Indian kidney scam highlights bioethics challenge

Egyptian shows scar after kidney stolen from him in hospital, 3 Aug. 2007/Nasser NuriBefore it slips from the news, take a look at a scandal in India that illustrates one of the biggest bioethical challenges we face in a globalised world. Last weekend, Nepal handed over to Indian authorities an Indian man arrested on suspicion of running a huge illegal kidney transplant racket. It seems this ring duped poor Indians into selling kidneys that could be transplanted into rich Indians and foreigners at many times the fee that the unwitting donors received. At least five foreigners — two U.S. and three Greek citizens — were found in a luxury guesthouse run by the racket in a city of high-tech companies just outside New Delhi.

Demand for cheap kidneys has skyrocketed in recent years in rich countries, mostly because people there are becoming more obese and suffering from kidney failure. This has led to “transplant tourism” where patients from rich countries travel to the developing world to receive new kidneys. It has led to serious proposals to set up a global kidney market to meet the demand.

This black market in kidneys for transplants is widely denounced as illegal and immoral because it exploits poor people. But would creating a worldwide organ trade make the practice any more moral? Is the danger of exploitation of the poor so strong that lawmakers should ensure that money doesn’t end up deciding everything?

Pakistani man shows scar after he sold a kidney, 11 Aug. 2006/Asim TanveerThis is one of those bioethical challenges that are multiplying as science and technology create situations that were unthinkable not so long ago. Ethics councils, churches and philosophers develop guidelines to keep up, but reality has a way of pulling ahead of them. Globalisation means agents in one country can arrange for patients in a second country to have the transplant performed in a third. We will probably see more rather than fewer cases like this one in Nepal and India.

We’ve written on this issue from several datelines over the past year. Here are a few that give an idea of the problem:

Science helps religion in stem cell debates

A microscopic view of undifferentiated human embryonic stem cells.Science and religion are sometimes portrayed as adversaries, especially by the “new atheists“, but the real picture has always been more complex. The latest breakthrough in stem cell research shows how quickly opposing sides can become allies. On Nov. 20, two research teams announced they had transformed ordinary skin cells into stem cells without destroying human embryos in the process. That meant that scientists could solve an ethical dilemma they had effectively created when they began using human embryos to produce stem cells.

Religious groups critical of embryonic stem cell research immediately hailed the breakthrough as an advance that opened the door to ethnical use of these potential wonder cells. They have now begun to use it as a welcome argument to bolster their positions in disputes on the issue. This must be happening in quite a few places, but here are two examples that show how science is helping religion in this case.

In Germany, the Roman Catholic Church has severely criticised the governing Christian Democratic Union (CDU) party for agreeing to loosen tight restrictions on embryonic stem cell research there. The law bars German scientists from working on stem cell lines developed after January 1, 2002. Researchers say this is hampering their work and want the cut-off date to be moved up to 2007.

Stem cell breakthrough — science the ethical way?

A microscopic view of undifferentiated human embryonic stem cells.We noted here just the other day the all-but-absent ethical angle in the Daily Telegraph story about the creator of Dolly the cloned sheep and a new technique for creating stem cells without embryos. Now, we have two reports from Maggie Fox, our Health and Science Editor in Washington, that address the scientific and ethical issues.

Our story length limits meant the two had to be broken up, but they should be read in tandem.

One deals with the science:

WASHINGTON (Reuters) – Two separate teams of researchers announced on Tuesday they had transformed ordinary skin cells into batches of cells that look and act like embryonic stem cells — but without using cloning technology and without making embryos.

Will science solve an ethical problem it helped create?

Cloning specialist Prof. Ian Wilmut, 2005The Daily Telegraph had a fascinating scoop over the weekend — Professor Ian Wilmut, the creator of Dolly the cloned sheep, has abandoned the therapeutic cloning method for a new way to create stem cells without an embryo. In classic Fleet Street style, the London daily announced in the second paragraph that the decision “will send shockwaves through the scientific establishment.” It took another 16 paras to get to other constituencies for this story, who are mentioned in passing in the line that “there is an intense search for alternatives because of pressure from the pro-life lobby, the opposition of President George W Bush and ever present concerns about cloning babies.

