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Organ Donation: A Double-Edged Sword

Reason is the natural order of truth; but imagination is the organ of meaning. - C. S. Lewis

Organ donation is one of the crowning accomplishments of medical science in the twentieth century, and it has saved the lives of countless people. The swift recovery of life-saving organs is a complicated procedure that requires the collaboration of a team of experts. Organ donation can legally come from live, genetically linked people; living, unrelated people in specific cases when there is no improper payment to the donor; or cadavers.

The first live donation of a single kidney took place in 1954, however live donation of organ components is a more recent idea from the 1990s. The scarcity of organs can be attributed to a number of Factors. People are often afraid to give organs, which is one of the most prevalent reasons. There are also other reasons: for example, clinicians may fail to ask family members if they would consent to organ donation if their loved one died. In other circumstances, persons in a position to deliver on the deceased's desires to donate his or her organs may be unaware of those requests.

The purpose of this article is to examine the idea of organ donation, organ donors, legal considerations, the procedure of pledging organs by a living person, the current situation in India, and whether an organ market or in simple terms selling of organs be legalised in India.

Introduction
A physician is obligated to consider more than a diseased organ, more even than the whole man - he must view the man in his world.- Harvey Cushing

Organ transplantation is the process of transferring an organ from one body to another. The person who donates the organ is known as the donor, and the person who gets it is known as the receiver. Organ transplantation is a procedure that replaces a damaged organ in the recipient with the donor's functional organ, allowing the recipient to function properly. Organ transplantation is a gift to the medical business since it has saved the lives of people who might otherwise have died. Human organs are in high demand for transplantation. In reality, the demand for transplantable organs significantly outnumbers the supply.

As a result of this imbalance, several laws have been enacted in an attempt to govern scarce resources transplantable human organs and to provide an equitable system for allocating organs where they may do the most benefit. Until now, cadaveric donors have been the primary source of organs and tissues in the Western world. When living tissue loses its blood supply, it deteriorates quickly, thus organs must be refrigerated and transferred within a few hours for transplantation into the recipient. The acknowledgement of brain stem death' as death allowed for a quick transfer time, which required removing organs from beating heart' donors.

The demand for organs is increasing across the world, but the availability of organs and tissues for transplantation is not keeping up. Only about 900 people in the UK become organ donors each year, despite the Fact that over 6000 people are waiting for eligible organs. In the United States, there is a similar problem, with 70 000 people on the waiting list and only around 5500 cadaveric donors per year.

Organ donation is now governed by three primary legislative systems across the world. Opting-in' systems exist in the United Kingdom, as well as a number of European nations, such as Germany and Italy, as well as Canada, Australia, and New Zealand. This implies that the person who has legal custody of the corpse can provide permission for organs and tissues to be removed. In practise, the deceased's next-of-kin is generally asked for a contribution.

Many other nations, such as Austria, Belgium, and Singapore, have implemented opt-out or presumptive consent procedures, which assume that individuals have given their approval for their organs to be donated in advance of death unless they express otherwise. A required request, or routine inquiry of a potential donor's next-of-kin, is part of state legislation in the United States. It stipulates those hospitals who do not comply with the required request policies will be refused money from healthcare funding bodies.

History Overview
The human voice is the organ of the soul.- Ferdinand Foch

In comparison to the world's most industrialised countries, India has a far shorter history with organ transplantation. In the 1970s, India was the first country to undertake a kidney transplant. In the 1980s and early 1990s, transplantation activity increased, but it was mostly limited to live donor kidney transplants in a few major regions.

Kidney transplantation activities gradually expanded as additional facilities opened and the number of skilled personnel grew. However, this resulted in the well-known kidney trade in India in the 1980s, which received widespread media attention. Patients from all over the world began flocking to India for transplants from a paid donor.

In 1991, in response to the growing kidney scandal in India, the Central Government formed a committee to produce a report that would serve as the foundation for legislation controlling organ transplantation throughout the country. It was also done in order to provide a clearer explanation of the phrase brain death.

