Desperate Kiwis look overseas for organs
Each year a few Kiwis travel to China to receive organ transplants, in a practice that has been condemned by the international transplant community, reports Laura Walters.
New Zealand has tried to increase its comparatively low number of organ donors, with increased resourcing and a new national strategy, but with a current waiting list of more than 550 people, a few desperate Kiwis - often those with dual Chinese citizenship – are paying to jump the queue.
Transplant tourism has grown out of the trade of human organs for profit, and is most prolific in China, India and the Middle East.
A lack of donors, long waiting times, and the relative ease which people can travel are all driving factors in transplant tourism.
Auckland transplant physician Ian Dittmer said it wasn’t common among Kiwis - only about two or three people each year – but it raised both medical and ethical complications.
And in 2012 University of Canterbury law researcher Rachel Walsh said a small number of desperate Kiwis were turning to the mostly illegal practice due to a shortage of organs at home.
The Ministry of Health does not keep statistics on the number of people who get organ transplants overseas, either live transplants from people on an overseas register or deceased transplants, but medical practitioners who gave post-operative care and anti-rejection therapies upon patients' return dealt with a small number of cases.
In 2007, the World Health Organization (WHO) found up to 10 percent of transplants worldwide involved trading organs for money, and potentially coercive practices.
In China, there was evidence to show the organs of executed prisoners – often Falun Gong practitioners - were being removed and sold on the black market. A WHO report found about 12,000 kidney and liver transplants were performed in the country in 2005, and the majority of the transplant organs were alleged to have been procured from executed prisoners.
The 2008 Declaration of Istanbul, endorsed by transplant organisations including The Transplantation Society of Australia and New Zealand, said trafficking and transplant tourism “violate the principles of equity, justice and respect for human dignity and should be prohibited”.
There is debate surrounding the ethics of transplant commercialism, but most countries, like New Zealand, have laws against paying for organs, which means there is no legal ambiguity.
Meanwhile, Australia is conducting a Parliamentary inquiry into organ trafficking, and how to improve policy frameworks to better protect Australians from the risks of organ trafficking and organ transplant tourism. Chair of the Human Rights Sub-Committee, MP Kevin Andrews, said the committee was concerned by reports the worldwide demand for organ transplants was driving a growing black market in human organs.
“The Sub-Committee is particularly concerned that Australians may be placing themselves and others at significant risk by travelling overseas for organ transplants,” he said in June.
NZ could do more
International human rights lawyer David Matas said New Zealand should be doing more to stand up against organ trafficking and transplant tourism.
Matas has spent the past 12 years researching and advocating against organ trafficking in China, and was in New Zealand this week to participate in a panel discussion about the role lawmakers could play in opposing the practice.
Matas was asked to research the extent of the issue in China for a report, which drew the attention of the UN Committee Against Torture. When he began his research he was not sure whether the claims about executed prisoners were true.
It was hard to believe something like this was happening, and there was a general lack of knowledge about the issue in western countries, he said.
But the trail of research led him to find evidence to support the allegations. After completing a report for the United Nations, he continues to advocate for measures to end the practice.
“I figure if I walk away from this, it will die… I had to keep the issue alive.”
Matas said the rise of social media made it easier for agents and marketers to target patients in a range of countries, and people were being sold all-inclusive transplant packages.
While New Zealand was somewhat removed from the practice, the country was in a good position to speak up against organ trafficking and call on China to put in place more robust laws. It was easier to speak out when a country wasn’t complicit in such a practice, he said.
There was also the potential to change policy frameworks in order to prosecute marketing agents that targeted Kiwis, he said, adding that going after desperate recipients was contentious.
NZ's transplant strategy
In 2016, the former National government carried out a review of new Zealand’s organ donor and transplant system. There was also a law change to fully compensate live donors for lost wages.
Last year, a national strategy was developed which included six priorities to improve the rate of deceased donor rates: improving public awareness; improving the donor registration system; improving training; increasing capacity; establishing a national agency outside the DHBs; and measuring process.
“New Zealand’s rate of deceased organ donation is increasing as a result of the efforts and expertise of Organ Donation New Zealand (ODNZ) and ICU Link doctors and nurses," the strategy paper says.
“However, it is still relatively low compared with rates in other countries. New Zealand has a unique cultural make-up and provides geographical challenges to organ retrieval and transplant, but some countries have achieved significant improvements in their rate of organ donation after introducing comprehensive strategies.”
In 2017, there was a record number of deceased organ donations and 290 transplant operations – up 32 on the previous year.
National Party health spokesman Michael Woodhouse said there were ways to further improve the system in order to stop people looking overseas.
New Zealanders had a history of going overseas for medical treatment, including appearance procedures and joint surgery. But in the case of transplants, the potential medical complications and need for continuity of post-operative care could put patients’ health at risk and put pressures on New Zealand’s health system, he said.
In order to further increase donor rates, Woodhouse proposed a register with advanced consent in place of the current driver licence system. Less than 1 per cent of people die in a way that makes them medically eligible to be an organ donor, and in some cases families override a patient’s decision to be a donor because of personal or religious beliefs.
Woodhouse said there was a debate to be had over medical autonomy, which would see the deceased’s wishes upheld, and help further increase the number of deceased donors.
Meanwhile, the number of life donors – mostly kidney donors – is also on the rise, with fulltime coordinators in transplant centres, and a liberalisation of the criteria of who is medically eligible to be a live donor.