TRANSPLANT TOURISM AND ORGAN TRAFFICKING

1. TRANSPLANT TOURISMAND ORGAN TRAFFICKING E2 GUS 2010

2. E2 (22) AchmadShidiq DillaAprilia Dimas Setiaji DiniDesmona Monika Hasna MutiaAyu NadyaIswandari NoerOlivy NurAfifah Tara Zhafira WulanDwiSakinah

4. Market and Demand

5. 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.

6. The Gap is Widen Data from optn.transplant.hrsa.gov and OPTN/SRTR Annual Report.** Data include deceased and living donors

7. I need the kidney, I have the money I have the kidney, I need the money

11. 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.

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

13. 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 apotential to be misused need a regulation, ethically and legally.

14. International Convention and National Regulation The Declaration of Istanbul on Organ Trafficking and Transplant Tourism WHO Guiding Principleson Human Cell, Tissue, and Organ Transplantation UU No 23 Tahun 1992 PP No 18/1981

15. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism “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.”

16. WHO Guiding Principleson Human Cell, Tissue, and Organ Transplantation Guiding Principle 5 Cells, tissues and organs should only be donated freely, without any monetary payment or otherreward of monetary value. Purchasing, or offering to purchase, cells, tissues or organs fortransplantation, 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 reimbursingreasonable and verifiable expenses incurred by the donor, including loss of income, or paying the costsof recovering, processing, preserving and supplying human cells, tissues or organs for transplantation.

17. UU No 23 Tahun 1992 Pasal 33 • Dalampenyembuhanpenyakitdanpemulihankesehatandapatdilakukantransplantasi organdanataujaringantubuh, transfusidarah, implanobatdanataualatkesehatan, sertabedahplastikdanrekonstruksi. • Transplantasi organ danataujaringantubuhsertatransfusidarahsebagaimanadimaksuddalamayat (1) dilakukanhanyauntuktujuankemanusiaandandilaranguntuktujuankomersial. Pasal 34 • Transplantasi organ danataujaringantubuhhanyadapatdilakukanolehtenagakesehatan yang mempunyaikeahliandankewenanganuntukitudandilakukandisaranakesehatantertentu. • Pengambilan organ danataujaringantubuhdariseorangdonor harusmemperhatikankesehatan donoryang bersangkutandanadapersetujuan donor danahliwarisataukeluarganya. • Ketentuanmengenaisyaratdantatacarapenyelenggaraantransplantasisebagaimanadimaksuddalamayat (1) danayat (2) ditetapkandenganPeraturanPemerintah.

18. PP No 18/1981 BAB V TRANSPLANTASI ALAT DAN ATAU JARINGAN TUBUH MANUSIA Pasal 10 • Transplantasialatdanataujaringantubuhmanusiadilakukandenganmemperhatikanketentuan-ketentuansebagaimanadimaksuddalamPasal 2 huruf a danhurufb. • TatacaratransplantasialatdanataujaringantubuhmanusiadiaturolehMenteriKesehatan. Pasal11 (1) Transplantasialatdanataujaringantubuhmanusiahanyabolehdilakukanolehdokteryang bekerjapadasebuahrumahsakityang ditunjukolehMenteriKesehatan. (2) Transplantasialatdanataujaringantubuhmanusiatidakbolehdilakukanolehdokter yang merawatataumengobatidonor yang bersangkutan. Pasal 12 Dalamrangkatransplantasipenentuansaatmatiditentukanoleh2 (dua) orangdokteryang tidakadasangkut-pautmedikdengandokter yang melakukantransplantasi. Pasal 13 PersetujuantertulissebagaimanadimaksuddalamPasal 2 huruf a, Pasal 14, danPasal 15 dibuatdiataskertasbermateraidengan 2 (dua) orangsaksi.

19. PP No 18/1981 BAB VIII PERBUATAN YANG DILARANG Pasal 17 Dilarangmemperjualbelikanalatdanataujaringantubuhmanusia. Pasal 18 Dilarangmengirimdanmenerimaalatdanataujaringantubuhmanusiadalamsemuabentukkedandariluarnegeri. Pasal 19 LarangansebagaimanadimaksuddalamPasal 17 danPasalPasal17 18 tidakberlakuuntukkeperluanpenelitianilmiahdankeperluan lain yang ditetapkanolehMenteriKesehatan.

20. To which person will you give the kidney? Why?

21. Conclusion • Organ transplant  tindakan yang mulia, tapihanyabolehdilakukandenganconsentdari donor danmemperhatikanrisiko donor, efektivitaspendonoran, kemungkinankeberhasilanpadapenerima, sertaadatidaknyaunsur “jualbeli” ataukomersialisasididalamnya. • Secara legal, Indonesia bersamanegara lain menentangadanyaorgan traffickingmaupuntransplant tourism.

22. Thank you!  “we make a living by what we get, but we make a life by what we give” -Winston Churchill

23. 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