect of this strategy is that it strongly enforces the concept of individual autonomy of the organ donor. A mandated choice policy would require an enormous level of trust in the medical system. People must be able to trust their health care providers to care for them no matter what their organ donation wishes
c. Presumed consent
This method of procuring organs is in fact the policy of many European nations. In countries with presumed consent, their citizens’ organs are taken after they die, unless a person specifically requests to not donate while still living. Advocates of a presumed consent approach might say that it is every person’s civic duty to donate their organs once they no longer need them (i.e. after death) to those who do. People against presumed consent would argue that to implement this policy, the general public would have to be educated and well-informed about organ donation, which would be difficult to adequately achieve. Doubters of the presumed consent approach might also argue that requiring people to opt out of donating their organs requires them to take action and this might unfairly burden some people. The countries having presumed consent principles like Spain and Canada shows higher donation rate 40-50 per million population [Miranda et al 1998 & Rithalia et al 2009].
d. Incentives
Incentives take many forms [Beier et al 2008]. Some of the most frequently debated incentive strategies are:
- Give assistance to families of a donor with funeral costs
- Donate to a charity in the deceased person’s name if organs are donated
- Offer recognition and gratitude incentives like a plaque or memorial
- Provide financial or payment incentives
Proponents say that since the person will be dead and unable to receive the recognition, that this would not be a coercive action. Some ethicists believe that many of the incentives above, while not attached directly to cash money, are still coercive and unfair. They believe that some people will be swayed to donate, in spite of their better judgment, if an incentive is attractive enough. They further argue that a gesture may seem small and a mere token to one person, but others might interpret it quite differently. A final anti-incentives argument offered by some ethicists discourages the practice of incentivizing organ donation [Jasper et al 1999]. They believe that society should instead re-culture its thinking to embrace a communitarian spirit of giving and altruism where people actively want to donate their organs
4.2.2. Maximizing donation form deceased donorsIn order to maximize the donation from deceased donors it is important to consider the following:
- Legal and organizational framework
- Coordinating authority over health system
- Citizen's understanding: donation in school curriculum
- Ongoing reality and momentum in media
- Adaptation of relevant models (Spain) in emerging countries
It is another issue that needs considerate discussion. Living donors provide the best outcome for children undergoing renal transplantation. Most of these donors are parents. When parents are unable to donate, siblings are often considered. But what if the siblings are also children? Should they be permitted to donate? They are below 18 years of age and not able to consent and they might be pushed or convinced to donate. And what about those who are mentally subnormal and their families wants to use them as donors?
Sometimes there are reports that children have been kidnapped, only to re- appear later lacking one kidney, or that they simply disappear and are subsequently killed to have all their transplantable organs removed for profit. However, the issue is covered in a broader sense by more general provisions. There are endless rumors surrounding this area. Members of various organizations who travel in the suspected countries say that the trafficking in children who are sold for transplantation is well known, but it is too difficult and very dangerous to catch the people involved [Spital A 1997],
4.4. Executed prisoners as donors
Several authors and ethicists have recently commented on the current practice in some countries of the use of organs from executed prisoners. While all societies strongly condemn the arbitrary use of taking organs from executed prisoners, which is a common practice in some countries, where organs are taken and given to various institutions for transplantation or even sold to other countries. It is suggested that it will be ethically permissible to allow a prisoner on death row to donate an organ to a relative or a friend. [Miller 1999].
One argument in favor of taking organs from prisoners, who are put to death, is that it is the execution that is ethically unsound and not the organ removal. Indeed, in light of the severe organ shortage, some ethicists could make the argument that to not use the organs for transplantation is wasteful. Some ethicist, put forth the argument that obtaining organs from condemned prisoners is allowable if the prisoner or their next of kin consents to donation, as long as organ donation is not the means by which the prisoner is killed because that violates the principle that a cadaveric donor be dead prior to donation. Some could argue that organ retrieval from executed prisoners is morally justifiable only if a “presumed consent” donation practice was in place. Many, if not most, bioethicists consider taking organs from condemned prisoners a morally objectionable practice. And immoral [Cameron et al 1999].
4.5. Alternative organ sources
Some potential non-traditional sources of organs are:
4.5.1. Animal organs – “xenotransplantation”Animals are a potential source of donated organs. Experiments with baboon hearts and pig liver transplants have received extensive media attention in the past. One cautionary argument in opposition to the use of animal organs concerns the possibility of transferring animal bacteria and viruses to humans. Some argue that xenotransplantation is the only potential way of addressing this shortage. As immunological barriers to xenotransplantation are better understood, those hurdles are being addressed through genetic engineering of donor animals and the development of new drugs therapies [Starzl et al 1964 & Grant et al 2001]. The focus of ethical attention has changed from the moral correctness of using animals for research/therapy to an increasingly appreciated danger of the establishment and spread of xenozoonses in recipients, their contacts and the general public. There are a number of reasons for not using subhuman primates for xenotransplantation, including their closeness to humans, the likelihood of passing on infections, their availability (gorillas, chimpanzees), their slow breeding and the expense of breeding them under specified pathogen free conditions. The pig, although domesticated and familiar, is too distant to evoke the same feeling as we have for primates, has the correct size organs, is probably less likely to pass infections, breeds rapidly and is not endangered; moreover, millions of them are eaten every year. Although drawing ethical conclusions is difficult at the stage of knowledge and debate, it seems acceptable to manipulate pigs genetically and to proceed to using their organs for xenotransplantation trials when infection control measures and the scientific base justify it [Bukler et al 1999 & Sim et al 1999]. The use of pigs in Muslim countries would be more controversial and disruptive although it is acceptable by Islamic religion in case of a real need and when there is no alternative [Rahman 1998]. In this case the question of informed consent is likely to be ambiguous and awkward. It might end up more of a binding legal contract than consent, as we understand it now. Xenotransplantation is also unlikely to cost less than or significantly alleviate the shortage of cadaveric organs in the short term. The international dimension of the risk of infection is becoming obvious, but there has so far been no effort to convene an international forum to agree on universally acceptable guidelines However, before xenotransplantation can be fully implemented, both the scientific/medical communities and the general public must seriously consider and attempt to resolve many complex ethical, social and economic issues that it presents [Platt 1999].
4.5.2. Artificial organsArtificial organs are yet another potential option.
The ethical issues involved in artificial organs often revert to questions about the cost and effectiveness of artificial organs. People who receive artificial organ transplants might require further transplanting if there is a problem with the device.
4.5.3. Organs from fetusesThe ethics of using tissues and organs from fetuses have been a matter of enormous discussion. Aborted fetuses are a proposed source of organs. Debates address whether it is morally appropriate to use organs from a fetus aborted late in a pregnancy for transplantation that could save the life of another infant. Many people believe that this practice would encourage late-term abortions, which some individuals and groups find morally objectionable. Another objection comes from people who fear that encouraging the use of aborted fet al organs would encourage “organ farming,” or the practice of conceiving a child with the intention of aborting it for its organs[Golmakani et al 2005]., but the use of spontaneously aborted fetus or anencephalic newborn could be encouraged. Although there is ethical debate concerning the possible use of organs of anencephalic babies for transplant. Some have argued that because of the absence of neocortex these are ‘nonpersons ‘and are ‘brain-dead’ and thus, such infants should be available for organ donation if this is the wish of the parents. However, as brain stem function is present in these infants, the ‘whole of the brain’ or ‘brain stem’ requirement for certification of brain death precludes removal of organs until cardiorespiratory death occurs.
4.5.4. Stem cells –“The future”Stem cells are cells that can specialize into many different cells found in the human body. Researchers have great hopes that stem cells can one day be used to grow entire organs, or at least groups of specialized cells [Bartholomew et al 2001 & Eradini 2002]. Some of the very recent developments in transplantation over the past decade have been the use of stem cells from bone marrow, cord blood, and from fet al and adult tissue, including somatic cells and neural cells. These cells have the great potential for differentiation and proliferation into other types of body cells including neuronal, hepatic, hemopoietic and muscular and thus help many patients with organ failure after their transplantation into the patients. These stem cells have also been shown to induce immunological tolerance and chimerism when they are transplanted into recipients of vital organ grafts and their rejection of a transplanted organ such as bone marrow, kidney, heart, liver, is prevented [Fandrich 2002]. A new hope is emerging now with the possibility of preserving the architecture of an organ i.e. preserving capsule, vascular structures and draining system and removing the destroyed or fibrosed cells and replace them with new cell mass produced by stem cells like removing all non-functioning Hepatocytes and replacing them with a new Hepatocyte cell mass, The ethical objections concerning stem cells have focused primarily on their source. While stem cells can be found in the adult human body, the seemingly most potent stem cells come from the first few cells of a human embryo. When the stem cells are removed, the embryo is destroyed. Some people find this practice morally objectionable and would like to put a stop to research and medical procedures that destroy human embryos in the process.
5. Life & death
With the development of mechanical ventilators, new drugs, and other forms of treatment, it became possible to artificially maintain circulatory and respiratory functions, even after the brain had stopped functioning. In the past four decades many countries amended their death statutes to include a definition of death by the complete and irreversible cessation of all brain functions. Since that time almost all cadaveric organs have been recovered from patients who have been declared "brain dead." Veatch has never been comfortable with the term "brain death," preferring instead "brain-oriented definition of death." Since the 1970s he has argued that the entire brain does not have to be dead for the individual as a whole to be dead. Instead, he advocates a "‘higher-brain-oriented definition’ of death—in other words, one is dead when there is irreversible loss of all ‘higher’ brain functions" he further proposes creating a new definition of death law that incorporates the notion that one need only have an irreversible loss of consciousness as opposed to an irreversible loss of all brain functions [Veatch 2008]. Veatch’s proposal is clearly controversial. It suggests a violation of an ethical boundary most clinicians are currently unwilling to cross. Perhaps he is correct that such a change is inevitable and that the "definition of death at the conceptual level is a religious/philosophical/social policy choice rather than a question of medical science".There was clear leadership from individuals such as pioneering transplant surgeon, Dr. David Hume; Dr. Hume wrote “there is only one definition of death, irreversible brain damage. Cessation of heart beat does not constitute death unless it has caused irreversible brain damage there must be no spontaneous respirations” [Delmonico 2010]. These observations were later corroborated by Dr. William Sweet published in the New England of Medicine when he wrote “it is clear that a person is not dead unless his brain is dead [Sweet 1978]. The time-honored criteria of stoppage of heart beat in circulation are long enough for the brain to die”. Dr. Sam Shemie has clarified the paradigm for donation and death by emphasizing on the “required absence of circulation” and by underscoring the vital functions of the brain as an essential criterion of life [Shemie 2007]. “Where the extracorporeal machines of transplantation can support or replace the function of organs such as the heart, lung, liver or kidney, the brain is the only organ that cannot be supported by medical technology”. On the other hand Byrne and others have rejected brain death as constituting death of the person contending the “cessation of the entire brain function, whether irreversible or not, is not necessarily linked to total destruction of the brain or the death of the person”. Byrne, apparently, bases his opinion regarding death as philosophically constituting a separation of the soul from the body [Byrne 1979]. However, applying that personal philosophy to the diagnosis of death defies a legal and medical standard, and an ethical and practical sensibility. No one knows when the soul may separate from the body at the time of death. However, the legal and medical definition of death is clear in terms of neurological and circulatory function. It becomes unethical to impose futile clinical treatments to a comatose individual, if the function of the entire brain is irreversibly lost. What would opponents of the brain death determination do with a patient on a ventilator with such a clinical condition have them maintained indefinitely in such a state? To propose the brain death criteria as constituting death was the central issue that confronted the Harvard Committee in 1967 [Ad Hoc 1968]. No one knows when the soul separates from the body, but a precise time of death must be specified for obvious legal, medical and social reasons, so that futile treatment can be concluded (without further obligation or responsibility to provide resuscitative or supportive technologies) and proper disposition of the body with burial and estate and property transfer, etc can be exercised. For many years, Truog has also objected to the determination of death by neurologic evaluation and by circulatory function. He wrote in the New England Journal of Medicine that “arguments about why these patients should be considered dead have never been fully convincing [Truog 1997]. The definition of brain death requires a complete absence of all functions of the entire brain yet many of these patients retaining essential neurologic function, such as regulated secretion of hypothalamic hormones”. The rebuttal to this assertion has been given by Shemie [Shemie et al 2006] who claimed that “the release of antidiuretic hormone (ADH) from the hypothalamus is not considered to be essential neurologic function. Brain death is determined by an absence of consciousness, receptivity and responsiveness, spontaneous movement, spontaneous breathing and absence of brainstem reflexes”. Brain death does not require every brain cell to be nonviable but the criteria require an irreversible loss of neurologic function of a patient interminably supported by a mechanical respirator. For Truog and others however, these patients are not considered dead because they indeed can be supported indefinitely beyond the acute phase of their illness. It is well known however that despite the irreversible loss of brain function the remainder of the body can be maintained by mechanical support; for example, even by patients who become brain-dead during pregnancy yet successfully have their fetuses brought to term. The clinical condition still constitutes the death of the mother and a viable fetus buys continued mechanical support until birth. Again in the New England Journal of Medicine. Truog and Veatch [Veatch 2008 & Truog et al 2008 & Life 9 November 1962] have asserted the donation after cardiac death (DCD) is not acceptable; that is, the recovery of organs after the determination of death by circulatory and respiratory criteria. Troug suggests that recovery of the heart following DCD is “paradoxical” because the hearts of patients who have been declared dead on the basis of the irreversible loss of cardiac function have in fact been transplanted and successfully functioned in the chest of another”. Veatch is similarly not convinced that the donor is dead and stated that “if someone is pronounced dead on the basis of irreversible loss of heart function, after all. It would not be possible for heart function to be restored in another body. Both Veatch and Truog misinterpret the uniform declaration of death act UDDA which precisely stated that it applies to an individual who had sustained irreversible cessation of circulatory and respiratory functions. It is not a matter of the cessation of heartbeat or cardiac function per se but an irreversible cessation of circulation in the donor. The consequence of the absence of circulation is upon the function of the brain results in an irreversible loss or neurologic function – the UDDA definition of death [Ad Hoc committee 1968 & President Commission 1981 & Delmonico et al 1999].
