Ethical Dilemma of Physicians Informing Patients of Foreign Organ Transplant Alternatives

Ethical Dilemma of Physicians Informing Patients of Foreign Organ Transplant Alternatives Sean Poole, OMS-II; spoole3@student.touro.edu Benjamin Selander, OMS-II; Touro bselande@student.touro.edu Joseph P. Hardy, MD, Associate Dean for Clinical Education Weldon Havins, MD, JD, LLM, FCLM, Emeritus Professor Touro University Nevada College of Osteopathic Medicine, NV Ever since the introduction of transplant surgery in the latter half of the 20th century, organ transplantation has improved the lives of thousands of people around the world. However, the demand for organs is steadily rising while the supply remains limited. This inevitably leads well-to-do individuals, placed on lengthy organ waiting lists, to seek organ transplants abroad in less ethical and less legal ways. Many procure these organs in China, where it is believed that non-consenting Falun Gong practitioners are persecuted, placed in detention centers or labor camps and illegally harvested for their organs. There are also issues of illegal brokers taking advantage of vulnerable individuals in developing nations, such as the Philippines and Moldova. However, regardless of how the organs are acquired, “organ tourists” are met with virtually no legal repercussions. The increasing need for organs has created a global issue. This practice, called “organ tourism”, has been condemned, but not criminalized, by the greater international community in the Declaration of Istanbul, created in 2008 and supported by over 150 countries. Though internationally condemned, engagement in “organ tourism” has seen an increase in recent years. There are currently no U.S. laws prohibiting organ tourism, nor are there any mandates requiring physicians to report patients who have participated in organ tourism. Therefore, physicians are faced with an ethical dilemma; in what capacity, if any, to advise their patients regarding organ transplantation abroad. This review utilizes the Army’s 7 Steps in Problem Solving Model to provide a concise and conclusive framework to determine if there exists an ethical obligation for physicians to advise their patients of foreign transplant alternatives. By following the Army’s 7 Steps in Problem Solving Model, certain guiding criteria are established, such as: non-judgmental regard and fiduciary responsibility for patients who return with transplanted organs, deterring hopeful transplant patients from involving 2021 American College of Legal Medicine JOURNAL OF LEGAL MEDICINE 2021, VOL. 41, NO. S1, 36–37 https://doi.org/10.1080/01947648.2021.1914488 themselves in organ transplant systems engaged in crimes against humanity, and considering the greater societal impact of the benefits of organ tourism. This review concludes it is the physicians ethical duty to advise their patients of foreign options to obtain organ transplantation. However, there should be no obligation to inform patients of transplant organ systems which take part in highly unethical practices, such as those considered to be participating in crimes against humanity. Future research topics are offered and encouraged. References available upon request 37