Bills regulating organ donation and transplantation discussed

Committee Source: HEALTH

THE MEDICAL BREAKTHROUGH in organ and tissue transplantation has given much hope to patients suffering from end-
stage organ failure. At the same time, however, this gave rise to ethical questions brought about by the proliferation of
organ and tissue trafficking around the globe due to the scarcity of transplantable organs and tissues.

The Philippines is known as a �medical tourism paradise� but it is more because of the commercial trade of organs
where these can be had at very low costs, mostly victimizing donors from poor families. 

To address these problems, four legislative measures, aimed at curbing organ trafficking and ensuring the sufficient
supply of organs and tissues for transplant purposes, were filed and are now under consideration by the Committee on
Health, chaired by Representative Arthur Pingoy Jr. (2nd District, South Cotabato).

These are House Bill 6210, authored by Rep. Pingoy; HBs 3374 and 6011, authored by Rep. Narciso Santiago III (Party-
List, Alliance for Rural Concerns); and HB 5930, authored by Rep. Ana York Bondoc (4th District, Pampanga). 

Regulatory measures

House Bills 6210 and 5930 seek to regulate the donation and transplantation of human organs and tissues from living
and deceased donors, while HB 3374 focuses on the regulation of �living non-related organ donations.� On the other
hand, HB 6011 seeks to promote organ donation awareness. 

Rep. Pingoy explained that the Anti-Trafficking in Persons Act (Republic Act 9208) passed by Congress in 2003
criminalizes human trafficking, including organ trafficking, with penalties up to life imprisonment. But, he said, a new law
is needed to effectively regulate organ donation and transplantation since RA 9208 does not sufficiently cover this
aspect. 

�Living non-related� donor

In explaining HB 3374, Rep. Santiago said that �organ donation from a living non-related donor is also acceptable (as in
the case of a living related donor), but it should be emphasized that there should be no form of profiteering (between)
donor and agent.� 

Inasmuch as exploitation, profiteering and trafficking almost always happen in cases of living non-related organ
donations, which refer to organ or tissue donations from persons other than the relatives of patients, Rep. Santiago said
this aspect must be properly regulated. 

Citing a statement from the Department of Health (DOH), Rep. Santiago stated that �although the sale of an organ does
not violate any law� the organized practice of organ donation for profit is against ethical standards and is not within
the commerce of man.�

Victims mostly poor

Rep. Santiago added that organ traffickers dupe mostly poor Filipinos who are often ignorant of the deleterious
consequences of the operation to harvest the organ, which sometimes lead to infection or excessive bleeding, more so if
they are not given proper care afterwards. 

Dr. Albert Chua, chairman of the Philippine Society of Nephrology (PSN), agreed that the worldwide shortage of organs
for transplantation has stimulated commercial trade in this area, particularly involving living donors who are unrelated
to recipients. 

He mentioned that the implementing rules and regulations (IRR) of RA 9208 which carry anti-organ trafficking provisions
have not yet been issued by the agencies tasked to do so, referring to the Department of Justice (DOJ), the DOH and
Department of Social Welfare and Development (DSWD). 

Complementing the bills regulating organ and tissue donation and transplantation, Rep. Santiago�s HB 6011 promotes
increased awareness of organ donation and its benefits particularly among the youth by making this part of the health
education course in the high school curriculum. 

�Opt out solution�

Explaining her filing of HB 5930, Rep. Bondoc stated: �The overwhelming demand for organ donors has led to abuse,
manipulation and exploitation due to organ trafficking. Our country is known as a �medical tourism paradise� where
organs are available for only P30,000.�

Rep. Bondoc also revealed that most of the organ donations come from living donors because very few sign up to
become donors in the event of death. 

To remedy the situation, she said, the Philippines should adopt the so-called �opt out or dissent solution� which will
automatically make adult Filipinos organ donors in the event of death unless one �opts out� or refuses to donate his
or her organs. She mentioned that this kind of approach is being practiced in many countries like Singapore, Spain,
Israel, Sweden and Austria.

HB 5930 includes a provision which authorizes a designated officer of a hospital to remove any organ from the body of a
person who dies in said hospital for the purpose of transplantation except on certain conditions, including in the case of
a person who, during his lifetime, has registered his objection to the removal of his organ upon his death. The objection
must be properly made with the National Organ Donation and Transplantation Center, which is also proposed to be
created under the bill.

Istanbul Declaration

In relation to the bills� objectives, Dr. Chua informed the Committee of the efforts of the medical world against
unethical practices in organ donation and transplantation. He said the International Society of Nephrology (ISN) and The
Transplantation Society (TTS) have organized the �Istanbul Summit on Organ Trafficking and Transplant Tourism� in
2007 and forged the �Istanbul Declaration.� 

The international instrument declared that �organ trafficking and transplant tourism violate the principles of equity,
justice and respect for human dignity and should be prohibited.� It also called on countries to prohibit the purchase
and sale of human organs for transplantation as �transplant commercialism targets impoverished and otherwise
vulnerable donors, (which) leads inexorably to inequity and injustice.� 

WHO guiding principles

Dr. Chua further said that on the same year, the World Health Organization (WHO) released the �Guiding Principles on
Human Cell, Tissue and Organ Transplantation� to provide an orderly, ethical and acceptable framework for the
acquisition and transplantation of human cells, tissues and organs. 

In the local scene, he added, the Philippine College of Physicians (PCP) and the Philippine College of Surgeons (PCS) have
recently formally declared their full support for the Istanbul Declaration and WHO Guiding Principles. 

Implement the law

Agreeing that organ trafficking must be curtailed, Dr. Chua made several suggestions to this end some of which are: the
publication of the IRR of RA 9208 and the active implementation of the law; total and permanent ban on kidney
transplants to foreigners using Filipino living or deceased donors; vigorous development and implementation of a
�deceased donor program� by the DOH; and public education and awareness campaign on organ donation. 

Also present in the meeting were DOJ Assistant Secretary Teresita Domingo, DSWD Legal Counsel Sally Escutin, Dr. Ma.
Dominga Padilla of Eye Bank, and Dr. Enrique Ona of the National Kidney and Transplant Institute (NKTI), who all gave
their support for the bills.

The Chair requested the resource persons present to participate in the discussions by the technical working group that
will be created to consolidate the bills.

Source: Committee Administrative Support Service, Committee Affairs Department