Bernat has written that circulation – not heartbeat – is the critical function that must be lost using circulatory-respiratory tests to determine death [Bernat 2008]. For example, we do not declare patients dead who are on heart lung machines during cardiac surgery, on ECMO awaiting heart transplantation (even if they never receive a heart), or carrying artificial hearts because, despite absence of heartbeat, their circulation remains continuously maintained. That is why the death standard requires absence of circulation. “Whether the asystolic heart is subsequently left alone, removed and not restarted or removed and restarted in another patient is irrelevant to the circulatory status of the just-declared dead patient [Norton 1992]. Removing and restarting the heart elsewhere simply has no impact on the previous death determination because that patient remains permanently without circulation in exactly the same way as if the non-beating had been left in place”. And as an everyday example after slaughtering the rooster it jumps higher and stronger as never than done in its life, this movement doesn’t indicate that he is still alive and it continues bleeding strongly indicating that the heart is still functioning, and on the opposite side the heart beating may stop spontaneously, known as cardiac arrest and attempts of rescue continue, in many cases the restitution succeed. The heart start beating again and life gets back to its normal state, moreover doctors can stop the heart for hours during the operation of the open heart, however the blood circulation does not stop, not even for seconds, therefore the heart beating does not mean life and the stoppage of heart beating does not necessarily mean death. Irreversible loss of consciousness may be due to partial or total brain injury [Shewmon 1998]. For the determination of brain death, irreversible coma must be due to injury to the brain so severe as to cause loss of brain functions
Death is when blood stop reaching the brain causing a permanent harm to the brain and leading to a permanent loss of all its functions including the brainstem functions and to diagnose death it is necessary to prove the cessation of the functions of the brain, and then brain commences disintegration and its known that many cells from a dead person remain alive after the declaration of his death. Therefore we find that the muscular cells responds to electrical stimulations and some cells within the liver continue transforming the glucose to glycogen, so cells do not die all at once, however they differ in their timing of death and perish after death of the person. We can extend the life of these cells if they are put in saline solution, especially with the flow by means of a pump hence allowing the use of organs and cell of the dead person for another patient needing them, the death is a process and not an event.
Brain death can be defined as follows: When the brain is damaged, and its activities completely cease, brain death is present, even if it is possible for the patient to be kept breathing and his heart is beating with artificial respiration and medications; even if the heart and liver are functioning that is not live it is just artificial. The consideration of legality of brain death as “true death” was first considered in the early 1960’s; with the 1968 Harvard report becoming the “standard” definition of brain death. the majority of countries and international professional associations have accepted it.
5.1. Islamic opinion
The majority of Muslim jurisprudents consider organ transplantation to be permissible on the basis of principles that needs of the living outweigh those of the dead. Saving a life is of paramount value in Islam as the following verse from the Quran illustrates “And if any one sustains life, it would be as if he sustained the life of all mankind” [Ebrahim 1995 & Ebrahim 1998 & Van Bommel 1999 & Al Faqih 1991]. The Islamic jurisprudence Assembly Council in its meeting in Saudi Arabia on Feb 6-11, 1988 ratified resolution number 26.1.41 declared the following fatwa the permissibility of proxy consent: “Transplantation of an organ of the dead to a living human being whose life or essential function of the body would rely on the donated organ is allowed, provided that the dead (before his death) or his heirs permit it. Shiite scholars have made similar rulings. The majority of Shiite jurisprudents confirm organ transplantation especially when human life is at stake.[Moqaddam 2000 & Ghods et al 2006 & Zargooshi 2008].
Ordinarily, the dead have a right in Islam to the sanctity and wholeness of their body, but as we have already noted, the need to save a life overrides this injunction as it has a prima facie importance in the mundane affairs of mankind. While saving a life is of paramount importance in Islam, the family of the deceased must consent and there are in no way obliged to consent to organ donation even if it involves the death of another person who is alive but gravely ill. It has been reasoned that the “ownership” of organs, like that of property, is relative and subjective because God is the ultimate “owner” of the universe having created it. Therefore, it would be permissible to donate them because God had placed great value on saving a life.
5.2. Church opinion
In the address of pope John Paul II to the Transplantation Congress in Rome in 2000, regarding the determination of death, he said …”it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of the unitary and integrated whole that is the personal self”. And that “it is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio respiratory signs to the so-called neurological criterion. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity” [Abouna 1984 & Pope John Paul II 2000].
6. Brain death is death
6.1. Misuse of terminology
Patients who fulfill the brain function criterion for death are commonly said to be ‘brain dead’. This term, unfortunately, suggests that there are two ways of being dead, being ‘brain dead’ and being ‘really dead’. The term ‘brain death’ is also used, incorrectly, in other contexts to describe much lesser degrees of neurological dysfunction than it strictly implies. This misuse of the term is to be found in the medical and related professions as much as in the general public. It has lead to confusion surrounding the idea of a brain function criterion and its relation to ‘brain death’. It may be that it is too late to reclaim the term for its legitimate use. Whenever it is used, it is important that it is sufficiently qualified to ensure that its meaning is clear, and professional medical bodies may have a role to play in encouraging correct application of the term.
6.2. Explaining brain function criterion to the family of the deceased donors
Even apart from confusion over the use of the term ‘brain death’ it can be very difficult for families to fully understand the reality of death based on a brain function criterion. To casual observation, patients fulfilling the brain function criterion for death appear to be sleeping rather than dead. The skin is warm. The chest rises and falls with mechanical ventilation. The heart and the kidneys continue to function. There are even reports that pregnancy may be maintained in patients fulfilling the brain function criterion for death. This ambiguity is reflected in the way medical and paramedical staff relates to the beating-heart cadaver in the period before organ donation. Nurses will often talk to such a cadaver as they carry out their nursing care as if the body retained the ability to hear. Acceptance of death by the brain function criterion in the context of organ donation asks much more of a family than does the same diagnosis with a view to cessation of treatment. Community education programs might go part way in helping families understand the issues involved. Detailed explanations with appropriate written material should be provided. Practitioners dealing with families should be trained in the process of explaining the brain function criterion and in grief counseling in general. Families should be provided with the opportunity to ask relevant questions and to have their questions answered in a genuinely sympathetic environment. Sufficient time should be provided to ensure that families really understand the brain function criterion before the issue of organ donation is broached. Families should then be allowed whatever time and assistance are necessary to make a decision concerning organ donation and then to deal with the particular grieving problems over the ensuing days and weeks. They should be offered the opportunity to view the body after the retrieval process has occurred when it has the appearance of being dead [Shemie et al 2006 & Delmonico et al 1999 & Norton 1992].
6.3. Deciding to donate or not to donate organs after death
The main reason why people may consider donating organs is because of the very great benefit that this can bring to others. Organ transplantation may be a lifesaving treatment for patients with liver or heart disease, and it may be the only hope of treatment there is. For kidney patients, having a transplant can mean being able to cease, and this can bring a great improvement in health and lifestyle. For instance, it may enable a kidney patient to return to the workforce, or to work longer hours, and it can even mean that a woman can now have a baby. The transplantation of a cornea can give someone back his or her sight [Ehtuish et al 2006 & Abouna 1998 & Hunsicker 1999 & Alashek et al 2009 & Cohen et al 1995]. Transplantation is generally a very successful procedure. The success rates of transplantations vary, but in all cases these have increased considerably since transplantation first began (Fig. 4b). It can be difficult in medical science to predict which procedures will become more successful and eventually routine. However, kidney transplantation is now considered to be accepted medical treatment and this is likely to happen in other areas of transplantation. Some people decide not to donate organs because they are not confident that donation would be in accordance with their dead relative’s wishes. Some people think that transplantation is a very costly procedure from which relatively few people benefit. If you believe that your family may gain some comfort from donation, this may be a reason to consider it for yourself. On the other hand, if you feel that your family may be upset about donation, you may decide against it. This shows the importance of discussing donation with your family. You need also to bear in mind that the people who donate organs are mostly those who have died suddenly and unexpectedly and they are often quite young. For the families of these patients, death may be especially traumatic. When deciding about donation for yourself before death, you may begin by thinking of how you would feel if you were in the position of needing lifesaving organ or tissue transplantation. In making your decision, you also may feel, for instance, that you no longer need your body, and would like to feel that you had done something to help others. Or you may feel that it is important that your body remains intact for burial or cremation. If you belong to a religious faith, you may want to consider how organ donation and transplantation is understood from that religious point of view. Indeed you may wish to consult a religious advisor on the appropriateness of organ donation in your particular circumstances.
6.4. Making a decision when a relative has died
Deciding about organ donation on behalf of a loved relative who has just died may be a very difficult decision to make. Often the relative’s death will have been the result of a traumatic event such as a car accident or a head injury. This makes the death an especially sad one for family and friends, means that people are asked to make a serious decision at a difficult, stressful and emotional time. You may feel shocked, bewildered, angry, and numb [Norton 1992]. But, for practical reasons, if organ donation is to occur, it must take place within a certain time period: so there will be only a limited time in which to make this decision. The difficult circumstances in which the decision has to be made make it all the more important that you are well-informed and that you feel confident that you have considered the matter as fully as you wish. Families are greatly assisted in their decision-making at a time of crisis if they have previously discussed organ and tissue donation and the wishes of individuals are known. There are three scenarios that need to be considered: (1) Your relative dies having made known his or her wish to donate organs after death: in this case the family is consulted in order to clarify what the person’s wishes were in relation to organ donation and to see whether the family has any objections to the deceased’s wishes being acted on. Donation will not proceed in the face of objection from families. If you know that your relative wished to donate his or her organs and/or tissues, this may provide you with a substantial reason for you to consent to the request for donation. Islamic religion respect the intestate and wishes of the person before he died and the relatives are obliged to implement the intestate that is clear in many verses in Quran. (2) Your relative dies having made known to you his or her wish not to donate organs: in this case, made this known to hospital staff and organ donation will not be discussed further. (3) Your relative dies and either had no views about organ donation (as in the case of a young child) or had not made his or her views known to you: in this case the hospital authorities will consult the family to find out whether anything is known about the deceased person’s wishes and/or to find out whether the family will consent to donation on behalf of their deceased relative. One thing that you may like to do in this situation is to make a judgment based on your knowledge of that person. What was his or her attitude to transplantation: had he or she ever shown any sign of being in favor or against it? What were his or her beliefs and feelings about the body and about how it should be treated after death? Was he or she the kind of person who would want to help others? Would he or she have been likely to have discussed organ donation with someone outside the family? It is professional practice not to pressure people in any way. The decision that you have to make is not a purely rational or ‘head’ decision but also an emotional or ‘heart’ decision. You may need time to come to terms a little more with the emotional significance of events, may be to accept that your relative really is dead. You may wish for time to imagine how you may feel afterwards, whatever decision you make; and how others in your family may feel. You may feel you need time alone, or time with just your family [Evans 1993 & Courtney et al 2009].
