“I am not Sherlock Holmes”: suspicions, secrecy and silence of trans­­­plant professionals in the organ trade

F. Ambagtsheer, L. van Balen, W. Weimar

Wednesday 9 march 2016

12:35 - 12:45h at Theaterzaal

Categories: Plenaire sessie

Parallel session: Plenaire sessie II - Nieuwe uitdagingen in de transplantatiegeneeskunde

In 2013 we circulated an anonymous survey amongst 546 Dutch transplant professionals (TPs) (response rate: 241/44%) about their experiences with patients who purchased kidneys abroad. We found that of the 100 (42%) TPs who treated patients who traveled to a country outside the European Union for a kidney transplant, 31 (31%) were certain and 65 (65%) had suspicions that patients had bought kidneys. To gain more insight into TPs' experiences with these patients, we also conducted in-depth anonymous interviews with 41 TPs (24 male), of whom 29 nephrologists, 5 nurse practitioners, 5 social workers, one research coordinator and one transplant surgeon. The interviews took place at 6 transplant centres and 12 non-university hospitals according to a topic list that addressed TPs' opinions and their behaviour towards these patients. Most TPs (n=30) suspected that patients bought kidneys abroad. They described their suspicions as having a "gut feeling" that patients purchased kidneys. Eighteen TPs emphasized that patients did not tell them how the kidney was obtained and from whom. Nonetheless, 12 TPs did treat patients who told them that they had purchased the kidney. Twenty-four TPs said that they refrain from "interrogating" their patients about their alleged purchase to avoid harming the relationship with their patients (n=12), because the questioning serves no medical purpose (n=10) or because they did not want to know or were not interested in their patients' alleged purchases (n=9). Almost all TPs (n=38) understand why patients buy organs. Nevertheless many (n=25) also condemn their patients for purchasing organs. Eleven TPs indicated that purchase does not justify a breach of their secrecy oath. Many TPs (n=24) do not consider it their duty to investigate or report their patients' purchase and emphasized that this is the responsibility of law enforcement. Seven TPs however would consider reporting their patients. Only 2 TPs mentioned the importance of doctors as gatekeepers who may be in the position to report organ trade to national authorities. TPs' reluctance to enquire after their patients' possible kidney purchase and the absence of disclosure by TPs may explain why prosecutions of the crime hardly exist and why the crime persists. TPs should become more active in reporting organ trafficking networks, such as the names of the centres or transplant staff that facilitate (illegal) transplants.