TRANSPLANT TOURISMAND ORGAN TRAFFICKING

E2 GUS 2010

E2 (22)

Achmad ShidiqDilla ApriliaDimas SetiajiDini DesmonaMonika HasnaMutia AyuNadya IswandariNoer OlivyNur AfifahTara ZhafiraWulan Dwi Sakinah

“The 20th century miracle”

Best treatment

• Survival rate ↑• Cost effective• Quality of life

↑

The only available

treatment

• For end-stage failure

Market and Demand

Market and Demand?About 112,600 solid organs transplanted

worldwide in 2011. There was 5.1% of increase over 2010. It was only ≤ 10% needs.

Global Activity in Organ Transplantation 2011 Estimate (Global Observatory on Donation & Transplantation, 2011)

Kidney Liver Heart Lung Pancreas Small Bowel

76.118 23.721 5.741 4.278 2.564 209

Data from optn.transplant.hrsa.gov and OPTN/SRTR Annual Report.** Data include deceased and living donors

The Gap is Widen

I have the kidney, I need

the money

I need the kidney, I have

the money

Organ Trafficking

Recruitment, transport, transfer, harboring or receipt of persons, by means of the

threat or use of force or other forms of coercion, of abduction, of fraud, of

deception, of the abuse of power, of a position of vulnerability, of the giving or

receiving of payments or benefits to achieve the consent of a person having

control over another person, for the purpose of exploitation by the removal of organs, tissues or cells for transplantation

(UN Trafficking Protocol, 2000)

The commercial transaction is a central aspect of organ

trafficking; the organ becomes a commodity and financial

considerations become the priority for the involved parties instead of the health and well-

being of the donors and recipients

Transplant Tourism

Has become a

connotation for organ trafficking

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 (UNOS)

However, not all medical tourism that entails the

travel of transplant recipients or donors

across national borders is organ

trafficking. Transplant tourism may be legal and

appropriate.

The Real Victims in Organ Trafficking

Vulnerable populations (such as illiterate and impoverished persons, undocumented immigrants, prisoners, woman, children and political or economic refugees) in resource-poor countries.

5–10%of kidney transplants performed annually around the globe are currently via organ trade.

At least 20 nationals from other countries such as the Australia, Japan, Oman, Morocco, India, Canada and the United States traveled as transplant tourists for trafficked organs.

China (2006-2007) 11000 transplant were performed from executed prisoners 8000 kidney, 3000 liver, approx 200 are hearts

The 8000 kidney transplants alone in China in 2006 would account for at least 10% of the total number of annual organ transplants done in programs of organ trafficking.

100 nationals from countries such as Saudi Arabia (700 in 2005), Taiwan (450 in 2005), Malaysia (131 in 2004) and South Korea (124 in the first 8 months of 2004) went abroad annually for a commercial kidney transplant.

In Indonesia?

• 1st kidney transplant in Ina RSCM, 1977• In Indonesia 40.000 people need kidney transplant. Only

500 had it. • Kidney donors alive and only a few. Mostly patients

underwent the transplant in China (many donors and not so expensive)

• Underwent kidney transplant elongated age by 29.9 yrs (Transplant Centre Directory, 1992)

• As a medical procedure, organ transplant has a potential to be misused need a regulation, ethically and legally.

International Convention and National Regulation

WHO Guiding Principles on Human Cell, Tissue, and Organ

Transplantation

The Declaration of Istanbul on Organ Trafficking and

Transplant Tourism

UU No 23 Tahun 1992

PP No 18/1981

“Organ trafficking and transplant tourism violate the principles of equity, justice, and respect for human dignity and should be prohibited. Because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should be prohibited

a. Prohibitions on these practices should include a ban on all types of advertising (including electronic and print media), soliciting, or brokering for the purpose of transplant commercialism, organ trafficking, or transplant tourism.

b. Such prohibitions should also include penalties for acts, such as medically screening donors or organs, or transplanting organs, that aid, encourage, or use the products of, organ trafficking or transplant tourism.

c. Practices that induce vulnerable individuals or groups (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) to become living donors are incompatible with the aim of combating organ trafficking, transplant tourism, and transplant commercialism.”

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism

WHO Guiding Principles on Human Cell, Tissue, and Organ Transplantation

Guiding Principle 5Cells, tissues and organs should only be donated freely, without

any monetary payment or other reward of monetary value. Purchasing, or offering to purchase, cells, tissues or organs for transplantation, or their sale by living persons or by the next of kin for deceased persons, should be banned.

The prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income, or paying the costs of recovering, processing, preserving and supplying human cells, tissues or organs for transplantation.