The Transplantation of Human Organs Act (THOA) was passed by the Indian government in 1994. Furthermore, in 1995, the Transplantation of Human Organs Rules were changed, expanding the scope of donation and adding tissues for transplantation. The act made organ marketing illegal and formalized the idea of brain death in India, allowing for deceased organ donation from brain stem dead people.

Because locating a live donor is an ad hoc procedure that relies heavily on the efforts of the potential recipient, government monitoring of the process is minimal. Living organ donation has generally been the duty of individual transplant hospitals[2]. Although the Organ Procurement and Transplantation Network (OPTN) has gathered and evaluated data on deceased donors, it has very little information on the living donation procedure and its long-term impact on living donors.

One reason for this disparity might be that the National Organ Transplant Act of 1984, which formed the OPTN, did not include a provision for live donation. Living gift was not as important a part of total donation at the time as it is now. As a result, there are significant gaps in the data on live donation and its repercussions on donors.

In recent years, living donation has grown more common (Figure 9-1), with notable increases in the number of unrelated donors over the last ten years (Figure 9-2). Over 77,000 people were killed between 1988 and December 2005[3].

The most common organs donated by living donors are kidneys, which accounted for 95% of the organs transplanted in 2005. (OPTN, 2006). About 20% (1,812 kidneys) of the 8,873 kidneys transplanted in 1988 were from living donors (OPTN, 2006). In 2005, a total of 16,477 kidney transplants were done, with 9,915 (60.2%) of the operations coming from deceased donors and 6,562 (39.8%) coming from live donors (OPTN, 2006).

Risk-Benefit Ratios
Science is a beautiful gift to humanity; we should not distort it.- A. P. J. Abdul Kalam
The ethical rationale for using organs from live donors starts with weighing the possible advantages, mostly to the recipient but also to the donor, against the dangers to the donor, which are measured in terms of both the likelihood and amount of damage. Before a potential live organ donor takes the choice to give, he or she should have a thorough awareness of the risks and potential advantages of doing so.

However, as this chapter will demonstrate, the information provided to potential donors to help them understand the dangers is often insufficient since, for example, the long-term health effects of living donation, particularly for nonrenal organs, are still being researched.

The Fact that the donor faces practically all of the hazards complicates calculating a risk-benefit ratio for living organ donation. The receiver, on the other hand, is the main beneFactor due to the shorter time it takes to get an organ, increased survival, and enhanced health and quality of life if the transplant is successful.

A secondary beneficiary might be the donor, who would benefit from the psychosocial advantages of donating an organ to someone in need. In other words, the live donor accepts the dangers of major surgery for the benefit of another person's health, as well as any psychosocial advantages[6]. In this case, doing a risk-benefit analysis is hard and challenging. Nonetheless, the transplanting group, as well as, ideally, an unbiased donor advocacy team, must make a decision on the risk-benefit ratio's acceptability for specific potential donors, who must also make their own decision. Before continuing, the transplantation team and donor advocacy team must be satisfied with the risk-benefit ratio.

For example, they may consider the dangers to a possible donor to be excessive because of a prior medical condition, such as a disease that increases the probability that his or her remaining kidney would fail in the future. The donor must also consider information about the potential recipient's medical condition and the likelihood of a successful transplant.

Even if these groups believe that the risk-benefit ratio is appropriate, the potential donor, whose subjective assessment is critical to the choice, must make his or her own decision. The contribution is ruled out if either side makes a negative decision. Nonetheless, the decision of the possible donor is frequently influenced by his or her connection with the potential receiver, at least in part.

Live donors frequently claim that exercising their choice to become a living donor has provided them with significant psychological and social advantages. The kind of advantages that are expected and actually experienced differ to some extent depending on the sort of relationship that exists between the donor and the recipient. Donors may sense greater self-esteem for making such a gift, appreciation from the recipient, admiration from others, and so on when they are biologically and emotionally linked to the receiver. Similarly, even if the donor is unrelated to the receiver, donors may gain satisFaction from doing a selfless deed and earn acclaim from others[7].