6.5. Some key questions you might consider in case of organ donation
Do I think that donating organs and/or tissues for transplantation (or other purposes) is a worthwhile cause? How would I feel if I needed a transplanted organ? How does organ donation fit with my religious, spiritual and moral beliefs? How would I feel if a friend or relative needed an organ? What do my other family members think about organ donation? Have I made my wishes about organ donation known to my family? If I decide I want to donate organs, how will this affect my family? Am I satisfied that I understand the concept of ‘brain death’ as a way of determining death? Do I feel that I could trust the medical staff involved if I were ever in a situation to be a potential organ donor? How do I think of my body after death? Are there some organs I would like to donate, and not others? Will my family try to carry out my wishes? Will counseling be available for my family if they need it? Am I satisfied that respect will be shown to my body? Are there other people I would like to consult? [Miranda et al 1998 & Jasper et al 1999 & Cameron et al 1999 & Cohen et al 1995]
7. Entry of patients to transplantation programs
Decision-making becomes necessary at two stages of the process of organ and tissue allocation. The first stage deals with those considerations which should be taken into account in deciding on the identity of the individual patients to whom offers of transplants are to be made. Decisions of this type, by reason of the technical details involved, will remain a responsibility of medical personnel. Entry to, and exclusion from, a transplantation program both raise ethical issues.
Entry to a program is offered following assessment of patients by the program personnel. Exclusion criteria include age restrictions, abnormalities in other organ systems, previous history of malignant disease and other medical considerations. In making decisions about which patients are to be admitted to a program, there is merit in more than one medical practitioner being involved.
The second stage of decision-making relates to whether an individual chooses to become a transplant recipient. This is a decision to be made by the patients in the light of advice received from their medical attendants and consultation with their families. Acceptance of the offer requires an informed decision on the part of a patient and/or their family. Prior to this decision, a patient should receive a full description of what is entailed in being in the program, what procedures can be expected and their possible risks and benefits. On the other hand, if a patient is excluded from a transplantation program, he or she is entitled to know why? [Turcotte et al 1989].
In an attempt to ensure that transplanted kidneys have the best outcome possible for individual patients, concurrent medical conditions that introduce a potential risk following transplantation should be managed before acceptance on to the waiting list, If a pre-existing condition is likely to be affected adversely by the ongoing immunosuppression required after transplantation (for example, immunosuppression increases the risk of recurrence of cancer and of persistence of chronic infection) a patient may be excluded from transplantation in his or her own interest. Though some may think it is unfair to deny a patient the opportunity to receive a transplanted kidney because of renal disease which could recur in the graft, others might consider it unreasonable to inflict repeated transplantation when there is a high risk of rejection. In rare circumstances, the kidney allocation system may be suspended to provide an organ for transplantation to a critically ill patient. To ensure fairness in allocation, the selection criteria and weighting of different criteria are subject to repeated review by personnel from all institutions involved in renal transplantation.
7.1. Factors influencing entry to, and ranking in, a transplantation program
- The patient sickness.
- The patient most likely to benefit based on medical or other criteria.
- The length of the patient on the waiting list.
- All patients on the waiting list should have an equal chance.
- The patient’s importance for the well-being of others, for example previous organ donors.
- The patients who have previously had one or more transplants.
- Capacity of the patient to pay.
The allocation of kidneys occurs under circumstances not paralleled in the case of other organs because candidates for transplantation are drawn exclusively from patients already within a dialysis program. This introduces the difficulty that, whereas selection to receive a kidney is determined by clearly defined and promulgated criteria that are uniformly applicable nationally, selection to enter dialysis programs is affected by a variety of sets of guidelines. In some cases uniform criteria for entry to dialysis are being formulated. However, in other instances, individual clinics have their own guidelines, not all of which are readily available. This lack of transparency precludes ethical assessment of the procedures employed and this should occasion concern: it is an ethical issue in itself. As kidneys can be preserved safely by simple cold storage for at least twenty-four hours, the results of a blood T-cell cross match and tissue matching can be available before transplantation is undertaken. Because of the length of waiting lists, several potential recipients are commonly equally well matched with each presenting donor. Allocation of kidneys should be organized on a national basis so that recipients with the closest tissue matching with the donor are selected to receive the organs. This provides the best chance of success. Currently, kidneys are raised by allocation of transplant resources allocated to potential recipients according to the best available tissue match. If there are no suitably matched potential recipients on the national waiting list, the length of time on dialysis usually determines the recipient. Factors such as recipient age, period on dialysis, pre-sensitization to tissue antigens, presence of diabetes mellitus and the previous receipt of a transplant are likely to be taken into account.
The concept of distributive justice – how to fairly divide resources – arises around organ transplantation. Distributive justice theory states that there is not one “right” way to distribute organs, but rather many ways a person could justify giving an organ to one
Particular individual over someone else. Equal access criteria include [UNOS 2001]:
- Length of time waiting (i.e. first come, first served)
- Age (i.e. younger to younger, older to older or youngest to oldest)
- Organ type, blood type and organ size
- Distance from the donor to the patient
- Level of medical urgency
Successful transplants are measured by the number of life years gained. Life years are the number of years that a person will live with a successful organ transplant that they would not have lived otherwise. This philosophy allows organ procurement organizations to take into account several things when distributing organs that the equal access philosophy does not – like giving a second organ transplant to someone who’s already had one or factoring in the probability of a successful medical outcome.
Three primary arguments oppose using the maximum benefit distribution criteria. First, predicting medical success is difficult because a successful outcome can vary. Is success the number of years a patient lives after a transplant? Or is success the number of years a transplanted organ functions? Is success the level of rehabilitation and quality of life the patient experiences afterward? These questions pose challenges to those attempting to allocate organs using medical success prediction criteria. The second argument against maximum benefit distribution is that distributing organs in this way could leave the door open for bias, lying, favoritism and other unfair practices more so than other forms of distribution due to the subjective nature of these criteria. Third, some ethicists argue against using age and maximizing life years as criteria for distributing organs because it devalues the remaining life of an older person awaiting a transplant. Regardless of how old someone is, if that person does not receive a transplant they will still be losing “the rest of his or her life,” which is valuable to everyone.
9. Organ trafficking
Organs trading
The transfer, traveling, hosting, receiving living or deceased persons, or their organs, through threat, by force or any other forms of oppression or kidnapping or fraud, or deceit, or misuse of power or position, mis-receipt by a third party of money or subsidies submitted to oppress the contingent donor and use him as an organ donor.
Commercialization of organs
It is the policy or conduct by which the organ is dealt with as if it is a trade goods, including their purchase, sale or use for material gain.
Travel for organs transplantation
It is the travel of organs, donors, recipients or professionals of organs transplantation over the international borders for purpose of organs transplantation.
9.1. Methods and means used for organ trafficking and transplant tourism
The donor, recipient and surgeon may be of the same country. The agreement may be done before they get to the surgeon. The donor and recipient may travel to the country of the surgeon. The patient may travel to the donor country and vice-versa. The donor may be from one country, the patient from another country and the surgeon from third country, and all may travel to a fourth country to perform the transplantation
[Bramstedt 2007] Fig (8 & 9). This needs organizers and coordinators, until the matter arrived to the existence of organized gangs aiming for benefit and do not care of the donor or the patient. They are standing on extortion principle and earning profits on the account of poor people and those in need. The matter arrived to even stealing organs, yet to kidnap children and women and even men in order to get their organs for selling them to whom pays more [Fasting et al 1998].
9.2. Organ sale
Paying people to donate their kidneys is one of the most contentious ethical issues being debated at the moment. The most common arguments against this practice include:
- Donor safety
- Unfair appeal of financial incentives to the economically disadvantaged
- Turning the body into a money-making tool “commodity’
- Wealthy people would be able to access more readily
Figure 10.Kidney bazar
The drawback is that physical harm comes to one person for the benefit of another. However, this is considered an acceptable side effect because of the rule of choosing between the lesser of two maladies, i.e. one person dies and one lives, or, two people live, both with physical deformities. It is not surprising, therefore, that this practice of trading in human organs has alarmed the medical profession, the public and many governments and it has rightly been condemned by all major religions, and by most transplant societies. Organ sale has serious negative impact on all aspects and on everyone involved in the process of transplantation, including the donor, the recipient, the local transplant program, the medical profession and the moral and ethical values of the society. Most ethicists believe that organ sale is an affront not only to altruism, but also to basic human dignity as opposed to a utilitarian approach to the important issue of transplantation for the following main reasons: (a) Organ sale promotes coercion and exploitation of the poor. (b) It promotes poor quality of care to the donor and particularly to the recipient as a result of poor standards of donor selection and inadequate screening for transmissible disease. (c) It benefits ruthless entrepreneurs, greedy doctors who care for their egos and financial gain. It is also against the patient’s right for autonomy. It is contrary to accepted moral and ethical beliefs of most societies, including the major religions of Islam, Christianity, and Judaism. It diminishes the current benefit of altruistic donation by living donors and the families of cadaveric donors. It makes human organs a commodity for profit and sale thus inviting corruption and an unjust and unfair system of organ access and distribution and it predisposes to criminal tendencies of selling, kidnapping or killing children and women for organ sale, which has been reported [Spital 1997 & Danovitch et al 2006]. Some proponents of organ sale claim that well-controlled organ purchase does have several major advantages: by making more organs available it can reduce the waiting time for organs, reduce the number of deaths among waiting list patients as well as reduce the overall cost of treatment of patients with end-stage kidney disease. Some professionals in the transplant community believe that it will be much more productive as well as protective from sale of organs by vendors, at least in the developing countries where cadaver organs are not available, if the practice of organ sale is regulated by an independent organization. They argue that the feeling of repugnance of organ sale for the rich and the healthy should not justify removing the only hope for the destitute and dying. Cameron and Hoffenberg [Cameron et al 1999 & Ghods et al 2006 & Friedman 2006 & Laurance 2008] have recommended that organs be paid for through nationally established organ sharing networks to ensure the quality of care received by donors and to promote the equity of distribution which will involve the ethical and medical problems that exist with organ sale. Radcliffe-Richards et al. [Radcliffe et al 1998] have emphasized that current exploitation of donors and lack of informed consent through organ purchase are due to poverty and lack of education, which do not justify banning organ sale. They suggest that a national organization be established to regulate the sale of organs or provide educational and appropriate consultation to patients to enable them to have informed consent and even a ‘guardian’ for the donor. Also this organization will regulate and control organ vending, proper selection, payment of fees and provision of necessary care which will prevent the current exploitation, the risk of removing organs, both for the donor and the recipient, and provide screening and counseling, together with reliable payment and financial incentives [Friedman E 2006 & Friedman Al 2006 & Surman et al 2008]. They believe that this will not affect cadaveric donation, since payment can also be made to the family of the deceased. Some have proposed a market for organ donation or sale. The proponents of this model propose a legitimate governmental or nonprofit nongovernmental organization to take charge for the responsibility of compensating the donor, without any direct contact between donors and recipients. This would eliminate profit-seeking middlemen and organ brokers. While in certain instances, this practice has led to elimination of the waiting list [Matas 2008], evidence for negative impact of kidney donation for the donors have been reported. The best is to avoid people and their organs of being a commodity in the market weather it is an open black market or an organized and controlled market. In addition to direct payment, various other forms of compensation such as life and health insurance, medal of honor, reimbursement for travel expenses, compensation for time out of work, or a tax credit have been proposed. The potential problem with this model is that if it is not well organized, it will open the door to an organ market, where the organs are sold to the highest bidder, benefiting the rich and disadvantaging the poor [Chapman 2008 & Godlee 2008 & Thomas 2000]. Concern has also been raised that this will reduce altruistic kidney donation and discourage deceased multi-organ donation. However, some believe that it does not preclude increased donation, and others have shown that it has not inhibited the establishment of deceased donor transplantation programs. Opponents to any form of compensation and an organ market cite the concern that the poor will be viewed as mere providers of spare parts and will live with fewer organs, adding to this their list of disadvantages. According to this viewpoint, the market will be driven by poverty and the poor will be a disadvantage compared to the ealthier, feeling a disproportionately higher pressure to sell their organs Fig (11). On a global scale this could translate into people from rich nations travelling to poor countries to buy organs. There is the concern that the market could potentially lead to demeaning bodies to “articles of trade”. Degrading human relationships, and particularly damaging the altruistic bond. There is also the concern about the occasional coercion of a spouse by an addicted spouse into selling an organ to pay for the addiction.
With related donor transplantation, altruism is the expected driving force; however, regarding unrelated donors, several valid question have been raised. Why should the unrelated donors not be at least partially rewarded for their donation? Why should they be expected to undergo the surgery and live with one less organ for the rest of their lives? Are the other parties involved (physicians, surgeons, nurses, etc,) providing their services only altruistically? Why should the only individuals sacrificing their bodies not be appropriately acknowledged? Although current laws in most countries and guidelines by WHO and professional societies prohibit the sales of organs, it has been debated that provision of financial incentive seems not only fair, but may also encourage donation and subsequently benefit the patients on the waiting list [Novelli et al 2007 & Satel et al 2008 & Kranenburg et al 2008]. The main opponents of providing financial incentives have voiced concern over “devaluing” the body to a mere commodity and the potential for commercialization. Some would argue that the body is a property and, in fact, the most valuable commodity that an individual possesses. They would contend that the owner of this property has a right to sell part of it for his/her better good.
