Abstract
Bangladesh, a Muslim-majority country, has a national organ donation law that was passed in 1999 and revised in 2018. The law allows living-related and brain-dead donor organ transplantation. There are no legal barriers to these two types of organ donations, but there is no legislation providing necessary costs and incentive measures associated with successful organ transplants. However, many governments across the globe provide different types of incentives for motivating living donors and families of deceased donors. This study assesses the merits and demerits of incentive measures already in use around the world and proposes ethical measures that can promote organ donation in Bangladesh. The primary focus of this paper is to present an ethical analysis of the comparison of incentive measures on organ donation between Bangladesh and the Islamic Republic of Iran as two Muslim countries that operate organ donation for transplantation practices according to Islamic principles. In this paper, I mainly argue that providing a fixed bare minimum financial incentive measure to distantly related living donors and families of deceased donors will encourage Bangladeshis to donate organs in a manner that is ethically justifiable, morally permissible, and socio-economically appropriate. The government of Bangladesh should revise the existing biomedical law to include a provision related to incentive measures and set a strict policy to properly regulate these measures as key stewardship that can ethically promote organ donation for transplantation.
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References
Aksoy, Sahin. 2001. A critical approach to the current understanding of Islamic scholars on using cadaver organs without prior permission. Bioethics 15 (5–6): 461–472. https://doi.org/10.1111/1467-8519.00254.
Al-Bar, Mohammed Ali, and Hassan Chamsi-Pasha. 2015. Nonmaleficence. In Contemporary Bioethics: Islamic Perspective, 119–128. Cham: Springer. https://doi.org/10.1007/978-3-319-18428-9_7.
Atighetchi, Dariusch. 2007. Islamic bioethics: problems and perspectives. International Library of Ethics, Law, and the New Medicine, vol 31. Dordrecht: Springer.
Bagheri, Alireza. 2005. Organ transplantation laws in Asian countries: a comparative study. Transplantation Proceedings 37 (10): 4159–4162. https://doi.org/10.1016/J.TRANSPROCEED.2005.11.016.
Bagheri, Alireza. 2006. Compensated kidney donation: an ethical review of the Iranian model. Kennedy Institute of Ethics Journal 16 (3): 269–282. https://doi.org/10.1353/ken.2006.0017.
Barr, Mark L., Jacques Belghiti, Federico G. Villamil, Elizabeth A. Pomfret, David S. Sutherland, Rainer W. Gruessner, Alan N. Langnas, and Francis L. Delmonico. 2006. A report of the Vancouver forum on the care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines. Transplantation 81 (10): 1373–1385. https://doi.org/10.1097/01.tp.0000216825.56841.cd.
Cherry, Mark J. 2015. Kidney for sale by owner: human organs, transplantation, and the market. 2nd ed. Gerogetown University Press.
Council of Europe. 1997. Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: convention on human rights and biomedicine. Council of Europe https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164. Accessed on January 20, 2022.
Council of Europe. 2002. Additional protocol to the convention on human rights and biomedicine concerning transplantation of organs and tissues of human origin. Council of Europe https://www.coe.int/en/web/conventions/full-list/-/conventions/treaty/186. Accessed on January 20, 2022.
Delmonico, Francis L., and Nancy Scheper-Hughes. 2002. Why we should not pay for human organs. The National Catholic Bioethics Quarterly 2 (3): 381–389. https://doi.org/10.5840/NCBQ20022328.
Delmonico, Francis L., D. Martin, B. Domínguez-Gil, E. Muller, V. Jha, A. Levin, G.M. Danovitch, and Alex M. Capron. 2015. Living and deceased organ donation should be financially neutral acts. American Journal of Transplantation 15 (5): 1187–1191. https://doi.org/10.1111/ajt.13232.
Dhami, S., and A. Sheikh. 2000. The Muslim family: predicament and promise. The Western Journal of Medicine 173 (5): 352–356. https://doi.org/10.1136/ewjm.173.5.352.
El-Menyar, Ayman, Hassan Al-Thani, Tulika Mehta, Betsy Varughese, Yousuf Al-Maslamani, Ahammed Abdulla Mekkodathil, and Rajvir Singh. 2020. Beliefs and intention to organ donation: a household survey. International Journal of Applied & Basic Medical Research 10 (2): 122–127. https://doi.org/10.4103/IJABMR.IJABMR_108_19.
European Union. 2010a. Charter of fundamental rights of the European Union, Official Journal of the European Union. https://www.google.com/search?q=charter+of+fundamental+rights+of+the+european+union&oq=Charter+of+Fundamental+Rights+of+the+European+Union&aqs=chrome.0.0i512l10.525j0j7&sourceid=chrome&ie=UTF-8. Accessed 12 Jan 2022.