Due to a lack of data on the health outcomes of live donation, it is difficult for transplantation teams, independent donor advocacy teams, and prospective donors to conduct studies and assessments of risks, benefits, and risk-benefit ratios. Even among the more than 67,000 live donors who donated a kidney between 1998 and 2004, evidence on short-term health outcomes is lacking, and there has been insufficient long-term follow-up to evaluate the physical and mental implications of living donation over time[8].

The number of persons who require a kidney transplant after donating a kidney is an example of the necessity for follow-up statistics; as of 2002, a review of the OPTN database revealed 56 live donors who had had a kidney transplant or were on the renal transplant waiting list[9].

Nonetheless, the risk-benefit ratio appears to be highly dependent on the organ or organ part to be given, based on the currently available data, because the risks of death and morbidity as a result of donation vary substantially depending on the organ or organ portion to be donated. The risk-benefit ratio is also influenced by the motive of the donor, which is linked to the type of connection between the donor and the beneficiary.

A highly motivated donor may gain large psychological benefits from his or her contribution, making him or her willing to take on greater risk. Complications can arise during the donor workup, during and immediately after surgery, or long after donation, regardless of the organ that is donated.

Status Of Organ Donation In India

However good a Constitution may be, if those who are implementing it are not good, it will prove to be bad. However bad a Constitution may be, if those implementing it are good, it will prove to be good.- B. R. Ambedkar

Organ donation in India is at an all-time low, with over 10 lakh individuals waiting for corneal transplants, 50,000 for heart transplants, and 20,000 for lung transplants. This is especially terrible given the Fact that single organ donor can save up to nine lives by donating up to 25 different organs to individuals in need. The transplant waiting lists in India are becoming longer by the day.

Organ donation is permitted in India under the Transplantation of Human Organs Act (THOA) of 1994, which also legalises the idea of 'brain death,' or the complete loss of all brain functions. Although a person cannot sustain life after brain dead, crucial bodily functions can be preserved in an ICU. Such patients are kept on artificial life support in order to keep their organs healthy.

Brain death differs from coma, which is a deep state of unconsciousness in which the brain continues to operate without assistance. A person will not be pronounced brain dead if there is any activity in the brain.

Before organs may be taken in India, a panel of four physicians - a medical administrator, an accredited specialist, a neurologist, and the doctor treating the patient must collectively proclaim someone brain dead. After then, a battery of tests is carried out to confirm brain death.

An ICU is needed to diagnose a brain death donor since it has the resources to keep the patient's other organ systems alive. However, there is a shortage of such ICUs, which are mostly concentrated in major cities. These are already overworked, understaffed, and operate without a centralized command structure. So, on one hand, there is a dying patient, and on the other, there is a patient who is already dead but requires special treatment in order to successfully retrieve body organs. As a result of this condition, medical practitioners instinctively place a lower emphasis on the brain-dead patient.

Obtaining consent (informed consent) from family can be a difficult process. The doctor in charge of the therapy may not be sufficiently motivated to obtain such approval from the families. In other circumstances, the patients may be without family or may not be present when the brain death diagnosis is made. Although the Act grants the medical practitioner the ability to remove organs for donation if the body is not claimed by its family within 48 hours after death.

If the person's family are found after the time period has passed and protest to the act, it might be a major issue. Furthermore, organ donation is not a choice made by a single relative, and the whole family may require persuading, resulting in the loss of critical time. Transplantation is a time-consuming and costly procedure for which there is no government financing. The majority of dead donation occurs in the private sector, according to reports.

Furthermore, many donors and receivers come from private facilities. This creates an imbalance in terms of accessibility, regardless of their capacity to pay, because the bulk of organs are now going to the wealthy, while the poor do not have the same opportunity.

