By Ashwin Sritharan and Katarina Zorcic

When discussing organ donation and the reasons why one may be hesitant to donate, a common theme that arises is the idea of a “black market”. This idea typically manifests as the image of a criminal underground where the organs of unsuspecting victims circulate through cunning organ harvesters and are sold to the highest bidder to do whatever they please. Coupled with mistrust in health officials behind transplantations (1), this can lead possible donors to worry about the risks of being preyed on and their potential contribution to this black market. While organ transplantation has saved many suffering from critical organ failure, the need for organ donors in Canada is steadily increasing (2). Although the organ donation system was originally built on altruistic principles, other incentives have been pushed forward to better increase the amount of organ donors to meet demand (2). These incentives, coupled with media reports blowing the incidence of illegal donations out of proportion, have sown the seeds of mistrust and embedded the image of a black market in the collective consciousness of many would-be donors in Canada (2). To best dispel these worries, we must pull back the veil of organ donation and transplantation to understand this process, and what illegal harvesting looks like in Canada to avoid common red flags. 

Organ donation in Canada can come from two sources: living and deceased donors (2). However, living organ donors in Canada only donate one of two kidneys, as a person’s quality of life can remain the same with just one kidney (3). In order to become a donor, an individual must get in contact with their respective province’s living donation program and indicate their interest (3). They then undergo medical tests and evaluations to ensure that they are a suitable donor, such as ensuring that they are healthy enough to have surgery and will remain healthy with only one kidney (3). There are two forms of living donations: directed donations, where the potential donor knows the individual receiving the kidney and is a match to that person, or a Non-directed Anonymous Donation (NDAD), where the person offers to donate a kidney to anyone that is a match. The former situation is more typical for biologically related receivers or for individuals that donors personally know such as a friend or co-worker, while NDADs can go to anyone on a waitlist for receiving a kidney. Deceased and registered individuals are used as organ donors as various organs and tissues can be removed that would negatively impact the wellbeing of a donor if they were living. This way, an individual can continue to help others even after they have passed. Across Canada, each province maintains its own registry for indicating interest in organ and tissue donations after death, with individuals being able to revoke their consent if they choose to at any given time. Organ donation in Canada is only viable when an individual dies in one of two ways: either the brain permanently loses all function or the heart permanently stops beating. The family of the individual can also be consulted to confirm whether the hospital is allowed to remove organs or tissues for transplantation, so it is encouraged for registered individuals to let their family know of their registration as an organ donor. While most deceased individuals are capable of donating tissues post-mortem, only a fraction can be considered for organ donation, and so there is a greater need for registered organ donors. Furthermore, there is no cost or liability to the family to cover surgery for organ or tissue donations of a family member.

In Canada itself, illegal usage of organs doesn’t come in the expected form of criminal healthcare workers or surgeons extracting from patients without their knowledge and/or consent, but rather in the form of transplant tourism (4). Transplant tourism is a phenomenon where Canadians will travel to another country with more lax regulations on organ collection and storage to receive an organ transplant (4). This would usually happen for individuals who are unable to receive critical organs for transplant due to long wait times, and instead turn to a more legally gray route to maximize their chances of survival (4). Furthermore, Canada is one of the biggest global importers of organs across the globe, which can encourage the activity of illegal organ harvesting in other countries as a way to make money (5). Transplant tourism is also further complicated as it is not necessarily illegal in all cases, as the donor may not be forced or deceived into donating the organ, and thus the entire procedure is legal. The greatest impact that Canada has on illegal organ harvesting, then, is not the conduct of stealing organs within our own country, but the impact that we can have on countries around the world where predatory organ harvesting takes place.

Recently, the Senate Bill S-204 was put forward to make transplant tourism illegal, which is a step towards hindering the progression of illegal harvesting in other countries by cutting off a critical supply line. This especially protects those in poverty around the world, as these populations are particularly targeted by organ merchants as easy targets. The next step would be to provide better social support for these populations to further protect them against organ harvesters that would exploit them for financial incentives.

In Canada, there is an increasing demand for organ donors, however supply is not increasing to match this. With more donors needed every year and thousands of Canadians in need of life saving transplantations, we must tackle the stigma behind registering as a donor to make organ transplantation more transparent and a more openly talked about subject. Speaking to a certified healthcare worker and registering online with your respective province’s registry can ensure that you follow a carefully regulated and legitimate procedure for organ donation. Furthermore, supporting action against transplant tourism also helps to prevent the predatory nature of organ harvesting in foreign countries. Through leading by example, Canada can shape the landscape of organ donation and transplantation to reduce stigma and increase transparency.

References

  1. https://www.tandfonline.com/doi/full/10.1080/10410230701805158?casa_token=LmBC61fRFCYAAAAA%3AvDV9_PSx7XDxM5w1l2FzozJWBIf2Kzut1ofqB3474VniC2mKZ9zGt4m5qHMemdOsZg3-tWvk2-UVTA
  2. https://journals.sagepub.com/doi/full/10.1186/2054-3581-1-7
  3. https://journals.lww.com/transplantjournal/Fulltext/2017/01000/Public_Solicitation_of_Anonymous_Organ_Donors__A.8.aspx?casa_token=VpB3kg0YU6QAAAAA:bCoeuYiFG9_y1fpYYipOb_1vfsKt0-HBmvua9WBxFnSAWlYCAoNgx05s3f745s2eEFZvrme6eOoKLoLUHMcgvCwd
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191195/
  5. https://journals.lww.com/transplantjournal/FullText/2010/10270/Policy_Statement_of_Canadian_Society_of.3.aspx? casa_token=pB8m1JbFzEUAAAAA:PublEE1SiivokE0SA2qlkrgSClai0DlxN-a3W6CIGkXoplDFylIzXehIxtpMsHbOk3xFOwwnBEAUzP2Xoy_y0_7R

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