European Union. 2010b. Directive 2010/45/EU of the European Parliament and of the Council of 7 July 2010 on standards of quality and safety of human organs intended for transplantation. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32010L0053. Accessed 12 Jan 2022.
Fan, Ruiping, and Chunyan Ding. 2020. Organ donation in Mainland China and Hong Kong: learning from international models and adopting proper motivational measures. In Handbook of Public Policy and Public Administration in China, ed. Xiaowei Zang and Hon Chan, 1st ed. Cheltenham: Edward Elgar. https://doi.org/10.4337/9781789909951.
Gansen, Beth. 2002. Organ donation system: revision in three phases and counterarguments to concerns presented by proponents of the current altruistic system. Major Themes in Economics 53: 49–69. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.194.8919. Accessed 12 Jan 2022.
Ghods, Ahad J. 2002. Renal transplantation in Iran. Nephrology, Dialysis, Transplantation 17: 222–228.
Giving gifts in Islam. 2019. Islamweb.Net. https://www.islamweb.net/en/article/135329/giving-gifts-in-islam. Accessed 12 Jan 2022.
Government of Bangladesh. 1999. The Human Organ Transplantation Act. Legislative and Parliamentary Affairs Division. http://bdlaws.minlaw.gov.bd/act-details-828.html. Accessed 12 Jan 2022.
Griffin, Anne. 2007. Iranian organ donation: kidneys on demand. BMJ 334: 502–505. https://doi.org/10.1136/bmj.39141.493148.94.
Hammond, Samuel. 2018. How Iran solved its kidney shortage, and we can too. Niskanen Center, 12 September 2018. https://www.niskanencenter.org/how-iran-solved-its-kidney-shortage-and-we-can-too/. Accessed 20 Jan 2022.
Lavee, J., T. Ashkenazi, A. Stoler, J. Cohen, and R. Beyar. 2013. Preliminary marked increase in the national organ donation rate in Israel following implementation of a new organ transplantation law. American Journal of Transplantation 13 (3): 780–785. https://doi.org/10.1111/AJT.12001.
Levy, Mélanie. 2018. State incentives to promote organ donation: honoring the principles of reciprocity and solidarity inherent in the gift relationship. Journal of Law and the Biosciences 5 (2): 398–435. https://doi.org/10.1093/jlb/lsy009.
Mahdavi-Mazdeh, Mitra. 2012. The Iranian model of living renal transplantation. Kidney International 82 (6): 625–626. https://doi.org/10.1038/ki.2012.247.
Min, Lim. 2018. Living organ donation in Singapore. Asia Law Network, 5 December 2018. https://learn.asialawnetwork.com/2018/12/05/living-organ-donation-in-singapore. Accessed 20 Jan 2022.
Moazam, Farhat. 2006. Bioethics & organ transplantation in a Muslim society: a study in Culture, Ethnography and Religion. Bloomington, IN: Indiana University Press.
Moniruzzaman, Md. 2010. ‘Living cadavers’ in Bangladesh: ethics of human organ bazar. PhD Thesis: University of Toronto. https://tspace.library.utoronto.ca/handle/1807/26212. Accessed 20 Jan 2022.
Moniruzzaman, Monir. 2012. ‘Living cadavers’ in Bangladesh: bioviolence in the human organ bazaar. Medical Anthropology Quarterly 26 (1): 69–91. https://doi.org/10.1111/J.1548-1387.2011.01197.X.
Moniruzzaman, Monir. 2019. The trade in human liver lobes: bioviolence against organ sellers in Bangladesh. Journal of the Royal Anthropological Institute 25 (3): 566–586. https://doi.org/10.1111/1467-9655.13083.
Natour, Ahmad, and Shammai Fishman. 2011. Islamic Sunni mainstream opinions on compensation to unrelated live organ donors. Rambam Maimonides Medical Journal 2 (2): 1–7. https://doi.org/10.5041/RMMJ.10046.
Nuffield Council on Bioethics. 2011. Human bodies: donation for medicine and research. https://www.nuffieldbioethics.org/publications/human-bodies-donation-for-medicine-and-research. Accessed 12 Jan 2022.
Prothom, A. 2020. First-ever cadaveric kidney transplant in Bangladesh in ‘Mujib Borsho’. Prothom Alo English Desk. https://en.prothomalo.com/bangladesh/First-ever-cadaveric-kidney-transplant-in. Accessed on 20 Jan 2022.
Rashid, Harun Ur. 2014. Management of end stage renal disease -Bangladesh perspective. The Open Urology & Nephrology Journal 7: 108–112.
Rashid, Harun Ur, Mohammad Rafiqul Alam, Khanam Asia, M. Muhibur Rahman, Shamim Ahmed, Mamun Mostafi, Shakib Uz Zaman Arefin, et al. 2021. Nephrology in Bangladesh. In Nephrology Worldwide, ed. José A. Moura-Neto, José Carolino Divino-Filho, and Claudio Ronco, 221–238. Cham: Springer. https://doi.org/10.1007/978-3-030-56890-0_18.
