The shortage of organs for transplantation is a universal problem. The supply of organs is way below the demand. And demand is increasing due to progress in medical science and increasing average age. The demand comes mainly from developed countries. The reason is that life expectancy is higher in these countries, and therefore also the demand for organs. Also, the health care system is more developed and hence more likely to engage in transplants.
There are two ways to harvest organs: deceased organ donation, and live organ donation.
Deceased organ donation
In some countries, deceased organ donation is hampered by social, cultural, religious, legal and other factors. In some cases, donors have to state their intent while living. They have to opt in. In other cases, they have to opt out and hence they are donors by default, which tends to produce higher rates of donation.
In other cases still, family members of the deceased have to consent, which brings down rates.
Live organ donation
The use of live donors for non-vital organs such as kidneys and parts of liver, for example, is also practiced, but the purchase and sale of transplant organs from live donors are prohibited in many countries.
Transplant tourism and international organ trade
The shortage of a local supply of organs – due to some of the reasons given above, or a combination – has led to the development of transplant tourism and international organ trade. Poor people in developing countries are often forced to donate a non-vital organ; forced by poverty or forced by outright violence. People are kidnapped and operated under duress, and often don’t even get paid. Sometimes they simply get killed because this bypasses the requirement of consent. Corpses are also harvested, not rarely without the consent of the deceased or his or her relatives. The legality of live organ donations in some countries encourages poor people to sell some of their non-vital organs such as kidneys. However, the circumstances in which they are operated can turn a non-vital organ donation into a fatal one.
Rich people travel to countries where these different kinds of harvesting are possible, legally or illegally, and where hospitals are willing to cooperate in such a scheme and are relatively capable so as not to scare away patients. China is a well-known destination because there’s the enormous supply of thousands of people executed every year.
Although those who can afford to buy organs are obviously exploiting those who are desperate enough to sell their organs, the recipients may also suffer from the trade. They may receive substandard or even sick organs.
Some contend that the poor should be allowed to sell their organs, because we merely contribute to their poverty. Exploitation may be morally preferable to death, but given the risk of forced donation and of complications during surgery, this is a slippery slope.
Someone has aptly called the whole business New Cannibalism.
One can also see a trend to declare a person dead at an earlier stage than in the past, for example some seconds after cessation of brain activity or heart activity, rather than minutes. Some organs become useless after a certain waiting period. This means shifting the definition of life and death, and perhaps less reanimation enthusiasm. Another, and opposite form of abuse is keeping brain-dead people artificially “alive” as an “organ warehouse” for future donations.
Also, the use of cloning and designer babies for the purpose of organ production is controversial, as is the use of animal organs.