Legal Position Of India In Organ Donation

Excellence is a continuous process and not an accident. - A. P. J. Abdul Kalam

The following are the key sections of the THO Act and the recently passed Gazette by the Government of India
  1. For live donation, it establishes who is eligible to contribute without having to go through any legal hoops. Mothers, fathers, siblings, sisters, sons, daughters, and spouses are all permitted to give. Grandparents have just been included to the list of first cousins in the new Gazette. The first cousins must show confirmation of their link through genetic tests and/or legal documentation. If there are no immediate relatives, the receiver and donor must seek special approval from a government-appointed authorization committee and appear in front of the committee for an interview to establish that the motivation for the donation is entirely altruistic or affectionate for the recipient.
     
  2. The following criteria are used to determine brain death and its declaration: Six hours apart from doctors, two certificates are necessary, two of which must be doctors recommended by the relevant government body, with one of the two being a neurology specialist.
     
  3. In each state or union territory, an Authorization Committee (AC) and Appropriate Authority (AA.) are formed to regulate transplant activity.

    Each has a distinct function to play, as follows:
    1. The Permission Committee (AC) has the responsibility of regulating the authorization procedure to accept or reject transplants between the recipient and non-first-degree relatives. The committee's major responsibility is to guarantee that the donor is not exploited for monetary gain by donating their organ. The recipient and donor's combined application is investigated, and a personal interview is required to convince the AC of the donor's real motivation for donation and to verify that the donor is aware of the surgery's possible dangers. The affected hospitals get notification of approval or rejection by mail.
       
    2. The goal of the Appropriate Authority (AA) is to control the removal, storage, and transplantation of human organs. Only after receiving a license from the authorities is a hospital allowed to engage in such operations. The removal of eyes from a donor's dead corpse is not controlled by such an entity and can be done at any location without the need for a license. The AA's powers include inspecting and registering hospitals for transplant surgery, enforcing the required standards for hospitals, conducting regular inspections of hospitals to examine the quality of transplantation and follow-up medical care of donors and recipients, suspending or cancelling the registrations of erring hospitals, and investigating complaints for violations of the Act's provisions[10].

Punishment Under The Act:
According to Section 18 of this Act, anybody who is responsible for the removal of a human organ or tissue with the right to do so can be sentenced to ten years in jail and a fine of up to Rs. 20 lakhs. If that individual is a medical practitioner, the AA will report his name to the State Medical Council, which will take necessary measures, such as deleting his name from the council's register for three years for the first infraction and irreversibly removing it if he/she commits another offence.[11]

If a person engages in the commercial trading of human organs, he or she can be sentenced to a term of imprisonment of not less than 5 years, but not more than 10 years, as well as a fine of not less than Rs. 20 lakhs, but not more than Rs. 1 crore, according to Section 19.

In accordance with Section 20. Any individual who breaches any other provision of this act can be sentenced to up to 5 years in jail or fined up to Rs. 20 lakhs.

Myth Or A Fact?
I don't believe in funerals. I believe in celebrating life, and showing people, while they're alive, how much I care about them. And I don't believe in this business of burial. I'm an organ donor. Whether it's my skin or my eyeballs, use whatever bits are intact and put the rest in the garbage. - Carmen Dell'Orefice
  1. Myth: If Physicians Discover I'm A Donor, They Won't Attempt To Save My Life.
  2. Myth: If Physicians Discover I'm A Donor, They Won't Attempt To Save My Life.
  3. Myth: I Can't Donate Because Of My Medical Condition.
  4. Myth: It's My Choice, And I Don't Want My Family To Know About It.
  5. Myth: I'm Afraid I Won't Be Dead Long Enough For The Physicians To Harvest My Organs.
  6. Myth: Doctors Will Chop The Body, Rendering It Unsuitable For Cremation Or Burial.

  1. Fact: A doctor's primary concern is to preserve your life. It's secondary whether you're a donor or not.
  2. Fact: Only a few medical disorders render a donor's organs ineffective. Doctors can decide what organs can be utilised after you're dead based on the organs you've agreed to give.
  3. Fact: If you choose to be an organ donor, it is critical that your family understands and accepts your decision. Emotions are strong at the time of death, so your loved ones should be aware of your decision to allow surgeons to take your organs.
  4. Fact: Before organs may be removed, a panel of four specialists must designate the deceased as brain dead.
  5. Fact: When it comes to incisions, transplant specialists take great care to ensure that they do not disfigure the body.