UU No 23 Tahun 1992Pasal 33

(1) Dalam penyembuhan penyakit dan pemulihan kesehatan dapat dilakukan transplantasi organ dan atau jaringan tubuh, transfusi darah, implan obat dan atau alat kesehatan, serta bedah plastik dan rekonstruksi.

(2) Transplantasi organ dan atau jaringan tubuh serta transfusi darah sebagaimana dimaksud dalam ayat (1) dilakukan hanya untuk tujuan kemanusiaan dan dilarang untuk tujuan komersial.

Pasal 34

(3) Transplantasi organ dan atau jaringan tubuh hanya dapat dilakukan oleh tenaga kesehatan yang mempunyai keahlian dan kewenangan untuk itu dan dilakukan di sarana kesehatan tertentu.

(4) Pengambilan organ dan atau jaringan tubuh dari seorang donor harus memperhatikan kesehatan donor yang bersangkutan dan ada persetujuan donor dan ahli waris atau keluarganya.

(5) Ketentuan mengenai syarat dan tata cara penyelenggaraan transplantasi sebagaimana dimaksud dalam ayat (1) dan ayat (2) ditetapkan dengan Peraturan Pemerintah.

PP No 18/1981BAB V

TRANSPLANTASI ALAT DAN ATAU JARINGAN TUBUH MANUSIA

Pasal 10(1) Transplantasi alat dan atau jaringan tubuh manusia dilakukan dengan memperhatikan ketentuan-

ketentuan sebagaimana dimaksud dalam Pasal 2 huruf a dan huruf b.(2) Tatacara transplantasi alat dan atau jaringan tubuh manusia diatur oleh Menteri Kesehatan.

Pasal 11(1) Transplantasi alat dan atau jaringan tubuh manusia hanya boleh dilakukan oleh dokter yang

bekerja pada sebuah rumah sakit yang ditunjuk oleh Menteri Kesehatan.(2) Transplantasi alat dan atau jaringan tubuh manusia tidak boleh dilakukan oleh dokter yang

merawat atau mengobati donor yang bersangkutan.

Pasal 12Dalam rangka transplantasi penentuan saat mati ditentukan oleh 2 (dua) orang dokter yang tidak ada sangkut-paut medik dengan dokter yang melakukan transplantasi.

Pasal 13Persetujuan tertulis sebagaimana dimaksud dalam Pasal 2 huruf a, Pasal 14, dan Pasal 15 dibuat di atas kertas bermaterai dengan 2 (dua) orang saksi.

PP No 18/1981BAB VIII

PERBUATAN YANG DILARANG

Pasal 17Dilarang memperjual belikan alat dan atau jaringan tubuh manusia.

Pasal 18Dilarang mengirim dan menerima alat dan atau jaringan tubuh manusia dalam

semua bentuk ke dan dari luar negeri.

Pasal 19Larangan sebagaimana dimaksud dalam Pasal 17 dan Pasal Pasal 17

18 tidak berlaku untuk keperluan penelitian ilmiah dan keperluan lain yang ditetapkan oleh Menteri Kesehatan.

A 65 yo that able to pay all

costA 25 yo with no

insurance

To which person will you give the kidney? Why?

Conclusion

• Organ transplant tindakan yang mulia, tapi hanya boleh dilakukan dengan consent dari donor dan memperhatikan risiko donor, efektivitas pendonoran, kemungkinan keberhasilan pada penerima, serta ada tidaknya unsur “jual beli” atau komersialisasi di dalamnya.

• Secara legal, Indonesia bersama negara lain menentang adanya organ trafficking maupun transplant tourism.

“we make a living by what we get, but we make a life by what we give”

-Winston Churchill

Thank you!

References• http://organdonor.gov/about/data.html• Delmonico FL. The development of the Declaration of Istanbul on Organ Trafficking

and Transplant Tourism. Nephrol. Dial. Transplant. (2008) 23 (11): 3381-3382.• Budiani-Saberi DA, Delmonico FL. Organ Trafficking and Transplant Tourism: A

Commentary on the Global Realities. American Journal of Transplantation 2008; 8: 925–929.

• Tazeen H. Jafar, MD, MPH. Organ Trafficking: Global Solutions for a Global Problem. American Journal of Kidney Diseases, Vol 54, No 6 (December), 2009: pp 1145-1157

• The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. http://cjasn.asnjournals.org/content/3/5/1227.full

• http://www.balitbangham.go.id/PERANGKAT%20UU%20TERKAIT/UU.%2023.pdf• http://hukum.unsrat.ac.id/pp/pp_18_1981.htm