There is little doubt that commercialization of organ donation is fraught with drawbacks, dangers and potential immoral consequences. On the other hand, it is clear that efforts to increase the rate of organ donation through education have failed and sole moral incentives have not worked [Delmonico et al 2008 & Colakgin et al 1998 & Prasad et al 2006]. Organs are currently limited by supply, and in the hope of expanding the available organs, it seems prudent to provide incentives not only to encourage donation, but also in order to express appreciation. In the process, we should be cognizant of the fact that we might be sacrificing some good for the sake of other potentially more meritorious goods, weighing the ethical and morals risks of one against the other. The obligation of society is to establish safeguards to protect all parties involved, as well as the humane inter-relationship between donor and recipient. In this regard, the method of acknowledging the good deeds of donors is of paramount importance.
It is clear that we need to look for feasible, ethical alternatives to the current model. This is not limited to whether or not donors should be compensated. Now that living unrelated transplant (LURT) has become an ever increasing reality Fig (12). Society and the transplant community should devise safeguards to scrutinize the process [Matas 2007 & Chapman 2008 & Godlee 2008 & Novelli et al 2007 & Satel et al 2008 & Kranenburg et al 2008 & Leung 2006].
10. The struggle against international organ trafficking
The antimarket campaign could change things. To be able to do so, however, it needs to embrace a strategy combining new discursive and practical elements.
The campaign against transplant commercialism could be coherent and possibly successful only if it explained that the suffering-preventing capacity of a kidney disease-free and poverty-free world is considerably greater than that of any regulated market in organs [Danovitch et al 2008 & Turner 2008].
10.1. WHO guiding principles for cell, tissue and organ transplantation
WHO has condemned the commercialization of organs in several occasions, starting from the decision of the General assembly No. 40.13 in year 1987 and No. 42.5 in year 1989, and requested the countries to consolidate efforts to implement the decision, then the decision No. 44.25 for the year 1991 which has adopted the first draft of the WHO guiding principles regarding the human cells, tissues and organs transplantation, and which has contoured the methodological and ethical standard framework.
Among the most important recommendations issued by the general assembly, are those issued in its fifty-seventh session (decision 57.18) in may 2004, where the organization has required from the member countries the necessity of existence of an actual supervision on the organ transplantation, and promotion of both living and deceased donation, and to take the necessary measures to protect the poorest and exposed to the organs transplantation tourism. In year 2008, the guiding principles of the WHO have been updated regarding the human cells, tissues and organs transplantation [WHO 2008]. They were adopted by the executive council in its session held in November 2008 these guidelines are.
- Consent for deceased donation
- No conflict between physicians determining death
- Deceased but also live consenting donors
- Minors and incompetent persons be protected
- No sale or purchase
- Promotion of donation no advertising nor brokering
- Physician responsibility on origin of transplant
- Justifiable professional fees
- Allocation rules
- Quality safety efficacy of procedures and transplants
- Transparency and anonymity
A group of meetings were held by the WHO joined number of scientists and international and national organizations in order study the challenges facing human cells, tissues and organ transplantation. Open consultations were done in Karachi, Geneva and Madrid, different experts were invited The purpose of all such consultations is to determine the problem about such a matter and also to extract preparatory ideas in order to make them implemented and to encourage countries to have national or regional strategies for self sufficiency by promoting both living and deceased donation and to cooperate towards organ trafficking free world. They urge the need for an international binding treaty to regulate transplantation and to combat organ trafficking [Carmi 1996]. Fig (13)
Figure 13.
10.3. Amsterdam forum on the care of the kidney donor: Data and medical Guidelines
Kidney and transplant surgeons met in Amsterdam. The Netherland, from April 1-4, 2004 for the international forum on the care of the live kidney donor. Forum participants included over 100 experts and leaders in Transplantation representing more than 40 countries from around the world. The Forum analyzed the sentinel events associated with live kidney donation; the data emphasized the extremely low Operative mortality rates and the long-term safety of this procedure. Forum participants affirmed the necessity for live donors to receive complete medical and psychosocial evaluation prior to donation. A great detail of discussion focused on prevention of transmissible infectious diseases through live kidney transplantation [Delmonico et al 2007].
10.4. Lisbon conference for the care of kidney transplantation recipients in February 2006
An international conference about the care of the kidney transplantation recipients, held in Lisbon, Portugal, February 2nd-4th 2006, with the cooperation between the WHO and different international and national societies of organs transplantation. The conference has joined more than 100 experts and leaders in organ transplantation. It represents more than 40 countries from all over the world. The conference aimed to determine the main issues and to set recommendations to improve the outcome of kidney transplantation all over the world [The Consensus Statement of the Amsterdam Forum 2004].
10.5. Asian campaign against organs commercialization
A meeting was held in Taipei – January 2008, About the immoral and unfair practices related to the organs transplantation in Asia by local citizens and by others from other areas. The recommendation of the Asian campaign stressed the importance of collective measures against organ trafficking [Bagheri 2005].
10.6. Istanbul declaration
An international summit was held in Istanbul on May 2nd 2008, joining more than 150 representatives for medical professional, governmental and non governmental organizations, and transplant societies from 78 countries and 20 international organizations, The meeting was organized by The Transplantation Society (TTS) and the International Society of Nephrology (ISN). The recommendations of Istanbul Declaration have added very important dimensions to the international standards of organ transplantation and emphasized the encouragement of living and deceased donation and stressed on the living donors care and to view their act as a championship as they are sharing in the Gift of life and the necessity to evaluate the donors medically and psychologically before and after donation [Steering Committee of the Istanbul Summit 2008]. The declaration was centered on Organ commercialism, which targets vulnerable populations (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) in resource-poor countries, has been condemned by international bodies such as the World Health Organization for decades. Yet in recent years, as a consequence of the increasing ease of Internet communication and the willingness of patients in rich countries to travel and purchase organs, organ trafficking and transplant tourism have grown into global problems.
The Istanbul Declaration proclaims that the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad. Moreover, transplant tourists risk physical harm by unregulated and illegal transplantation. Participants in the Istanbul Summit concluded that transplant commercialism, which targets the vulnerable, transplant tourism, and organ trafficking should be prohibited. And they also urged their fellow transplant professionals, individually and through their organizations, to put an end to these unethical activities and foster safe, accountable practices that meet the needs of transplant recipients while protecting donors.
Countries from which transplant tourists originate, as well as those to which they travel to obtain transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop national self-sufficiency in organ donation. The Declaration should reinforce the resolve of governments and international organizations to develop laws and guidelines to bring an end to wrongful practices. “The legacy of transplantation is threatened by organ trafficking and transplant tourism. The Declaration of Istanbul aims to combat these activities and to preserve the nobility of organ donation. The success of transplantation as a life-saving treatment does not require—nor justify—victimizing the world's poor as the source of organs for the rich” [Epstein 2008]
10.7. Madrid conference March 23th-25th, 2010
A conference was held in Madrid. It has concentrated about the self-sufficiency of organs for each country or region. The conference has recommended the necessity to set national plans and strategies to promote the donation of organs from deceased and living persons, arriving to the self-sufficiency and to fight, struggle and limit organ trafficking and transplant tourism.
10.8. Global leadership symposium on organs donationDuring the period May 10th-13th, 2010, the global leadership symposium on organs donation was held in California. It was attended by a lot of workers in the promotion of organs donation and a number of the international experts in the organs donation and transplantation and ethicists from several countries to more support the organs donation and fight organ trafficking.
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OH, but in global Wall Street health systems it does justify victimizing the world's poor as a source of tissue and organs for the rich-------it does here in BALTIMORE.....again, if you are a race and class citizen not caring if these CRIMES AGAINST HUMANITY come to the US----one better wake up to the fact that our children and grandchildren will be those 99% extreme poverty ---if their skin or blood type are right watch out! There is a global 1% and their 2% looking for that BODY PART. This was the goal of Clinton/Bush/Obama's privatization and deregulation of our strongest in the world public interest health care and the media has us listening to garbage about a Trump saying mean things to a disabled person.
'The success of transplantation as a life-saving treatment does not require—nor justify—victimizing the world's poor as the source of organs for the rich” [Epstein 2008]'
The hundreds of billions of dollars stolen in fraud from our Federal health structures were used to expand health corporations globally----global Johns Hopkins was the worst of offenders in this. Bringing Western health industry technology to Foreign Economic Zones not a bad thing if it brought US standards of care and human rights but as with everything in Foreign Economic Zones overseas----the point of US corporate expansion overseas was to ignore all Western laws and morals. Asian and Latin American nations having Foreign Economic Zones have been battling these few decades the most profitable of health care procedures-----TISSUE AND ORGAN TRANSPLANT PREDATION. The Asian market didn't just occur while GOOD GLOBAL WALL STREET PLAYERS tried to stop this-----it was driven by global Wall Street players corporations getting rich.
We have cases of illegal tissue and organ harvesting RIGHT HERE IN BALTIMORE-----and indeed it is crimes against humanity.
An organ is sold every hour, WHO warns: Brutal black market on the rise again thanks to diseases of affluence
By Damien Gayle
Published: 00:52 EST, 28 May 2012 | Updated: 04:07 EST, 28 May 2012
Desperate: An Indian woman shows the scar from where she sold her kidney in a black market transplant op
An organ is sold once an hour, the World Health Organisation has warned, amid fears that the illegal trade is again on the rise.
The U.N. public health body estimates that 10,000 organs are now traded every year, with figures soaring off the back of a huge rise in black market kidney transplants.
Wealthy patients are paying up to £128,500 for a kidney to gangs, often in China, India and Pakistan, who harvest the organs from desperate people for as little as £3,200.
Eastern Europe also has a huge market for illegal organ donation and last month the Salvation Army revealed it had rescued a woman brought to the UK to have her organs harvested.
With kidneys believed to make up 75 per cent of the black market in organs, experts believe the rise of diseases of affluence - like diabetes, high blood pressure and heart problems - is spurring the trade.
The disparity of wealth between rich countries and poor also means there is no shortage of willing customers who can pay a premium - and desperate sellers who need the cash.
Dr Luc Noel, a WHO official, told The Guardian: 'The stakes are so big, the profit that can be made so huge, that the temptation is out there.'
The WHO does not know how many of the 106,879 known transplant operations in 2010 were performed with illegally harvested organs, but Dr Noel believes the figure could be as high as 10 per cent.
A lack of law enforcement in some countries, and an inadequate legal framework in others meant that the traffickers urging poor people to part with an organ have it too easy, said Dr Noel.
A medical source with knowledge of the situation in China told the Guardian anonymously that rich foreigners mainly from the Middle East and Asia are the usual customers.
'The stakes are so big, the profit that can be made so huge, that the temptation is out there' Dr Luc Noel, WHO official'
While commercial transplantation is now forbidden by law in China, that's difficult to enforce; there's been a resurgence here in the last two or three years,' he said.
He added that some of China's military hospitals are even believed to be carrying out the operations.
Jim Feehally, professor of renal medicine at University Hospitals of Leicester NHS Trust, said that the key issue was one of exploitation, with poor donors often left with no medical care to recover from the brutal operations.
'The people who gain are the rich transplant patients who can afford to buy a kidney, the doctors and hospital administrators, and the middlemen, the traffickers,' he said. 'It's absolutely wrong, morally wrong.'
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THE AFFORDABLE CARE ACT is that deregulation and globalization of health care that brings this morality to our US health care structures and the global Wall Street CLINTON/BUSH/OBAMA 5% TO THE 1% KNOW THIS. That was the primary objective of ACA----deregulating, consolidation, dismantling of all oversight and accountability so US cities deemed Foreign Economic Zones could have global health corporations and medical research operate in the US as it has overseas-----lying, cheating, stealing, no morals, no ethics----far-right wing PRAGMATIC NILISM-----do anything for profit.
US academics have watched this past decade as cases in the US of illegal tissue and organ harvesting often by our own local public health departments working in tandem with global health corporations. Sadly it is those once best in public interest health institutions----our public university and private university medical schools and hospitals that have been corporatized under CLINTON/BUSH/OBAMA that are now part of this problem. If a US city has a BALTIMORE PUBLIC HEALTH OR MARYLAND DEPARTMENT OF HEALTH AND HUMAN SERVICES that is corporate------working to expand health industries and profits-------those public health agencies are not providing oversight and accountability for public interest ----they are SEEING NO EVIL----HEARING NO EVIL----SPEAKING NO EVIL regarding how health industry profits are being made.
