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= Organ Donating in Foreign Countries =

Abstract
Organ donating has been a recognized practice in the medical field for quite some time. It is a long and complicated procedure that is still developing despite all the progress that has already been made. Many things can go wrong before, during, and after an organ transplant surgery. That being said, medical professionals are working on solutions to better treat people who are in need of an organ transplant surgery. These solutions include anything from preemptive programs to teach people to better take care of themselves to new developments on technology and science to make organ transplant surgeries more effective and safe. One might think life-saving medical procedures would be available to everyone across the globe; however, many factors make organ transplant surgeries inaccessible to people in other countries outside of the United States. These limitations and the growing need for healthy organs leads to criminal activity within the Black Market. Fortunately, there are many organizations around the world that are working to stop Black Market crimes and keep people safe.

Origin
Organ donating can be seen in multiple cultures’ mythology where gods would use the organs from animals or recently deceased bodies to heal the living. Looking into Ancient Greek, Roman, and Chinese myths, historians have been able to discover that humans have long wondered if it was possible to take organs from one person and transfer them to another person and use it to heal people from illnesses and afflictions (History.com Staff, 2012).

Developments over time
The idea of actually using body parts from a person’s body or from another person’s body to heal someone was first formalized in the 1600s with minor plastic surgeries being performed in Italy. Organ transplant surgeries weren’t actualized until the 1900s when European surgeons tried to save the lives of people suffering from renal failure by transplanting their failing kidneys with those from healthy animals that had similar internal body structures to humans. None of these surgeries were successful past the first few days post-surgery. The first successful major organ transfer occurred in Boston, Massachusetts in 1954. The 1960s became the decade for developing and researching methods of organ donating/transplantations. After this period time, organ transplantations became less uncommon, and safer (History.com Staff, 2012).

Pioneers in organ donating/transplant surgeries
Numerous medical professionals became pioneers in this particular field of medicine. Italian Gasparo Tagliacozzi began experimenting in medicine by doing remedial plastic surgeries between people’s body parts. Austrian ophthalmologist Eduard Zirm performed the first successful corneal transplant surgery in 1905. About a decade later, Alexis Carrell won the Nobel Prize for his research on how to have bodies better accept transplant organs. Almost 50 years later, the first successful heart surgery occurred in South Africa. After this, most of the development in organ donating/transplantations dealt with how to make organs fix themselves so this practice can fall out of routine (History.com Staff, 2012).

Organ transplant wait list
There is a process to getting on the organ transplant wait list. After consulting with a medical professional, and coming to the conclusion an organ transplant is the next step, a person can then decide to be put on the organ transplant wait list. This wait list is extremely long, and a person can die from waiting so long for a transplant. With this in mind, some people decide to not be put on the organ transplant wait list, instead they decide to use other types of treatment to make their situation more bearable and accept their condition (Transplant Living, 2017).

The organ transplant surgery process
In order to get to the surgery stage of organ transplantation, a person must first be matched with organ donor. This occurs in 5 steps: 1) an organ is donated 2) the transplant database generates a list of potential recipients 3) the transplant center is notified of the available organ 4) the transplant considers the organ transplant for the patient, and finally, 5) the patient’s body either accepts or declines the new organ. If the organ is accepted the patient can lead a healthy life. On the other hand, if the organ is declined, meaning the patient’s body didn’t take to the new organ, the patient could subsequently die or have to continue to wait for a viable organ (Transplant Living).

Medical
Organ transplantations are never a 100 percent guaranteed solution to one’s health issues. An organ transplant, after going through multiple tests, can still fail to take to its new host once the surgery is completed. This brings to light a sad reality in organ donating/transplantations: not every organ donated will save a life. Organs that were used in surgery, and rejected by the new host’s body, are then useless. An organ’s chance of being accepted by the new host’s body is one of the biggest issues in this field (Live Science, 2010). University of Pennsylvania School of Medicine did a study on 23,000 organ transplant surgeries, and the information they found is startling. Besides the organ taking to the new host, the issue of whether a hospital can accept a donated organ is a whole other issue within itself. This study discovered the most organ donations a hospital typically accepts is 58 percent of those offer, sometimes it’s as low as 16 percent. Out of those statistics, only 37 percent of those patients’ bodies take to the new organ. To conclude, this particular field of medicine is facing multiple medical issues (Yasinski, 2016).