That doesn’t take away from their scoop in any way — it is primarily a science story, written by their science editor Roger Highfield, and it’s a good one. But this second angle is of enormous importance to many readers out there who have moral scruples about embryonic stem cell research.

Dolly the cloned sheep, 2002I was intrigued by a line high up saying: “Most of his motivation is practical but he admits the Japanese approach is also “easier to accept socially.” If I read that correctly, it means that science — which helped create this moral dilemma by developing the embryonic stem cell technique — may solve it eventually with another breakthrough that looks equally (or more) interesting to the scientist. That could take care of this issue, but others are bound to pop up that cannot be solved with a technical fix. Wilmot discusses this on a linked page publishing an extract from a book that he and Highfield wrote called After Dolly: The Uses and Misuses of Human Cloning. He believes an embryo cannot be considered a person until it is about 14 days old because it has no nervous system. The Roman Catholic Church, for example, counts personhood from the moment of conception, since it considers the potential in the embryo just as important as the cells that are already there. It’s hard to see how a technical breakthrough can bridge that gap.

Bioethical dilemmas know no boundaries

Bioethical dilemmas know no boundaries. France found that out this weekend when the daily Libération revealed that a French couple that had used a surrogate mother in the United States had won a long legal battle to be recognised as the parents of the twin girls who resulted from the arrangement. Surrogacy is illegal in France. French officials refused to register the twins as the couple’s daughters, leaving them in a legal limbo for seven years. But an appeals court finally granted their wish, arguing it was in the children’s best interests to recognise the U.S. birth certificates that listed Dominique and Sylvie (their surname was not published) as the parents.

an expectant mother France banned surrogacy in 1994 in the hope of preventing a “rent-a-womb” market from developing. But this option is expressly banned by law only in France, Germany and Italy, according to the association CLARA which campaigns to change the French law. It is legal in other places, including Britain, Canada, Greece, New Zealand and some U.S. states. According to the twins’ father Dominique, between 20 to 40 French couples cross the Atlantic every year to have a child with a surrogate American mother.

Since Sylvie and Dominique were recognised as the twins’ parents in a state where surrogacy is legal, they could not be brought to court for breaking the law there. French courts tried to try them for aiding and abetting a case of surrogacy or violating the civil status of the children, but neither charge led to a conviction, Le Monde reported.

Does Italy have its own “Terry Schiavo case”?

File photo of patient Terry Schiavo in a Florida hospital, 2001Does Italy have its own “Terry Schiavo case“? Eluana Englaro has been in a persistent vegetative state (PVS) for the past 15 years and her father is trying to get legal permission to remove her feeding tube. Italy’s highest appeals court recently sent the case back to a lower court in Milan that had refused to let him do so. The local media have already dubbed Eluana “Italy’s Terry Schiavo” and the retrial (when it happens) looks set to spark off another major bioethics debate there.

Beppino Englaro has been caring for his daughter at home and says it’s time to free her from “the inhumane and degrading condition in which she is forced to exist”. The appeals court (Court of Cassation) said the lower court must determine whether her PVS is irreversible and whether she expressed the wish not to be kept alive if in a PVS. Her father said she had expressed that wish, but apparently has no living will or other tangible evidence to back that up.

Eluana’s case lacks the husband-vs-parents element that propelled the Schiavo case into the U.S. national headlines in 2005. But thorny cases of bioethics get into the national spotlight in Italy. A Roman judge is still investigating a doctor who last year removed the respirator of paralysed muscular dystrophy patient Piergiorgio Welby, 60, who had described his life as “torture” and asked for the right to die. Only Switzerland, the Netherlands, Belgium and the U.S. state of Oregon permit assisted suicide for the terminally ill.