Donation Or Sales?

The value of life is not in its duration, but in its donation. You are not important because of how long you live, you are important because of how effective you live.- Myles Munroe

The Fact that the organ is being sold or, at the very least, that financial motivations partially motivate the donation is a common ethical problem in live unrelated donation. Concerns about solicitations over the Internet, for example, have developed[12]. Money may also play a role in living-related gifts. Under Section 301 of the National Organ Transplant Act, "it shall be criminal for any individual to intentionally purchase, receive, or otherwise transfer any human organ for valued remuneration," regardless of the circumstances[13].

Compensation for live donors raises the danger of abusing the impoverished and underprivileged, as well as the risk of potential donors withholding crucial medical information.
The committee's grounds for rejecting a market in deceased individuals' organs[14] apply even more forcefully to a market in live people's organs.

Despite the Fact that some experts suggest that paying persons as much as $90,000 for a kidney for transplantation would be practical and cost-effective, and even propose changes in the legislation to allow such a payment in a controlled market, these arguments remain valid[15].

These proposed measures have still yet to gather momentum in the United States since they are irreconcilable with the fundamental ideas of morality that regulate transplantation[16], and because international markets in living individual organs appear to involve the exploitation of comparatively impoverished people, inadequately notified and possibly manipulated consent, while also, in many cases, harmful repercussions for both sellers and purchasers.

Despite the Fact that the direct sale of organs has been deliberated for centuries, most national and international government organisations and professional societies have denounced it citing concerns about human rights violations, the incapability of ability to rapidly informed consent, and the enslavement of vulnerable people, who are often vulnerable due to poverty[17].

Even though some argue that a controlled market would be a superior alternative than restriction, sceptics question that it would be able to avoid all of the bad repercussions. Furthermore, they are concerned about the societal impact of organ commercialization on human dignity.

These ethical problems also apply to organ markets that function in other nations, often illegally, and draw a global clientele[18].

Goyal and colleagues[19] performed a cross-sectional study of 305 people who had sold one of their kidneys in Chennai, India. Ninety-six percent of individuals polled said they were motivated by debt relief; yet, selling a kidney did not provide any long-term financial advantage toward those polled. The study found that family income had dropped by one-third, and the majority of participants were still in debt and living below the poverty line at the time of the survey[20]. Eighty-six percent of those polled said their health had deteriorated as a result of the nephrectomy.

Aside from the hazards to kidney sellers, so-called medical tourism frequently causes complications for kidney purchasers. A 2005 study of the health outcomes of 16 people[21] 10 years after purchasing organs from living unrelated donors mostly from India found comparatively poor consequences and several deaths due to severe pulmonary infections caused by sepsis, hepatitis B with liver cirrhosis, and other comorbidities.

Two patients died in the first month following transplantation, and two more died at the end of the first year[22]. All other ethical concerns aside, these findings show that the surgical and medical risks associated with such transplanting methods may exceed the benefits[23].

Current Scenario In India
It does not matter how much we donate; it matters whether the donation is meaningful. How to define meaningful? Let society and history judge. - Ronnie Chan

Despite the Fact that it was approved 15 years ago, the THO act has had no effect on organ trade or on the promotion of the dead donation programme to address the organ shortage. The global gap between the quantity of organs available and the number of patients joining the kidney transplant waiting list is expanding. Organs have become commodified as a result of strong demand, particularly in nations with a considerable proportion of the population living below the poverty line and weak regulatory agencies.

Many foreign organizations have expressed concern about the consequent transplant tourism. Due to the large frequency of fatal road traffic incidents in India, the potential for dead donation is enormous, and this pool has yet to be explored. In the country, only a few institutions and devoted NGOs have demonstrated that corpse donation is a viable alternative.

How About: An Organ Market?