Keep in mind most former US corporations have been gutted, sent into bankruptcy, rebuilt by being enfolded into global 1% corporations and these several years this consolidation is now mostly tying all global corporations to GLOBAL HEDGE FUNDS------our local senior care facilities are tied to GLOBAL HEDGE FUNDS-----wonder what profit-making policies come with SENIOR CARE?
Profits Soaring After Disgrace at Cohen’s Hedge Fund
By
Matthew Goldstein
July 29, 2014 5:41 pm July 29, 2014 5:41 pm
PhotoSteven A. Cohen, the founder of the family office Point72 Asset Management, at a New York Knicks game last year.Credit Justin Lane/European Pressphoto Agency
Updated, 8:38 p.m. | Three months after his once-powerful hedge fund entered a guilty plea to insider trading charges, Steven A. Cohen is doing quite well.
This summer, Mr. Cohen and his family rented a yacht off the Greek islands for a vacation. An avid art collector, Mr. Cohen attended Art Basel in Switzerland in June. And last weekend, he and his wife, Alexandra, were guests at a charitable event at the Hamptons home of the comedian Jerry Seinfeld and his wife, Jessica.
Most of all, Mr. Cohen, 58, is continuing to do what he has done best for more than two decades: make an astounding amount of money from trading stocks and bonds.
His renamed firm, Point72 Asset Management, which manages $9 billion to $10 billion of his personal fortune, is proving to be nearly as profitable as his former hedge fund.
Over the first six months of this year, the firm generated a profit of nearly $1 billion, said two people briefed on the matter. In 2013, SAC Capital Advisors’ last year as a hedge fund, Mr. Cohen personally made about $2.3 billion.
Funds play health care mergers; sell media companies and large financial institutions
By FactSet Insight | Aug 19, 2014
The 50 largest hedge funds significantly increased their equity exposure (+9.8%) in Q2 2014 in the wake of M&A activity in the Health Care sector. Four of the top ten equity additions were health care stocks involved in significant merger discussions—Allergan, Actavis, Covidien, and Questcor Pharmaceuticals.
Allergan, which was in the midst of acquisition negotiations with Valeant Pharmaceuticals International during the second quarter, was the funds’ top purchase by far. The market value purchased in the global health care company amounted to nearly three times that of the next most popular purchase ($7.4 billion versus $2.8 billion for Apple), and the stock’s exposure in the portfolio of the fifty largest hedge funds grew nearly 600%. The largest contributor to this trend was Pershing Square Capital Management, which took a 10% stake that amounted to nearly two-thirds the aggregate hedge fund portfolio’s increased exposure in the stock. Other funds that made significant purchases in the biopharmaceutical company included Paulson & Co., Mason Capital Management, and OZ Management.
The next largest purchase was Apple. The funds’ managed to show impressive quarter-over-quarter growth in the stock (+27%) despite a high ownership baseline (Apple was the second largest holding in the aggregate portfolio at the end of Q1). By the end of Q2, Apple was the largest holding in the aggregate portfolio, and its exposure comprised 1.6% of all equity holdings. However, Apple has been a stock that has shown a lot of turnover in the portfolio, and more funds listed Apple as their largest quarterly equity sale (4) than those that listed it as their biggest purchase in Q2 (3).
Actavis received the third largest increase in exposure at $2.2 billion, which represented 23% growth from Q1. The integrated pharmaceutical company was also affected by its widespread popularity, and consequently surpassed Apple to become the most widely held of any stock in the portfolio (29 funds hold Actavis compared to 28 for Apple). In addition, Actavis is the largest holding of four funds, which matches the number of funds that are anchored by Apple. Shortly after the end of the second quarter, Actavis closed the acquisition of Forest Laboratories.
On the other end of the spectrum, individual funds sold large interests in International Paper, Micron Technology, and several large financial institutions and media companies in Q2. International Paper received outflows from many funds in the wake of continued underperformance over the past year. Micron Technology, on the other hand, was the second largest sale of all equities despite outperforming the S&P 500 by significant margins. Top shareholders Greenlight Capital and Discovery Capital Management have been paring exposure to the semiconductor company over the last six months.
In addition, systematically important financial institutions (as designated by the Financial Stability Board) on the list of the top fifty equity holdings were pared in Q2. The exposure of JPMorgan Chase, Citigroup, and AIG in the aggregate hedge fund portfolio fell 15%, 5%, and 8%, respectively.
Another interesting trend in Q2 was the funds’ bets towards cable providers and away from media content companies. The funds added exposure to Comcast (+12%), Time Warner Cable (+10%), and Charter Communications (+10%), but Twenty-First Century Fox, Walt Disney Company, and Time Warner Inc. were among the funds’ three largest sales. Shortly after the end of the second quarter, Twenty-First Century Fox announced an unsuccessful bid to acquire Time Warner Inc. (the offer was cancelled on August 5th). Meanwhile, Netflix showed a 9% increase in exposure in the fund portfolio.
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For several decades of transplant medicine and advancement there have been very STRICT HUMAN RIGHTS/PATIENT RIGHTS and equity in how this process unfolds. Since access to health care was open to all there was no pressures to DONATE ORGANS OR TISSUES if it was against a personal, religious, or family belief. Pragmatic nilism------that far-right wing anything for profit philosophy says------hey, we're saying a human life here----you have two kidneys---two eyes-----you have a big liver that can be taken to half-----GIVE IT UP for that global 1% and their 2% ----
GOD WANTS IT THAT WAY SAY PRAGMATIC NILISTS.
Our US regulations, laws, morals and ethics protected against these kinds of abuses. Organ transplant was done by list---first come first serve whether you were poor or rich. Donation was encouraged not required ------a patient was not held captive to receiving ordinary hospital treatments to donating tissue or organs.
THAT IS WHAT HAS BEEN HAPPENING ACROSS THE US AND IT IS NOW GROWING AND GROWING ---AS ARE THE BLACK MARKET ORGAN HARVESTING SEEN IN DEVELOPING NATIONS WITH FOREIGN ECONOMIC ZONES.
What was a great opportunity to help another WE THE PEOPLE----has now become predatory and slowly mandatory excluding 99% of citizens not able to afford the right health plan or pay the costs of procedures. If you have a plan that will allow this today-----watch out as these health insurance plans start excluding MOST ORDINARY HOSPITAL CARE.
We want to emphasize---this article states doctors should make these transplant decisions not the courts----but ACO MANAGED CARE HEALTH SYSTEM CORPORATIONS are taking that control from our doctors and giving that power to global health organizations filled with corporate executives-----
Organ transplant decisions should be made by doctors, not courts
June 13, 2013|By Carla Hall
Sarah Murnaghan, center, celebrates the 100th day of her stay in Children's… (Handout )It’s wonderful that the 10-year old suburban Philadelphia girl in need of a lung transplant whose plight became national news was finally able to get one on Wednesday. “God is great! He moved the mountain!” exclaimed Sarah Murnaghan’s mother, Janet Ruddock Murnaghan, on her Facebook page.
Actually, it was her parents who took her case to court and a federal judge who moved the mountain. The judge ordered that Sarah, as well as an 11-year-old boy waiting for lungs at the same hospital, be allowed to compete for them on an equal basis with adults.
Transplantation always entails an extraordinary mix of heartache and joy. Someone must die and donate organs, so someone else gets a chance to survive. Meanwhile, people waiting for organs often die while people ahead of them on the list get organs and live.
Everyone on an organ waiting list is desperate and everyone deserves a chance. But how those chances are doled out is a complicated process, particularly with lung transplants. People waiting for lungs are grouped according to age—children under 12, adolescents, and adults—and get priority for lungs from donors in their age group. As Alan Zarembo reported in the Los Angeles Times, the rationale behind the rankings takes into account difference in lung size, different medical criteria, death rates, and survival rates.
We don’t let people buy organs and we don’t let someone’s race or religion dictate where they stand in line for them. Nor should we let the civil courts--or the court of public opinion--subvert medical decisions. As painful as it might have been, the judge should not have intervened. That doesn’t mean that people shouldn’t be thrilled that young Sarah did get an organ. We should be heartened when anyone has a successful transplant.
The methodology behind a transplant waiting list can change. (In fact, until 2005, the lung transplant list was simply first-come, first-served.) And national organ network officials are now studying whether the lung transplant list should be adjusted again. That’s fine. But who gets an organ and when must remain a decision made by medical experts.
The real way to fix this problem, of course, is to have more people designate themselves as organ donors. I confess that I am not a donor. But we should all consider it.
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We do not want to scare people from donating tissue and organs---we do want to SHOUT----THE SYSTEM IS CORRUPTED and dangerous to 99% of US citizens. It starts when the state government---Federal government decides they have control over an individual's body once they die----brain dead or no. In the past a person dies whether homeless or nameless----they were buried in POTTER CEMETERIES----then these people had their bodies donated to science------medical schools could use homeless, unidentified people as cadavers. Today, this has now moved to the tissue and organ donation circuit----and one does not have to be a rocket scientist to understand where all this leads. As far-right CLINTON/BUSH/OBAMA dismantle all our social safety net programs -----homeless shelters being closed---more and more people pushed into poverty----we are seeing policies in place that grow the predatory nature of organ and tissue harvesting and profiteering.
One needs to read these headlines ORGAN DONATIONS ON THE RISE to understand we have more people in the US dying on our streets---more low-income citizens shooting one another or police killing citizens whose lives end in our emergency rooms before they or their families have that chance to say I WANT TO BE THAT DONOR----WE WANT OUR LOVED ONE TO BE THAT DONOR. This is one step away from what has been overseas organized criminal organ harvesting for profit. Whether our public health department through deregulation weakens protections for our global health systems or whether global health systems receive organs or tissues collected illegally----
IT IS THE MOST PROFITABLE GROWTH INDUSTRY IN HEALTH CARE.
This article written in 2003 just after the Clintons spent 8 years deregulating health care---dismantling oversight and accountability ----opening the door to hundreds of billions of dollars in health industry frauds and corruption.
By Bootie Cosgrove-Mather AP August 14, 2003, 1:37 PM
Organ Donations On The Rise
organ donor card
AP CBS NEWS
Families agree to donate organs from brain-dead patients more than half the time, but that is far from enough to meet the growing need for transplants, new research shows.
Even if organs were harvested from all the potential brain-dead donors for transplants, there wouldn't be enough to go around, the researchers concluded after reviewing hospital records from around the nation.
They estimated the number of organ donor candidates each year at between 10,500 and 13,800 from the nation's 1 million hospital deaths. Previous estimates varied as high as 26,000.
There are 82,000 people on the nation's waiting list for transplants.
"It's a game of small numbers and every opportunity needs to be maximized," said Ellen Sheehy, who led the study for the Association of Organ Procurement Organizations, which represents organ banks.
The findings appear in Thursday's New England Journal of Medicine.
Thirty-six of the nation's 59 organ banks participated in the study. They checked hospital records for all patients who died in intensive care units from 1997 to 1999 to see how many met the criteria for organ donations and how many became donors.
Most transplanted organs come from patients who die because their brain stops functioning, although the number of living donors - especially for kidneys - has sharply increased.
Overall, 54 percent of families agreed to donate their loved one's organs, an increase from a consent rate of 48 percent in a 1990 study, and 42 percent actually became donors.
"One of the questions is, `Is the glass half full or half empty?"' said Sheehy. "While I think everyone agrees that there's still room to improve, the idea is not that we're going to get to 100 percent."
She said polling suggests that 75 percent of Americans would donate their organs.
The researchers also reported that consent wasn't sought for 16 percent of the patients they deemed potential donors. That has recently improved, Sheehy said, because of 1998 Medicare regulations requiring hospitals to alert organ banks of all deaths for evaluation.
There were lower rates of consent for older patients, nonwhites and those who died of causes other than trauma.
The researchers suggested that efforts to improve consent rates should be concentrated at larger hospitals since most of the candidates were found at those with 150 beds or more. One government program is compiling the best techniques from the most successful hospitals to share.
"We have to identify those people. We have to get everybody to say yes. But even then it's not going to solve the problem," said Dr. J. Harold Helderman of Vanderbilt University Medical School, who was the co-author of an accompanying editorial.
He said alternative sources of organs, including animals, have to be explored along with ways to keep people off transplant lists with better treatment for disease and anti-rejection drugs.
One potential way of increasing donations is for hospitals to follow the wishes of the patient, even if their family says no. Although some states allow it, hospitals are reluctant to do it and antagonize the family, Helderman said. That's why it is important for families to discuss organ donation and whether they'd want to be a donor, he said.
