UNOS DonateLife

June 26, 2007

UNOS Board Further Addresses Transplant Tourism

Richmond, Va. -- The Board of Directors of United Network for Organ Sharing (UNOS), at its meeting today, approved a series of resolutions amplifying UNOS' position regarding "transplant tourism" (purchase of a transplantable organ outside the United States in a way that bypasses laws, rules or processes of any or all countries involved). The resolutions build upon a position statement the Board adopted in June 2006 opposing the practice. The new statement and accompanying rationale are listed in their entirety below.

In related action, the UNOS Board approved a position regarding post-transplant medical treatment of individuals who have received an organ through transplant tourism. The position recommends that emergent care be provided to such recipients. However, should a physician raise a conscientious objection to non-emergent treatment of these recipients, the statement recognizes the physician's right to help the patient locate alternate care and possibly to end the physician-patient relationship. Finally, the UNOS Board denounced the use of organs from prisoners executed solely or primarily for the purposes of transplantation.

"We recognize the desperation that leads some patients and families to consider transplant tourism as a solution to their personal need," said UNOS President Sue McDiarmid, M.D. "But we cannot condone a practice that fundamentally violates human rights and exploits human vulnerability."

The Board adopted the statement below, with the following observations:

• The statement emphasizes that the underground practice of transplant tourism exploits vendors and recipients alike;
• The statement reflects the circumscribed scope of UNOS vis a vis national, rather than international concerns;
• The statement avoids moral exceptionalism, avoiding the hazard of singling out individual examples of exploitation and possibly making other forms of exploitation appear more morally acceptable;
• The statement is offered as an overview, rather than an exhaustive treatment of the many ethical issues surrounding the practice of transplant tourism; and
• The statement is restricted to transplant tourism and is not intended to minimize the importance of corollary ethical issues such as human rights, justice, and post-tourism care that are all deserving of independent consideration.

Statement on Transplant Tourism

The disparity between demand for and supply of organs for transplantation occupies the attention of the international transplant community, especially for the recipients whose lives hang in the balance. The plight of those awaiting a transplant has engendered numerous strategies to increase the number of available organs.

Transplant tourism is the purchase of a transplant organ abroad that includes access to an organ while bypassing laws, rules, or processes of any or all countries involved. Transplant tourism remains a refuge for desperate recipients of means, and there is anecdotal evidence that the practice is growing. It is the considered view of the UNOS Ethics Committee that the current practice of transplant tourism is predicated on exploiting the desperation of vendors, recipients and their families. Reports of outcomes from transplant tourism are necessarily anecdotal, given the underground nature of the exchange, but it is pertinent that with few exceptions, the literature on the subject is nearly uniform in reporting adverse consequences for vendors and recipients. Brokers of transplant tourism leverage the underground nature of the practice, exploiting the parties involved by obscuring the risks. Transplant tourism typically operates in countries where the rule of law is absent, or incompletely enforced. The practice of transplant tourism, by design, manifestly undermines the ethical principle of non-malfeasance.

The UNOS Ethics Committee condemns the practice of transplant tourism

Furthermore, it is the position of the Ethics Committee that participation in such a practice cannot be defended on ethical or current empirical grounds. However, the Committee would be remiss in failing to observe that the practice of transplant tourism might not exist but for the growing disparity between the demand for and supply of organs. It is the solemn obligation of the transplant community, not only to publicly condemn the exploitative practices of transplant tourism, but to endorse ethically defensible policies, which will ultimately render such practices unnecessary (Citations omitted).

A private, nonprofit organization, UNOS manages the nation's organ transplant system and oversees the world's most comprehensive database of clinical transplant information under contract with the federal government. UNOS operates the 24-hour computerized organ sharing system, matching donated organs to patients registered on the national organ transplant waiting list. UNOS seeks to increase organ donation through education and improve transplant success rates through outcomes-based research and policymaking.