Financial
            Along with medical complications within the organ donating/transplantations, there are also financial issues. One can only imagine how expensive these procedures are, and how expensive it is to wait for an organ. Before a person even has an organ transplantation, they have to deal with the costs of pre-transplant evaluation and testing, and fees for the recovery of the donated organ. Another possible cost for a person trying to receive an organ transplant is the cost lodging at a hospital. As one may imagine, this can cause a major shift in a family unit and household possibly resulting in unpaid utility bills, and day care payments because children cannot be taken care of right after school; and it doesn't end there. Families can spend anywhere from $260,000 to over $1 million on the procedure alone. Other financial aspects, that come up post-organ transplant surgery, are the costs of follow-up care and testing, fees to the medical staff who helped with the surgery, prescription drugs, and rehabilitation. Figure 1 depicts a broad look at how the cost for this procedure rises from beginning to end, and shows how the price varies depending on the organ needed. Fortunately, the American government and charitable organizations do help families suffering from the costs of the very procedure that kept themselves or a loved one alive (Transplant Living, 2017). Firgure1, created by Transplant Living Organization (2017)

Current Developments in Organ Donating/Transplant Surgeries
            Scientists are currently developing numerous procedures and machines to help move organ donating/transplantations forward. One method scientists are particularly focusing on is using stem cells to create organs. The research has been paying off considering 9 people have successfully had organ transplantations entirely with stem cells. These types of cells are applicable for organ transplantations because they can become whatever type of cell the body needs in that particular area. This is still a fairly new method, but the research is heading in the right direction, and this method could end the need for organ donating (Sifferlin, 2013). Medical professionals are also developing a way to detect a common pathogen found in people with weak immune systems, which would include those trying to get an organ transplantation. This particular pathogen, cytomegalovirus (CMV), can be especially detrimental in a patient’s recovery and, in some cases, be fatal. The problem is detecting and managing the pathogen. Novel antiviral chemotherapy is being looked at as a possible model of how to kill off this virus from patients. This project will take some time to produce a solution to this problem; however, researchers are determined to find an antivirus for CMV (Patel & Sia, 2000).

Iran
Iran has a unique look on organ donation. Unlike other countries, Iran allows its citizens to buy organs from living, healthy donors, and it’s a program that has been in place since 1988. The program works by getting the patient who needs to the transplant into Dialysis and Transplant Patients Association where they will go into dialysis treatment while waiting to be matched with a healthy donor in the system. The procedure is funded by the Iranian government. While most people find this to be very effective in saving lives by practically eliminating the kidney transplant waiting list, there are a significant amount of people who think this system targets the lower classes, and commercializes organ donating. Essentially, the general concern is that lower class citizens will purposely put themselves through a dangerous and life changing procedure for the money. Medical professionals in Iran admit that some people donate their kidneys purely for monetary gain; however, the rest of the kidney donors, after seeing transplant surgeries and people on dialysis treatments, donate one of their kidneys because they genuinely want to help someone. To conclude, Iran is currently the only country to have this program, and while it urges other countries to follow in its footsteps, it doesn’t look like that’ll be happening (Karimi & Gambrell, 2016).

Brazil
Unfortunately, Brazil’s organ donation program suffers from a problem that a lot of other nations suffer from as well: donated organs that are not healthy enough to donate. Brazil’s Coordinator of the ABTO’s Organ Removal Commission, José Lima Oliveira Júnior, states “In the past half of the year, 71% of organs donated in Brazil could not be used,” (Gandra, 2016). External elements effect whether or not an organ is suitable for donating. Brazil’s infrastructure can make a once healthy organ unsuitable for donating. The other half of this issue is that most of the people who need an organ transplant were rather healthy before; however, there are some that need an organ transplant because are older and have certain conditions that are causing their organ to fail. It is much easier for a once healthy person to receive an organ donation because their bodies are suitable for that kind of tough procedure. When the person in need of an organ donation is a bit older and has some health conditions, it is much harder for their bodies to take to the new organ. To sum, Brazil is suffering from the same general issue as many other countries when it comes to organ donating (Gandra, 2016).

Spain
Spain is one the world’s leading countries in regard to organ donations. Thanks to Rafael Matesanzs, director of Spain’s National Transplant Organization, Spain has been lowered their amount of people needing new organs. His plan, after obtaining this position in 1989, was to have all transplant coordinators be intensive care specialists. This eliminates psychological burnout and increases the success rate of these procedures. In addition to this idea, Spain has also more suitable organ donors than ever because their citizens remain healthy longer than other countries. This leads to older people being able to become organ donors, which means more organs are available to people who need them. Matesanzs belief, “We never blame the population. If people donate less, it must be something we have done wrong” has guided him in seriously impacting the health of Spaniards in a positive way. While this idea has proved to be very effective in Spain, it has encountered many problems in other countries due to difference in health insurance and the type of environments where a person can receive this procedure. To conclude, Spain has found a very intelligent solution to their once crippling organ donation epidemic; whether this solution can successfully be applied to other countries is another question entirely (Badcock, 2015).