"If we're perceived as stealing organs out of patients against their family's wishes, people are not going to be organ donors," he said.
In addition to donor cards or driver's license notations, some states have started donor registries that organ banks can check. Many of the registries are too new to determine their impact on donations, said Carol O'Neill of the organ banks' association.
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During this time the UK and Scotland by extension have dismantled its UNIVERSAL PUBLIC HEALTH CARE SYSTEM-----and today it is as global corporate and profit-driven as today's US health system-----seems people didn't have that urge to donate when all the health care they needed was UNIVERSALLY ATTAINED. We will look first at the history and current organ harvesting problems done illegally around the globe and then we will look at how pressures to access ordinary hospital procedures and not being able to pay PUSH CITIZENS into donating their organs or a loved ones......
WHAT ARE THE ETHICS ON THIS? WE HAVEN'T HAD THAT DISCUSSION BECAUSE THERE ARE NO ETHICS IN GLOBAL WALL STREET FOREIGN ECONOMIC ZONES.
Remember, this tissue and organ donation today no longer goes to that citizen in our community or across the nation-----global health tourism and systems are searching for consumers all over the world.
Someone reminded me when sharing this conversation that WW 2 was famous for medical experimentation and procedures designated CRIMES AGAINST HUMANITY----because all medical ethics were supposedly suspended during times of war.
NUMBER OF ORGAN DONORS RISES BY NEARLY 100% IN SIX YEARS
New statistics show that 341 organ transplants were carried out from deceased organ donors in 2013/14; an increase of around 62 per cent since 2007/8. Similarly in this period, there has been a 96 per cent increase in the number of people in Scotland who have donated their organs after death.
In 2013-14, in hospitals across Scotland, 106 individuals and their families made the selfless decision to donate and, in doing so, transformed the lives of people on transplant waiting lists across the country.
As of 31st March 2014, 2,110,881 people living in Scotland had made their organ donation wishes known by joining the UK Organ Donor Register. This represents 40 per cent of the Scottish population and compares well against the UK average of 32 per cent.
Last year the Scottish Government published A Donation and Transplantation Plan for Scotland 2013-2020 which sets out the ways in which it hopes to improve donation and transplantation in Scotland. The plan builds on the very good progress made under the auspices of the Organ Donation Taskforce between 2008 and 2013.
Public Health Minister Michael Matheson said: “First and foremost I want to offer my thanks to every donor and every donor’s family in Scotland who have demonstrated such kindness and benevolence in the face of tragic and difficult circumstances. It is our responsibility to ensure that people’s organ donation wishes are respected and to ensure that we make every donation count.
“Over the last few years we have made important strides in raising awareness of the importance of organ donation in Scotland and have been encouraging more and more people to make their wishes known. The staff working in the NHS do a fantastic job of ensuring that those wishes are respected and as a result more and more people are able to get the life-changing transplant they require.
"It’s important to remember however that around 600 people in Scotland are still waiting for an organ and we must be doing all we can to give them hope. I’d like to take this opportunity to encourage everyone to make their organ donation wishes known to their loved ones and to join the NHS Organ Donor Register.”
By 2020 the Scottish Government aims to increase deceased donation rates to 26 per million of population. This figure currently stands at 20 per million of population, up from 17.9 in 2012/13.
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The rise world-wide in organ and tissue trafficing occurred because CLINTON/BUSH/OBAMA created conditions for US health corporations to go overseas to operate and expand developed nation health care knowing there were no human rights standards---no structures to protect patients or citizens-----what CLINTON/BUSH/OBAMA saw was a global market bringing more profits to global 1% Wall Street. That is it.
It was US health professionals and corporations bringing and overseeing health industry growth in Foreign Economic Zones----they built the hospitals----trained medical personelle---and know what? These professional medical personelle came with no history of morals and ethics around health care-----they came with only a history of doing anything for profit----and this drove the global expansion of
CRIMES AGAINST HUMANITY-----ORGAN AND TISSUE TRAFFICING AND BLACK MARKET.
As all this is happening overseas driven by global US corporations and executives in the US CLINTON/BUSH/OBAMA were filling our US Federal, state, and local public health agencies with global Wall Street players-----people willing to HEAR NO EVIL---SEE NO EVIL----SPEAK NO EVIL-----and VOILA------we see human capital not citizens having no rights if they are poor these few decades---and that definition of human capital having no rights is climbing our economic ladder soon to include 99% of Americans.
Baltimore is ground zero for weakening the ethics and morals around tissue and organ harvesting-------we do not want to see this grow.
Deliberately pushing more and more people into poverty and then telling them they no longer have access to health care----especially when we have decades of PRE-PAID MEDICARE AND MEDICAID----decades of Federal taxes paying for all the medical infrastructure, medical discoveries, medical procedures----this is why health care in the US has served ALL CITIZENS.
April 28, 2014 2
The Rise of Black-Market Organ Trafficking
By Michelle Beshears, professor of criminal justice at American Military University
According to the Department of Health and Human Service (DHHS) more than 2,000 names are added to the national waiting list for organ donations every month, which already has a waiting list of over 100,000 patients.
The need far outweighs the current supply of legally obtained organs. In fact, it is estimated that approximately 18 people die each day while waiting for an organ transplant in the United States alone. However, the issue of supply and demand for organs is not limited to the U.S. This is an international problem that stems from the fact that there are just not enough donors to supply people in dire need of a life-saving organ transplant.
The laws in the United States (as well as many countries around the globe) prohibit the sale of organs. However, these laws seem to only fuel profiteers in the black market organ trade. Many patients are willing to turn to the black market and pay big money for a life-saving organ. Why not?
In reality, the law provides little deterrent to a patient who will likely die without the organ. And, for those impoverished people around the world who are in desperate need for money, they see the selling of their organs as the answer to their prayers.
However, in reality, the real profiteers in these situations are the brokers. In many cases the organ donor is paid very little for their organ compared to what the broker makes. In addition, the facility and the professional and para-professional personnel who are involved in the harvesting of the organs make a lot of money as well.
In the United States, the National Organ Transplant Act of 1984, Pub. L. 98-507, forbids any sale of organs that affects interstate commerce with a penalty of five years imprisonment and/or a $50,000 fine. In 2000, the Trafficking Victims Protection Act, Pub. L. 106-386, was first passed and was reauthorized in 2008. However, organ trafficking is not specifically included because the Act’s primary focus is the illicit trade in sex and in illegal immigration.
The truth is that even though the U.S. Code characterizes trafficking as ‘‘a transnational crime with national implications,’’ (22 U.S.C. § 7101(b)(24) (2010)), it is rare that trafficking is prosecuted in domestic courts. This is largely due to the fact that in most cases prosecutors do not desire to prosecute the recipients or the sellers. The belief is that in most cases people selling their organs are coerced and forced to do so. However, in reality, they are often compelled to do so by their destitute circumstances. Many of the sellers are so poor that they see this as their only way to earn much needed financial resources to survive.
However, the current supply shortage of organs may extend beyond an issue of the wealthy taking advantage of the poor and impoverished. There have been recent reports of human trafficking and possible organ harvesting from unwilling victims in Mexico, the UK and China:
- In March of 2014, a Mexican cartel henchman was arrested for killing children to harvest their organs.
- In October of 2013, it was reported that a young girl was smuggled out of Somalia and taken to the UK for the purpose of removing and selling her organs to the black market.
- In August, 2013 it was reported that a 6-year-old Chinese boy was drugged and his eyes removed for their corneas.
This leads to the question of what can be done to help stop incidents of human trafficking for the purpose of illegal organ trade and/or the exploitation of impoverished people around the world?
The truth is, unless something is done the issue of a shortage of organs around the world is not going to disappear and so the market for the illegal trading of organs will continue to thrive.
Should international law enforcement agencies take a tougher stance on current standing laws? Should laws be repealed to allow for the legalization of organ trade? Is there anything more that could be done to encourage the willingness of the public to donate freely, thus eliminating the large disparity currently seen in supply and demand?
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The Affordable Care Act funds what is called END OF LIFE COUNSELING-----and indeed as this article states our medical staff are counseling for donations of tissues and organs. Before profit-driven health care when all citizens needing transplants were able to get them----these kinds of counseling structures existed. Now, we have global ACO managed health systems driven by profit owned by hedge funds with personnel trained to encourage people to donate. PROFITEERING on transplants is huge----the doctors and hospital systems doing these transplants are charging more and more and more at the same time WE THE PEOPLE are told it is our moral obligation to save the life of someone in UPPER MONGOLIA.
The waiting lists that used to exist in the US were indeed long------think about these same waiting lists today with all this health care reform making it harder for most Americans to get basic hospital care----are they really still on these transplant lists because I am reading many people have been pushed off----denied -----
The amount of Federal funding to build organ transplant transport infrastructure to US global health system tourist destinations is huge-----while the actual ability of US citizens to access transplant process is in steady decline because that funding has been cut and redirected.
Tissue donation rises as nurses focus on bereavement support
18 August 2009 By Clare Lomas
A pioneering service that provides hospital staff with 24-hour access to a bereavement and donation officer has helped to dramatically increase the number of tissue donations at a Lancashire trust.
The nurse-led service at the Royal Bolton Hospital was introduced in 2005 as part of a package of measures to help address the low rates of organ and tissue donation.
This included combining the hospital’s bereavement and donation services, setting up a corneal retrieval service, and employing four extra nurses to offer round-the-clock support to hospital staff and families of the deceased.
Tissue donation rates, such as corneas, had been relatively low at the hospital, ranging from just six in 2002 to 37 in 2005. However, following implementation of the new service, this figure leapt to 234 by 2007.
The trust looks set to achieve even greater success in tissue donation, with every ward at the hospital recording at least one tissue donor over the last 12 months. Latest figures also show 108 cornea donations already between April and early August this year.
Additionally, a trigger system introduced in 2007 – which automatically refers all potential organ donors to the regional transplant donor coordinators – resulted in 31 referrals and nine successful multi-organ donations by the end of 2008.
The team have also made amendments to the end-of-life care pathway for dying patients to make sure staff include donation in end-of-life care, and they also provide training for all hospital staff, including monthly teaching sessions.
‘The aim of the service is to change the culture around donation, and to make it a normal part of end-of-life care,’ said Fiona Murphy, lead bereavement and donor coordinator at the Royal Bolton Hospital.
‘All choices around death and dying have to be made in a timely manner, and it is vital that patients and families have clear, concise information to be able to make informed decisions,’ she added.
‘It is about giving control to families in an uncontrollable situation, and providing the same high level of care for patients and their families regardless of whether or not they donate,’ Ms Murphy told Nursing Times.
Organ donation rates in the UK are among the lowest in Europe. In 2006, the government established the Organ Donation Task Force to help identify obstacles to organ donation and plug the gap between supply and demand.
Last year, the taskforce published a set of recommendations to help meet a target of increasing organ donation in the UK by 50% over five years, including encouraging hospital trusts to develop local initiatives.
However, if organ donation rates do not increase, the government is considering changing the law on organ donation to one of ‘presumed consent’, where it will be assumed that organs and tissues can be used unless people ‘opt out’.
‘Providing everybody with the information they need to make an informed choice about donation is a real alternative to presumed consent,’ said Ms Murphy. ‘It may not work in all settings, but it has really worked for us in Bolton,’ she added.
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The American people must be aware of this--------global health tourism comes with patients from overseas----mostly the 1% and their 2% being marketed and brought to US Foreign Economic Zones on the promise of transplant tissue and organ availability------this creates the mechanism in a global Wall Street governance to have that tissue and organ availability---ergo ethics and morals around collection DECLINE OR DISAPPEAR.
Second, what used to be called a long wait list for American citizens needing transplants of all kinds no longer means that----long wait lists can mean a global citizen has contracted with a US Foreign Economic Zone global health system for a transplant need. Meanwhile, a US citizen needing that transplant today may very well be told they need to travel to Thailand---or India for that transplant. Now, knowing Asian organ trafficing is driven by these developing nation transplant corporations----HOW DOES AN AMERICAN TRAVEL TO DEVELOPING NATIONS TO GET WHAT USED TO BE TRANSPLANT WAITING LISTS HERE IN THE US?
Of course the US has always had waiting lists for transplantation and yes, many US citizen have decided to go overseas to Foreign Economic Zones to get that transplant faster-----the point is this----the pressures around the globe are now driven by a 99% of global citizens not having the money for life-saving procedures and what extent people will go to get those treatments.
The morals and ethics have never been clear in a developed nation like the US------they do not exist overseas------and now US cities deemed Foreign Economic Zones are MOVING FORWARD to operate as they do overseas.