I think the city is the strongest social memory organ of humanity.- Emir Kusturica

One of several reasons against making the purchase and sale of organs legal is that it would inevitably lead to a society in which only the wealthy could benefit from life-saving organ transplants, and the poor would be the primary donors of those organs. Presently, the US system guards against this inequity by neither paying or charging individuals for organs, and only giving organ transplants to people on a first-come, first-served basis.

This implies that no matter how wealthy or impoverished a person is, they will have the same probability of obtaining an organ transplant as the next person. When an organ market exists, it generates an exploitative dynamic between the affluent and the poor, in which the destitute sell their organs and are frequently underpaid. This is one of the main reasons why the World Health Organization has urged countries to prohibit Transplant Tourism.

Due in large part to the process of transplant tourism, it has grabbed the attention of the world community as a fundamentally exploitative activity. This is because it frequently occurs in such a way that the poor sell their organs for a low price to a middleman, who then sells the same organs for a high price to wealthy buyers.

Prominent surgeons are urging the government to investigate the benefits of legalising the organ transplant industry. The physicians argue that a public debate on enabling patients to sell their organs will help them to make a more informed decision on a topic of such moral and medical importance.

Thousands of people's lives might be at risk if a suitable donor cannot be discovered in time. 8,000 individuals are on the transplant waiting list, with more than 500 dying each year before receiving an organ, and the number is growing at an annual rate of 8%.

However, there are considerable fears that offering rewards for those who donate their organs will put impoverished and vulnerable people under a lot of pressure to sell a part of their body to solve their financial issues.

Eighteen individuals die every day while waiting for an organ transplant. There are currently over 113,000 persons on the waiting list for a life-saving transplant[24]. Organ transplants are an advanced medical marvel in which a diseased one from one person is substituted with a healthy organ from a donor. Kidneys, corneas, lungs, skin, and pancreases are just a few of the organs that can be transplanted[25].

When an organ fails, the patient is placed on a waiting list for a replacement organ. As additional organs become available, a corresponding system distributes them based on Factors including genetic compatibility, location, and condition.

Kidneys are the most often required organ, with a median wait period of 3.6 years[26]. However, for many others, this is simply too lengthy. The person is reliant on dialysis as they wait for a replacement kidney.

Many variables make receiving a transplanted organ in the United States exceedingly challenging. To begin, it can cost between $5,000 and $20,000 for a living individual to donate an organ, and the donor will have to miss around six weeks of work. Furthermore, several chronic illnesses, like as high blood pressure and obesity, restrict the great majority of Americans from donating[27].

Obtaining an organ is even more difficult under current regulations. Organ donors are not entitled to receive remuneration under the National Organ Transplant Act (NOTA), which was established in 1984. Although the rule was meant to prevent at-risk and destitute people from selling their organs for a quick buck, it has also created hurdles to people receiving the organs they sorely need[28].

As a result, persons in desperate need of organs are compelled to hunt for a life-saving donation elsewhere. A black market has evolved as an alternate method of obtaining an organ, with one kidney fetching upwards of $200,000 on the underground market. According to the World Health Organization, at least 10% of kidney transplants are the result of black-market transactions[29].

The organ black market preys on the poor and weak who believe they have no option but to sell their organs. These people are solicited by "brokers," who take a large charge for facilitating arrangements between potential donors and recipients. Brokers make huge promises to donors, but after the procedures, they learn they were duped on their money and are uninformed of the procedure's negative effects[30].

The organ black market wants to take advantage including both folks who are in desperate need of life-saving transplants and poor people that will do anything to survive financially.
There has been discussion on how to tackle the rising problem and apparently endless scarcity of organs due to the challenges that both present legal methods of organ donation and the black-market face. One option is to make the voluntary purchase and sale of organs lawful in the United States.

Conclusion
The Constitution was the expression not only of a political faith, but also of political fears. It was wrought both as the organ of the national interest and as the bulwark of certain individual and local rights.- Herbert Croly

One of the most significant advances in medical science and technology is organ transplantation. However, not everyone will be able to reap the benefits of this achievement. In its current form, cadaveric donation in India mostly favours the wealthy and supports only a small fraction of patients who seek it. It has also resulted in underprivileged people being exploited.

