Exclusive interview with Prof. Arthur Caplan, PhD,
on unethical organ procurement and his new book REPLACEMENT PARTS
Dr. Caplan is the author, or editor, of thirty-two books, and of 600 papers in peer-reviewed journals of medicine and health policy, and has written extensively about unethical forced organ harvesting. He has served on many national and international committees and boards. He has consulted with many corporations, not-for-profit organizations and consumer organizations and served as the co-director of a United Nations/Council of Europe Study on organ trafficking.
Well known as the head of the Division of Medical Ethics, at New York University, Langone Medical Center, in New York City, Dr. Caplan is also fellow of the Hastings Center, the New York Academy of Medicine, the College of Physicians of Philadelphia and the American Association for the Advancement of Science. He is also on the Board of Trustees of the Institute for Ethics and Emerging Technologies and the AAUP Foundation.
QUESTION: What does your new book, Replacement Parts, add to the discussion of organ donation ethics, and why is it a must-read for all doctors?
Caplan: Our book brings together the latest thinking about the ethical and social dimensions of organ transplantation. Knowing the core ethical obligations of both procurement and allocation is crucial for working with patients, agencies, courts and policy makers.
QUESTION: Where are the hotspots in terms of unethical and forced organ procurement practices in the world? Do we see improvement, or a bleaching of ethical standards, given that global travel makes transplant tourism widely accessible?
Caplan: Sadly we have not emphasized the importance of ethical standards in international discussions of transplant. This has allowed pernicious practices such as trafficking and killing for parts to endure casting all of transplantation in a suspect light. That is not fair. The field must lead with its ethical commitments to protect patient and donor choice, fairness, non-profiteering, transparency and respect patient dignity and autonomy.
QUESTION: The Transplantation Society (TTS) and the Declaration of Istanbul Custodian Group (DICG) are ethically bound to insist on, and oversee, transparency and verification of global organ procurement standards. According to your research, do these organizations live up to their responsibilities?
Caplan: They try but governments and transplant programs are not bound to follow their recommendations. International groups and governments must be vigilant and enforce ethical and legal requirements to bolster what these groups do.
QUESTION: This August, China is set to host two transplant conferences. International medical organizations, e.g. TTS, WHO, and doctors from all over the world may attend. Doctors Against Forced Organ Harvesting has reservations concerning China’s unfeasible claim to build a voluntary organ donation system that yields 3,000-5,000 organs within 2-3 years. The Red Cross Society of China has staff that screens hospitals for death bed patients and offers monetary compensation in exchange for organs. This is in violation of WHO Guiding Principles. Hospitals continue to provide transplant organs, for example a liver, within two weeks and doctors returning from China report that executed prisoners are still subject to organ harvesting, or that they have helped their patients to receive organs in China. Is it naïve to attend the China transplant conferences and applaud the recent announcements without verification?
Caplan: Sadly the time has not yet come to end the ‘boycott’ of Chinese transplant science which I helped organize a few years ago. Until China truly creates a viable cadaver donor program not fueled by executed prisoners and distributes organs according to need not the marketplace protest should continue.
QUESTION: Considering the many aspects of evidence and reports, what most convinced you that prisoners of conscience were being killed for their organs in China, and how would you illustrate this to the public?
Caplan: Simple—the number of organs available cannot come from any other source but prisoners executed on demand for their parts. There is no true cadaver system in operation in China—prisoners are used and just caste, falsely, as choosing to donate.
QUESTION: In your book you write about transplant tourism and the “gaming the system.” What is the impact/consequence of this method, using the media to gain access to organs?
Caplan: The rich trump the poor and that is unfair and unjust!
QUESTION: As a strong and revitalized bill concerning the forced organ harvesting of falun gong practitioners and prevention of collusion in the U.S., House Resolution 343 is poised to demand global attention. What is the significance of Congress passing this legislative statement, and what do you think is needed to see it succeed in the House? How can we provide leadership for a change of consciousness at different levels of society?
Caplan: This is of enormous significance. A House Resolution will be heard and will trigger concern both inside China to reform procurement practices and internationally in terms of discouraging transplant tourism to China.