Israel
Israel is home to some true pioneers in the field of organ donating/transplantations. Until just recently, Israel was leading in the world with the lowest organ donors. This is because Israel is a Jewish country, and is heavily influenced by their religion. In this particular faith, it has been interpreted from their text that it is forbidden to either donate your organs or receive an organ donation. This has led Israel to trying a new system where patients who have agreed to donate their organs are a top priority for organ transplant surgeries if they need one. Israel’s new system has made it the first country to add non-medical criteria into the priority system; however, medical criteria is still the first priority. This system also opened discussion in Israel about what was acceptable and unacceptable in regard to organ donations. It turned out many Orthodox Jewish people were fine with receiving an organ transplant, but would never donate their own organs. Dr. Jacob Lavee, the creator of this system, noted this phenomenon in and, seeing how unfair it was, thought a change was needed in Israel. This system’s success is partially owed to the religious figures in Israel. Without their support for this new, unconventional system, this idea would have never of made it passed the first stage. Since this system is rather new, Israel hasn’t extensively tried to bring it to other countries. To sum, Israel has pushed the boundaries of their social norms with the implementation of this new system (Ofri, 2012).

Living organ donor
As seen in figure 2, from Transplant Living, most organ donations come from living participants. In most of these scenarios, the person giving the organ is from a relative because they are most likely to be a match for the person in need of a new organ. However, that is not to say people aren’t getting organ donations from strangers who happen to be matches. Like anything in the medical field, there are certain qualifications to be a living organ donor. For instance, a living organ donor one must be at least 18 years old, in good physical and mental health, and free from any diseases or health conditions. In the United States, and many other countries, a person has to register to become a living organ donor. This can be done by filling out specific forms in hospital or private clinic. To sum, living donors are a major part of the organ donation/transplant surgeries process, and it is fairly simple to become one (Transplant Living). Figure 2, created by Transplant Living Organization (2017)

Deceased organ donor
Becoming a deceased organ donor, meaning one’s viable organs after death will be donated to living people in need of new organs, is the same process as becoming a living organ donor with slightly different paper work. When at the Department of Motor Vehicles (DMV) to get/renew a license or I.D., one can register to have their organs donating if they were to die in an accident (Transplant Living).

Black Market Organ Crimes
The Black Market has been tied to a variety of types of crimes from theft, human trafficking, illegally trading dangerous weapons and endangered animals, and organ harvesting. Organ harvesting is when a person illegal steals the organs from inside another person. This illegal act has been linked to human trafficking, the kidnapping and trading of human beings, since the two often coincide. Organ harvesting in the Black Market is a result of the issues people are facing on the, sometimes deadly, organ waiting list. Desperation will make anyone do anything, especially when they have the resources to do it, and this includes obtaining a new organ off the Black Market (Small-Jordan, 2016). Figure 3 displays the average prices for certain organs on the Black Market (Perry, 2016).

Figure 3, found on Big Think

How to Stop Black Market Organ Crimes
            Governments from around the world have recognized the threat the Black Market poses on to the world. Organ harvesting is most prominent in Asia, Eastern Europe, and Africa. The United States has assigned the FBI to work on unearthing illegal organ harvesting rings within America. The United Nations created the Global Initiative to Fight Human Trafficking to help solve this issue worldwide (Perry, 2016). On a country to country basis, progress varies on how Black Market organ harvesting is being prevented due to a county’s individual culture and political issues. The development of such laws and policies will take time to be fully implemented in those society. Some countries allow international organ trading, which has been proven to be more harmful than helpful in more than a few studies. Besides the possibility of disease being spread over seas from one person to another, it has been found that the Black Market steals someone donated organs while in transport. This effects the person who donated the organ and the person who needed the new organ. This kind of organ trading is less invasive compared to organ harvesting considering there is no kidnapping, drugging, and the organ was taken out, technically, with the consent of the donor. With these statistics growing, certain countries updating their international organ trading laws. Countries that are creating laws to solve this problem include the United Kingdom, India, United States, South Africa, and China. Even though progress is being made, new organizations are being created within the Black Market to replace those being tried for organ trafficking. To sum, while much is being done to solve this worldwide epidemic, the Black Market is fighting back in sneaky ways so it can continue its criminal activity (Martin, 2012).