Ethics and Organ Transplantation
Heidi WilliamsA paper prepared for "Ethics in the Health Care Professions," an undergraduate class in the Religious Studies Department of Santa Clara University
In February 2003, 17-year-old Jesica Santillan received a heart-lung transplant at Duke University Hospital that went badly awry because, by mistake, doctors used donor organs from a patient with a different blood type. The botched operation and subsequent unsuccessful retransplant opened a discussion in the media, in internet chat rooms, and in ethicists' circles regarding how we, in the United States, allocate the scarce commodity of organs for transplant. How do we go about allocating a future for people who will die without a transplant? How do we go about denying it? When so many are waiting for their shot at a life worth living, is it fair to grant multiple organs or multiple transplants to a person whose chance for survival is slim to none? And though we, as compassionate human beings, want to help everyone, how far should our benevolence extend beyond our borders? Are we responsible for seeing that the needy who come to America for help receive their chance, or are we morally responsible to our own citizens only?
Rationing scarce resources presents an ethical challenge. I believe that since available organs are so scarce, it is imperative that the utility of donated organs be maximized. In this paper, I suggest that organ allocation be rooted in distributive justice, which demands that equals be treated equally and unequals be treated unequally. I will explore this formal principle and the substantive criteria of equality, need and efficacy (maximum survivability) as they relate to the just allocation of organs for transplant. I will apply these principles of justice to Jésica's case to show that while her first transplant was warranted, her second was not. And, finally, I will conclude that Jésica Santillán's case should serve as an example of what's wrong with our current system of organ allocation.
First, let's address equality as it applies to justice. All other things being equal, who holds a claim to the organs available for transplant in the United States—just citizens, or illegal immigrants, too? A recent Chicago news source cited the tragedy of "American taxpayers and their children who died last year waiting for the transplant that Duke University Hospital chose to give to a citizen of a foreign nation" (Bailey, 2). This article went on to state that our system "rewards illegal aliens for entering the United States to access our health care system, thus condemning some of the American taxpayers who pay for that system to premature deaths. Few could deny the sheer unfairness of such a situation" (Bailey, 2). But how true are these statements? Are organs allocated in a way that promotes inequality for American citizens? An ethicist's first responsibility is to look at the facts, and the facts in this instance tell a different story.
According to the United Network for Organ Sharing (UNOS), American citizens are more likely to receive organs of non-citizens than vice versa; "As a percentage, every year, U.S. citizens receive more organs than they donate" (Vedantam, 2). Also, UNOS limits the number of transplants allotted to non-citizens to no more than five percent of available organs; however, no limits on donations are made (Vedantam, 2). These facts indicate that Americans are benefiting from the organ donations of non-citizens, receiving more than an equal share.
Another question arises when we speak of justice regarding this issue: what does our society owe to illegal immigrants in light of the benefits we receive from their participation in our economic and social life? In his article, "Parties to the Social Contract? Justice and Health Care for Undocumented Immigrants," Kenneth DeVille explains the idea of the social contract as "individuals [who] create civil societies by joining together for their mutual benefit and protection" (306). According to DeVille, citizenship is not necessarily the best, nor the only, method of determining who is party to this contract. He notes, "In many cases, immigrants are socially, culturally and economically integrated members of our civil society…liv[ing] under the same laws as citizens…pay[ing] many of the same taxes" (307). He goes on to note the ambiguity of an American system that halfheartedly enforces immigration and work laws while "benefiting from, and in some cases exploiting, immigrant labor" (307). He makes the point that the social contract demands extending social goods to members of society who participate significantly within that society. Our economy relies on the low cost labor of illegal immigrants to keep produce prices down. We allow hordes of workers to do the backbreaking jobs we disdain, turning a blind eye to aliens working in our fields. If we, as citizens, benefit from their exploitation, we have a duty to honor our side of the social contract and allow them access to our services. In my opinion, UNOS has acted fairly in safeguarding equality of organ allocation by taking into consideration the moral mandate we have as human beings to care for one another. By allowing up to five percent of the organs within its system to be allocated to non-citizens, they are identifying the common bond between members of the worldwide community while respecting and carefully guarding the resources of the American community.
Equal opportunity to tap into the system of organ allocation is just one component of distributive justice surrounding organ allocation. As Ronald Munson points out in Intervention and Reflection, "we do not always expect that being treated justly will work to our direct advantage" (37). But in a situation where resources are scarce and not everyone who needs help will receive it, it is important that allocation be fair. In selecting a system of allocation, it would be wise to choose one "that favored those most likely to benefit from a transplant. Rational planners [behind the veil of ignorance], ignorant as to whether or not they will ever need a transplant or retransplant, would increase their own chances of benefiting from a transplant by setting up a system that, all else equal, distributed scarce organs to those most likely to gain long-term survival from a transplant" (Ubel, et al, 270). Maximizing utility just makes sense, so we need to determine which of the neediest candidates are most likely to have the highest success rate. The basic principle of justice that dictates similar cases be treated similarly, conversely allows for different treatment when cases are dissimilar. It is these dissimilarities that have the most effect on maximizing the utility (or the life) of a donated organ. The first criterion to be looked at is need.
In Transplantation Ethics, Robert Veatch outlines an interesting way of assessing need. He calls it the "over-a-lifetime perspective" (340). This approach takes into consideration a person's entire life when determining who is worst off. A 17-year-old and an 80-year-old both dying of heart failure are equally bad off, but this perspective allows that the person who has had 63 more years of life is better off, so the 17 year old is neediest (Veatch, 341). Veatch writes, "from this over-a-lifetime perspective, justice requires that we target organs for these younger persons who are so poorly off that they will not make it to old age without being given special priority. The younger the age of the person, the higher the claim" (341). This methodology furthers the goal of utilizing organs to their maximum potential.
Of course, it would be foolish to base allocation simply on the age of the neediest patients; efficacy, or expected survivability, must also be considered. Presently, our system of allocation gives priority to those who are the sickest or most in need of a transplant. But sometimes those who are the sickest and in the most immediate need will not receive the same benefit from the transplant as someone whose medical condition is currently more stable. Robert Veatch notes, "They may be so sick that they have a higher chance of dying regardless of treatment" (295). I believe there is a moral obligation, due to the scarcity of organs, to maximize the potential longevity of donated organs and place them where they are most likely to do the most good (bring the most health) over the longest period of time.
This brings us to the question of retransplantation. Years of collecting data show that "retransplant recipients at similar levels of urgency do significantly worse than primary transplant recipients, a difference that increases with each successive transplant" (Ubel, et al, 272). Though I don't believe those who have already received a transplant should be prohibited from receiving another, careful and objective consideration should be given to these cases. Reasons for the organ failure and current condition of the patient must be evaluated to determine if the retransplant candidate will maximize the utility of the organ. Preference in the allocation of scarce organs should be given to the patient whose chances of long-term survival are best.
Now that we have a model for organ allocation based on the principles of distributive justice, we turn to Jésica Santillán's case to determine if her transplants were warranted. Starting with her first transplant, let's review the facts. Jésica and her family entered the United States illegally from Mexico several years ago. Doctors in Mexico were not equipped to diagnose nor treat their daughter's rare heart condition of cardiomyopathy which prevents the heart from pumping blood efficiently and eventually leads to death, so, desperate to obtain medical help for their daughter, the Santilláns paid $5,000 to be smuggled into the country (Bailey, 1). Once in the United States, the family settled with relatives in a trailer near Duke University Hospital and their story was publicized in a local newspaper. A wealthy businessman took up the girl's plight, raising money for her medical care and lobbying successfully to get Jésica on Duke's transplant list. Meanwhile, her father had found construction work and her mother was employed as a janitor at a nearby college (Bailey, 1).
After being listed with UNOS in January 2002 for heart transplant, Jésica's condition deteriorated, and in May 2002 she was listed for heart/lung transplant (Fulkerson, 1). At 17 years old, Jésica weighed only eighty pounds and was just five feet tall. Her small size made finding an organ match more difficult. When a heart/lung block was offered to Duke's pediatric unit, the two potential recipients who had been identified by UNOS were unsuitable. In a tragic communication breach, the organs from a type-A donor were awarded to Jésica, whose type-O blood could only lead to acute organ rejection (Adler, 21). Five hours into the transplant surgery, when the organs had already been exchanged, the mistake was discovered. Powerful anti-rejection drugs were administered and UNOS was notified that Jésica was "in critical need of another transplant" (Duke, 1).
Let's stop here and apply the substantive criteria of equality, need and efficacy of a distributive justice model of allocation to Jessica's first transplant. Regarding equality, Jésica had a right to receive an organ transplant based on the UNOS guidelines allowing up to five percent of non-citizens to receive organs. Beyond that, her parents were also employed, contributing members of society-a party to the social contract. Jésica also fulfilled the requirement of need-without a transplant, she would die, and using Veatch's "over-a-lifetime perspective," she was a particularly deserving candidate-her youth gave her a higher claim. In the area of efficacy, Jésica looked to be suitable as well. Her age and current condition gave physicians every indication that the odds of her long-term survival were good. According to a distributive justice model, Jésica's first transplant was warranted. Continuing with the facts, we turn to the second transplant.
As a result of organ failure following the first transplant, Jésica was placed on life support and within two weeks a second set of organs was allotted to her. Before accepting the organs, doctors evaluated her brain activity and surmised she had not suffered irreversible brain damage; therefore, a second transplant was performed (Duke, 1). Though this heart/lung block was functioning well, the trauma of the first organ rejection, paired with being on life support for nearly two weeks caused irreparable brain damage, and two days after the retransplant "all brain function had ceased" (Adler, 24).
Applying the principles of distributive justice to the second transplant scenario presents a different outcome. Though Jésica still deserved an equal opportunity based on her illegal immigrant status, she was no longer equally entitled to a second set of organs because her odds of survival (and, thus, the odds of maximizing the utility of the organs) were greatly diminished.
Her need was sufficient to push her to the top of the list (Kher and Cuadros, 1). Her young age again made her an attractive candidate, but the expectation of her survival rate was now drastically changed, thereby minimizing the efficacy of the procedure. Duke's staff determined the results of Jésica's brain scan the day before the retransplant were inconclusive though they showed "some minor stroke damage and some bleeding on the brain" (Kirkpatrick, 1). In their urgency to save Jésica's life, the doctors discounted the ill effect of being on life support for nearly two weeks. Mark D. Fox, M.D., UNOS Ethics Committee Chairman, said that determining whether or not someone is too ill to receive a transplant is problematic in medical ethics because "the physician is always going to do what's best for the patient" (Kirkpatrick, 1). While that action supports a goal of maximizing the patient's chance for survival, it does not guarantee maximizing the utility of a scarce organ. If Jésica's condition before the first transplant had been the same as it was before the second, she never would have been a candidate; therefore, her second transplant was unwarranted.
Maximizing utility calls for hard choices but upholds justice by "contribut[ing] to giving people opportunities for equality of outcome" (Veatch, 295). The sad fact is that Jésica's second transplant deprived at least one and perhaps three people from receiving organs they also needed to survive. In a desperate effort to "control damage after its earlier transplant mistake" sound judgment was clouded and valuable organs were wasted (Kirkpatrick, 1). In "Rationing Failure: The Ethical Lessons of the Retransplantation of Scarce Vital Organs," the authors write,
Health care workers cannot always be expected to recognize when it is
time to forgo heroic lifesaving measures. Indeed, their traditional role
as patient advocates would seem to compel them to ignore the odds and
do whatever they can to help their patients…However, when such heroic
measures require scarce resources that could be better used to help others,
their good intentions can be unjust (272).
The tragedy of Jésica Santillán's death should be a call to physicians, transplant boards, and UNOS officials to consider allocation criteria outside the Intensive Care Unit where emotions are likely to misguide decision-making. Doctors should not be made to feel they are abandoning their patients during their greatest hour of need, but they should also not be allowed to drain the resource pool when the outcome is unlikely to be good. UNOS should implement a strict policy of organ allocation based on equality, need, and efficacy.
Obviously, I've placed myself behind the "veil of ignorance" in order to reach this proposal. If it were my daughter, my husband, my sister, or my friend who needed the transplant, I would be all for solely using the principle of need to determine allocation. But that's precisely the point: we must have a policy in place that moves decision-making from the more visceral, gut-feeling approach to a rational decision based on projected outcome that is more appropriate for maximizing the utility of our scarce resources. Heartbreaking, yes, but just.