As a result, while we should strive to increase contribution rates, we must not lose sight of the overall picture. Many of the concepts and methods used in modern dead donor transplantation come from the industrialised West, where societal values and health systems differ from those in India. We need to create an egalitarian, open, and non-oppressive framework in India. This will be a long and difficult process, one that may be linked to the larger fight for a more modern and accessible healthcare system for all.

End-Notes:
  1. *
  2. Steinbrook, 2005
  3. Abecassis M, Adams M, Adams P, Arnold RM, Atkins CR, Barr ML, Bennett WM, Bia M, Briscoe DM, Burdick J, Corry RJ, Davis J, Delmonico FL, Gaston RS, Harmon W, Jacobs CL, Kahn J, Leichtman A, Miller C, Moss D, Newmann JM, Rosen LS, Siminoff L, Spital A, Starnes VA, Thomas C, Tyler LS, Williams L, Wright FH, Youngner S. 2000. Consensus statement on the live organ donor. Journal of the American Medical Association 284(22):29192926.
  4. Figure 1- HRSA and SRTR (2006, Table 2.8).
  5. Figure 2- HRSA and SRTR (2006)
  6. Spital, 2004
  7. Spital, 2004
  8. Ellison et al., 2002; Matas et al., 2003; Davis and Delmonico, 2005; Ingelfinger, 2005
  9. Ellison et al., 2002
  10. Goyal M, Mehta RL, Schneiderman LJ, Sehgal AR. 2002. Economic and health consequences of selling a kidney in India. Journal of the American Medical Association 288(13):15891593.
  11. Gilbert JC, Brigham L, Batty DSJ, Veatch RM. 2005. The nondirected living donor program: A model for cooperative donation, recovery and allocation of living donor kidneys. American Journal of Transplantation 5(1):167174.
  12. Steinbrook, 2005
  13. Public Law 98-507
  14. https://www.nap.edu/read/11643/chapter/1
  15. Matas and Schnitzler, 2003; Matas, 2004.
  16. Delmonico et al., 2002
  17. Marshall and Daar, 1998
  18. Scheper-Hughes, 2000
  19. 2002
  20. on average, 6 years after they had sold their kidney
  21. mostly from Macedonia
  22. Ivanovski et al., 2005
  23. Ivanovski et al., 2005).
  24. "Transplant Trends" (ND) United Network of Organ Sharing. https://unos.org/data/transplant-trends/
  25. "Organ Donation and Transplantation" (2 Feb 2017). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/11750-organ-donation-and-transplantation
  26. "Organ Donation and Transplantation Statistics" (ND) National Kidney Foundation. https://www.kidney.org/news/newsroom/Factsheets/Organ-Donation-and-Transplantation-Stats
  27. Collins, Sam. "Why More Than 120,000 Americans Can't Get The Organ Transplant They Need." (20 Nov 2014). Think Progress. https://thinkprogress.org/why-more-than-120-000-americans-cant-get-the-organ-transplant-they-need-a7db72f8bfac/
  28. Fry-Revere et al. "America's Organ Transplant Law Is Criminally Unfair to Donors" (23 Oct 2014) The New Republic. https://newrepublic.com/article/119963/us-organ-transplant-law-needs-reform-let-donors-get-reimbursed
  29. Wagner, Lindsey. "Organ Trafficking: More Than Just a Myth" (11 Nov 2014). The University of Utah. https://law.utah.edu/organ-trafficking-more-than-just-a-Myth/
  30. Prochertchoo, Pichayada. "Kidney for Sale: Inside Philippines'' Illegal Organ Trade" (19 Oct 2019) Channel News Asia. https://www.channelnewsasia.com/news/asia/kidney-for-sale-philippines-illegal-organ-trade-12007722
Lavanya Ajaykumar Panicker - Student at DY Patil Deemed to be University School Of Law, Navi Mumbai, India & pursuing BA-LLB (hons)

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