Redirecting Human Organs to the Third World

The latest edition of The Lancet reports on an organ transplantation scandal from Germany.

A transplant surgeon, for the moment known only as Aiman O., diverted human livers for transplantation from Germany to Jordan and Oman. He also gave false addresses in Germany to Jordanian patients so that they might receive transplants in Germany.

The Lancet does not report Aiman O.’s motives, whether pecuniary (as seems most likely) or otherwise. But an important aspect of the scandal is that the authorities in Germany were alerted to the surgeon’s activities seven years before they acted to curb them, by which time a further 20 cases had come to light. Public trust in oversight of the German transplant system has plummeted.

But what exactly was wrong with Aiman O.’s conduct, assuming that as many people’s lives have been saved by it as if he had obeyed the rules laid down by the German law?

There are, after all, those who believe that there ought to be a market in human organs: that livers, kidneys, etc., ought to go to the highest bidder. But they probably also believe in an open market, not a restricted one such as that in which Aiman O. operated (if, that is, he operated in one at all). He would have been, in effect, insider trading.

But what if Aiman O. derived no financial benefit from his conduct, and acted in an economically disinterested fashion? What would have been wrong with his conduct in this case? After all, the doctrine of medical ethics is that all human life, with perhaps a few exceptions which do not apply here, is equally sacred, that all men are born morally equivalent. From the point of view of medical ethics, therefore, it does not matter whether a life is saved in Outer Mongolia or next door.

The Lancet itself is a strong proponent of this view, at least to judge by the proportion of its attention it devotes to the health and disease problems of the Third World, where only a small proportion of its readers and subscribers live and practice. The very edition in which the scandal is reported carried stories about the success of Niger (a Sahelian African country with a small population) in reducing its child mortality, and the need for a campaign to make anti-epileptic therapy more widely available in poor countries: very laudable, no doubt, but far from the main concerns of most of the journal’s readers.

German organ donors (or their relatives) might complain that the surgeon had broken faith with them: they had intended that the organs be used to save their fellow countrymen. But this objection is itself open to the objection that donors have no say as to the required characteristics of the recipients, for example that they should be of above average intelligence and education, or without a criminal record, much less that they must belong to a specified national, sexual, racial or religious group. They could object only that Aiman O. had himself failed to observe this neutrality by favouring recipients of one racial, geographical, or religious group. But the rules he had broken had specified that he did precisely that, albeit for a different group from the one that he actually favored.

The Lancet did not mention the possibility that the German authorities had been lax or tardy in this case precisely because of Aiman O.’s minority status. A bad historical conscience can have surprising consequences. Of course, it is also possible that incompetence, a much underestimated factor in human history, explains the failure of the German authorities.


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