Rizvi, S. Adibul Hasan, Anwar S.A. Naqvi, Naqi M. Zafar, and Ejaz Ahmed. 2009. Regulated compensated donation in Pakistan and Iran. Current Opinion in Organ Transplantation 14 (2): 124–128. https://doi.org/10.1097/MOT.0b013e328326f6ef.
Rodríguez-Arias, David, Linda Wright, and David Paredes. 2010. Success factors and ethical challenges of the Spanish model of organ donation. Lancet 376 (9746): 1109–1112. https://doi.org/10.1016/S0140-6736(10)61342-6.
Rosenblum, Amanda M., Alvin Ho Ting Li, Leo Roels, Bryan Stewart, Versha Prakash, Janice Beitel, Kimberly Young, Sam Shemie, Peter Nickerson, and Amit X. Garg. 2012. Worldwidevariability in deceased organ donation registries. Transplant International 25 (8): 801. https://doi.org/10.1111/J.1432-2277.2012.01472.X.
Roth, Alvin E. 2015. Transplantation: one economist’s perspective. Transplantation 99 (2): 261–264. https://doi.org/10.1097/TP.0000000000000645.
Sharp, C., and G. Randhawa. 2014. Altruism, gift giving and reciprocity in organ donation: a review of cultural perspectives and challenges of the concepts. Transplantation Reviews 28 (4): 163–168. https://doi.org/10.1016/j.trre.2014.05.001.
Siraj, Md. Sanwar. 2016. Organ donation for transplantation in Bangladesh: policy, practice and ethics. PhD Thesis: City University of Hong Kong. https://scholars.cityu.edu.hk/en/theses/organ-donation-for-transplantation-in-bangladesh-policy-practice-and-ethics(366a5c87-7c5c-48c5-a49e-19c2a3e6c55e).html. Accessed 12 Jan 2022.
Siraj, Md. Sanwar. 2020. Why is family-oriented organ transplantation policy and practice necessary for Bangladesh? Bangladesh Journal of Bioethics 11 (1): 1–8.
Siraj, Md. Sanwar. 2021a. Deceased organ transplantation in Bangladesh: the dynamics of bioethics, religion and culture. HEC Forum. https://doi.org/10.1007/s10730-020-09436-2.
Siraj, Md. Sanwar. 2021b. The human organ transplantation act in Bangladesh: towards proper family-based ethics and law. Asian Bioethics Review 13 (3): 283–296. https://doi.org/10.1007/s41649-021-00170-6.
Steering Committee of the Istanbul Summit. 2008. Organ trafficking and transplant tourism and commercialism: the declaration of Istanbul. The Lancet 372 (9632): 5–6. https://doi.org/10.1016/S0140-6736(08)60967-8.
Tober, Diane M. 2007. Kidneys and controversies in the Islamic Republic of Iran: the case of organ sale. Body & Society 13 (3): 151–170. https://doi.org/10.1177/1357034X07082257.
Truog, Robert D. 2007. Brain death - too flawed to endure, too ingrained to abandon. The Journal of Law, Medicine & Ethics 35 (2): 273–281. https://doi.org/10.1111/J.1748-720X.2007.00136.X.
WHO. 2010. Guiding principles on human cell, tissue and organ transplantation, as endorsed by the Sixty-Third World Health Assembly in May 2010 (Resolution WHA 63.22). https://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R22-en.pdf. Accessed 12 Jan 2022.
WHO-ONT. 2022. Global observatory on donation and transplantation. World Health Organization, and Organización Nacional de Trasplantes. http://www.transplant-observatory.org/. Accessed 12 Jan 2022.
Wu, Xiaoliang, and Qiang Fang. 2013. Financial compensation for deceased organ donation in China. Journal of Medical Ethics 39 (6): 378–379. https://doi.org/10.1136/MEDETHICS-2012-101037.
Zargooshi, J. 2001. Quality of life of Iranian kidney “donors”. The Journal of Urology 166 (5): 1790–1799. https://doi.org/10.1016/S0022-5347(05)65677-7.
Acknowledgements
I would like to express my gratitude to the anonymous reviewers for their insightful suggestions, which helped me improve the manuscript. A part of the writing of this manuscript was supported by the Hong Kong Government Postgraduate Studentship (UGC-allocated funds), HKSAR.
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This study was funded in part by the Hong Kong Government Postgraduate Studentship (UGC-allocated funds), HKSAR.
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Siraj, M.S. Ethical Analysis of Appropriate Incentive Measures Promoting Organ Donation in Bangladesh. ABR 14, 237–257 (2022). https://doi.org/10.1007/s41649-022-00208-3
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DOI: https://doi.org/10.1007/s41649-022-00208-3