Criminal, Legal, and Ethical Kidney Donation and Transplantation: A Conceptual Framework to Enable Innovation

Abstract

This article distinguishes criminal, legal, and ethical transplantation as three distinct concepts, with the goal of building a conceptual framework to enable innovation. We strongly believe that international efforts should concentrate on increasing the availability of ethical high-quality living donor kidney transplantation options in all countries. This is not the same as accepting legalized organ markets, as in Iran. But the present state of the discussion, and its legitimate concern with black markets, has become so dysfunctional that caught in the crossfire of these counterproductive discussions have been other ways of increasing the availability of legal, ethical, and safe transplantation, including various form of kidney exchange.

The 2017 Statement of the Pontifical Academy of Sciences Summit on Organ Trafficking and Transplant Tourism states that “organ trafficking and human trafficking for the purpose of organ removal” are “crimes against humanity.” Note that “crimes against humanity” entered the legal lexicon in the post-World War II Nuremberg trials of Nazi war criminals. There probably is little controversy about extending that term to murdering prisoners for their organs. But is that equivalent to “payments to donors or the next of kin of deceased donors?” Are the Nazi, Chinese, and Iranian governments committing the same crimes against humanity? We consider such overbroad generalizations unhelpful and, instead, encourage more attention to the dangers of black markets and the ways in which increasing safe, legal, and ethical transplant opportunities around the world can put an end to criminal black markets, which remain busy and profitable due to the shortage of legal and ethical alternatives.

Note:
Funding Information: This paper received no funding.

Conflict of Interests: MR is the unpaid CEO of the Alliance for Paired Kidney Donation. MR, AR, and IM own an equity interest in Rejuvenate Kidney Transplant Solutions that aims to improve the quality of care and reduce the cost of care for patients with kidney disease and their healthcare payers. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Keywords: kidney disease, transplantation, organs, black markets, trafficking, kidney exchange, Iran

JEL Classification: A00, I18, I10, K00