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When we hear organ donation is climbing in black citizens who historically did not donate----we need to think of this. We have 300 deaths in Baltimore each year from gun violence----we have had 100s more deaths from police interactions. We have 100s of deaths each year of homeless citizens----that is a great deal of citizens coming to our emergency rooms and medical examiner's offices-----often having no insurance, not identified----often poor black citizens-----and that is one reason black tissue and organ donation is UP. We can create societal structures designed to feel a predatory, global Wall Street driven economy----and we will if we keep MOVING FORWARD TO ONE WORLD ONE GOVERNANCE US CITIES AS FOREIGN ECONOMIC ZONES.
Below we see one incident of growing homelessness----Portland has one of the biggest populations of displaced many being WHITE citizens-----this is not about race, gender, creed---it will come to ALL CITIZENS-----we must keep our developed nation regulated, public interest, morals and ethics structures tied to PUBLIC HEALTH CARE.
Portland Woman Who Died of Hypothermia Was Evicted for Being Late on $338 in Rent
(Catie Cooper)
By Tarra Martin |
1 day ago
Karen Batts, 52, who died from hypothermia Saturday in a parking garage, was evicted from a downtown Portland apartment building in October for being overdue on paying $338 in monthly rent.
Portland police confirmed this morning Batts died from hypothermia. She was seen removing her clothes in the parking garage—at 730 Southwest 10th Avenue—shortly after 2 pm on Saturday, in the midst of a Portland snowstorm.
The Oregonian first reported today that Batts had been evicted.
A review of Multnomah County eviction court records by WW shows that Batts had been living in an apartment building at 333 SW Oak Street designed to provide affordable housing for seniors and people with disabilities.
But on October 21, 2016, Cascade Management, Inc. and Northwest Housing Alternatives, LLC, evicted Batts from the building they manage. The court records say only that she was evicted for being at least seven days late with the $338 rent for August.
The landlords sent Batts a 72-hour notice on Sept. 9, saying she owed $338 plus a $5 late fee. She does not appear to have paid that amount between Sept. 9 and Oct. 6, when an eviction complaint was filed with the court.
Batts did not appear at the scheduled Oct. 14 hearing, so the court found in favor of the plaintiffs by default. Multnomah County Circuit Judge Michael C. Zusman signed the order for her to leave the apartment by Oct. 21. (Disclosure: Zusman is a contributor to WW. He is not related to WW Editor Mark Zusman.)
Cascade Management and Northwest Housing Alternatives did not immediately return requests for comment.
Batts was believed to be homeless when she died. The SmartPark garage where she died is eight blocks from the apartment where she had lived.
UPDATE, 4:31 pm: Reed Andrews, a reporter with WW's news partner KATU-TV, spoke with Martha McLennan, the executive director of Northwest Housing Alternatives.
McLennan says Batts had been a tenant since 2007—but says her behavior changed in the spring.
"There were a variety of lease violations that were either damage of property or late payments, also incidents against staff and other tenants," McLennan tells KATU. "It's a terrible tragedy to have a situation where someone ends up alone and without resources."
McLennan tells WW that Northwest Housing Alternatives tried to get help for Batts before evicting her.
"We hate these sorts of situations," McLennan says. "But unfortunately, when someone decline services there's not much you can do. And I can say there were dozens of attempts to help."
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As costs of transplants in US soar because of global profit-driven health care systems and health tourism more and more Americans are being sold on traveling overseas where often the medical facilities are owned by the same global hedge funds. Yes, this is creating the growing organ trafficing and illegal harvesting situation. Let's ask this----if it is considered a crime against humanity to harvest organs from prisoners----is it not the same to harvest from our US city homeless---low-income killed? Of course--MORE SO.
As MOVING FORWARD to US citied deemed FOREIGN ECONOMIC ZONES occurs more people than already exist will be jailed as POLITICAL PRISONERS---what exists in China will very easily come to the US.
It is the PROFITEERING on transplant medicine driving global citizens whether patient or organ trafficer. The problem falls on MEDICAL DOCTORS AND PROFITEERING GLOBAL HEALTH SYSTEMS-----it is all pragmatic nilism.
It is the PROFITEERING on transplant medicine driving global citizens whether patient or organ trafficer. The problem falls on MEDICAL DOCTORS AND PROFITEERING GLOBAL HEALTH SYSTEMS-----it is all pragmatic nilism.
It's safe to assume prisoners dying in US prisons having lost touch with family are seeing themselves as TOTAL BODY DONORS.
Patients seeking transplants turn to China / Rights activists fear organs are taken from executed prisoners
By Vanessa Hua
Published 4:00 am, Monday, April 17, 2006
The San Mateo father of six learned in May 2005 that he had liver cancer. Chemotherapy seemed to knock out the tumors, but in January a scan turned up nine more and he was taken off the transplant list. Too risky, his doctors said. The cancer would probably return in the new organ, the doctors told De Leon, 50, a construction superintendent who cried when he learned of his prognosis.
He wanted to be around for his youngest children, who are 3 and 5 years old, and help put them through college. But the cancer would also probably return after the treatments his doctors were recommending -- so he decided to go outside the U.S. health care system.
De Leon researched overseas transplant centers on the Web, chose Yeson International Healthcare in bustling Shanghai and began a blog. The liver he received last month came from a 20-year-old, doctors told him.
Hundreds of Americans and other foreigners are now finding their last, best chance for survival with organ transplants in China, where businesses are opening to meet international demand. Roughly 17,000 Americans needed liver transplants in 2004; only 6,100 patients received them, based on availability, their risk of dying in surgery, their chances for long-term survival and other factors. It is unknown how many Americans are now going to China, India, the Philippines and other developing countries for transplants they cannot get in this country.
American doctors caution their patients against going overseas for transplants because the organs may not be screened for infectious diseases and the quality of care after surgery is questionable. Human rights activists raise ethical concerns about China in particular, saying transplant doctors there who cater to foreigners may be harvesting organs from executed prisoners without their permission, just for financial gain.
De Leon said his donor could have been in a car accident or was brain dead for another reason.
"I checked on the laws there," he said, noting that donors and their families would have been required to sign waivers.
"They didn't shoot someone so I could have a liver," said De Leon, who praised the quality of care at the hospital in Shanghai. The facility had new medical equipment, but the rooms were worn, with chipped paint and crank-up beds and often no remote control for the television, De Leon said. Most members of the staff did not speak English, so he used hand gestures to communicate.
New regulations going into effect in July will explicitly forbid the buying and selling of organs in China and require donors to give written permission for their organs to be transplanted, although Chinese Embassy spokesman Chu Maoming in Washington, D.C., said organs already are harvested ethically.
"The organs come from ordinary citizens who voluntarily give them," Chu said.
Critics of the new regulations say that they still fail to address the source of organs, the administration of organ donations or the definition of "brain dead" -- and that they apply only to live donors.
Chinese officials have confirmed that executed prisoners have been among the sources of organs for transplants, according to the U.S. State Department's annual human rights report released in March. The report questions whether anyone obtained meaningful or voluntary consent from the prisoners or their relatives before the organs were harvested.
So far, watchdogs haven't been able to determine how many transplants Chinese doctors have conducted on foreign patients because the Chinese government does not release such figures.
The human rights group Amnesty International estimated in 2004 that at least 3,400 people were executed in China and 6,000 sentenced to death. The totals could be much higher; Chinese authorities keep national statistics on death sentences and executions secret. Amnesty has repeatedly reported the harvesting of organs from executed prisoners and called for the Chinese government to forbid the practice if prisoners haven't given free and informed consent.
Adherents of Falun Gong, the spiritual movement banned in China, have accused the government of harvesting organs from thousands of the movement's followers in Liaoning province, charges that the U.S. State Department has urged the Chinese government to investigate.
Harry Wu, a human rights activist and founder of the China Information Center in Virginia, notes that Chinese, by culture and tradition, want to die whole. "They don't have a concept to donate body parts to other people," Wu said.
This deep reluctance, the high number of executions and the thriving transplant business add up to one conclusion, he said: "The death penalty is the base of (China's transplant) program."
In contrast, federal prisoners on death row in the United States are not allowed to donate their organs because it is assumed their incarceration impairs their freedom to consent. For prisoners on state death rows, the laws vary. In any case, many prisoners are medically unsuitable to donate organs because they carry transmissible illnesses such as HIV or hepatitis.
Going to China for organ transplants is "reprehensible," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.
"I understand people are desperate and want organs," Caplan said. "But there is a problem of dirty hands. It's not like there's a national assistance program of Chinese organs to the needy of the world. It's the rich who go and say, 'I'm going to look the other way.' "
In September, Daniel Farley of Sebastopol also received a liver transplant at Yeson in Shanghai, a booming commercial and cultural center in China. He grappled with the knowledge that the organs could have come from an executed prisoner.
"I'm a fairly liberal guy, and it's not the greatest thing to think about," said Farley, 57. "But when you're faced with a certainty -- and (the donors) have a certainty -- it's easier to take. Either someone was sentenced to die or it was their time."
However, the organs should be suspect because their origin often remains a mystery, doctors say.
"What was the health of the donors?" asked Robert Gish, division chief of hepatology and complex gastroenterology at the California Pacific Medical Center in San Francisco. "It's not as well defined as in the United States. It's also not clear, the circumstance of a donor's death."
Yeson International Healthcare, which provided both De Leon's and Farley's transplants, was one of the first in China to offer such services to foreigners, said Tony Lee, the company's senior medical consultant. Founded in 2000, Yeson now serves about 20 Westerners and up to 100 patients from Taiwan each year, he said.
"People come here because they're desperate, and we offer them a chance of living," Lee said in a telephone interview. "That's why they come here, because of something we have here and nowhere else is offering."
Yeson contracts with a hospital in Shanghai, which in turn handles the donation process with a government agency, said Lee, adding that the company follows Chinese regulations.
"We do the service part," Lee said.
The China International Organ Transplant Center, founded in 2003, also in Shanghai, performs more than 100 kidney transplants and more than 20 liver transplants each year, according to its Web site, which is written in English, Russian, Korean, Japanese and Chinese.
A kidney transplant at China International costs $62,000, a liver $98,000 to $130,000, a lung transplant $150,000 to $170,000 and a new heart $130,000 to $160,000.
A month after his transplant, De Leon said he feels great, though he has some numbness at the stitches across his abdomen.
He still has a high risk of recurrence of liver cancer, his doctors say. "We'll look after Eric and see how he does," said Nathan Bass, medical director of liver transplants at UC San Francisco. "Hopefully he'll be one of the lucky ones."
De Leon plans to take off another month or two before going back to work on remodeling projects in high-rise buildings. He also wants to write a book of advice for people going to China for transplants. Several patients and their families already have contacted him after coming across his blog.
"We want to help if we can," De Leon said. "What else can you do? People are dying."
Transplant tales: to China and backEric De Leon and his wife, Lori, wrote about his experience in China undergoing a $110,000 liver transplant in March, which they financed with a loan on their San Mateo home. Following are some of the entries from their Web log at newfilter.blogspot.com:
March 2: Well we made it to Shanghai after a long 13 1/2 hour flight. ... The coordinator Tony met us at the airport and escorted us to the hotel. We started our first full day by meeting with Dr. Fan the leading Transplant Surgeon. ...Then the rest of our day was full of Tests, Tests, and more Tests.
March 14: Well hopefully this is it. We received a call today saying that they had an organ match ... FINALLY!! Of course the screening still needs to be done.
March 15: One of the surgeons inquired on if we wanted to see the liver they removed from Eric. I told him yes. We went down to the surgery floor and the surgeon brought a large bowl with a huge roast. Really, Eric's liver was huge. The doctor said his liver was twice the size of a normal liver. This size was due to the Hep C and the cancer. The average liver weighs around 3 pounds Eric's was all of 6 pounds ...
March 17: The doctor told Eric that he was very lucky. He received a 20-year-old liver. Young and healthy. Hmmm ... Maybe that's why Eric is feeling so good already! He's already bored out of his mind. Partly due to the fact that he hasn't been able to sleep much. Plus he's a little paranoid. He thinks the nurses are screwing around with him. Tony said the paranoia is normal and is actually one of the side effects of the anti-rejection medicine. I think it might also have a little to do with the fact that there is a bit of a language barrier.
March 31: The normal meal Eric receives consists of 2 bowls of rice, and a banana. Along with that he also receives a dish of meat. ... Today's menu, for example, consisted of the following. Breakfast: meat bun and milk or fried shredded pork and pickled green noodles with egg. Lunch: braised weever with brown sauce (does anyone know what that is?), salted egg with minced pork, or stewed shredded eel and bamboo shoots. Supper: Gingeli and sliced fish. ...
April 3: It is now day number 19 since Eric's liver transplant. He is doing fantastic! Looking at him in the picture with the leading liver surgeon here at the hospital, who would ever think that he had just undergone such a life-saving operation? Eric is being released today and not a day too soon. We are being told continuously that he has recovered remarkably fast.
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