“CÓ NÊN HỢP THỨC HÓA THỊ TRƯỜNG NỘI TẠNG VIỆT NAM?”
Lê Gia Khánh (Ethan Le) quốc tịch Việt Nam, sanh năm 1995, học sinh lớp 11 nâng cao trường Trung học Ashbury- Canada (http://www.ashbury.ca/).
Niên học Xuân- Hè 2012, giáo sư nhà trường đã hướng dẫn học sinh lớp 11 nâng cao làm bài luận 4.000 từ và giao cho học sinh tự chọn đề tài mình quan tâm. Lê Gia Khánh đã chọn đề tài “Có nên hợp thức hóa thị trường nội tạng Việt Nam?”. Trong bài luận này, cháu đã phân tích lợi, hại của việc hợp thức hóa thị trường nội tạng và đề xuất cách giải.
Để bài luận đạt yếu tố khách quan, Lê Gia Khánh đã làm phiếu khảo sát đưa lên 3 mạng xã hội https://khoahocnet.com/; http://vietnammarcom.edu.vn/; www.surveymonkey.com và lắng nghe ý kiến trực tiếp từ: Nhà giáo, nhà sư, doanh nhân, kiến trúc sư, kỹ sư, bác sĩ, sinh viên, học sinh…
Khi đọc “Có nên hợp thức hóa thị trường nội tạng Việt Nam?” của Lê Gia Khánh, chúng ta sẽ dễ dàng nhận ra bài luận có nhiều sơ suất trong nghiên cứu, hạn hẹp trong đề xuất cách giải và nhất là câu từ tiếng Anh chưa chuẩn.
Nhưng chúng ta cũng mở lòng dung thứ vì nội dụng bài viết đã thể hiện sự bận lòng của một cháu trai 17 tuổi đối với cộng đồng Việt Nam của mình.
Khi chấm bài luận này, giáo sư trường Ashbury đã bút phê “Bài làm tốt, trình bày chuyên nghiệp, nội dung đầy đủ. Tuy nhiên đề tài hơi quá cao và quá lớn với một học sinh lớp 11. Riêng câu hỏi khảo sát cần soạn tập trung hơn vào nội dung bài luận”.
- Tạ Thị Ngọc Thảo
Economic Extended Essay
Should human organ market in Viet Nam be legalized?
Research question: This essay closely analyzes the human organ market in Viet Nam. Specifically, this essay evaluates and answers the research question “should human organ market in Viet Nam be legalized?”
Method of Collecting Data: To have a manageable and concrete data, I only choose the organ that most commonly trade around the world ( about 65 %) and in Viet Nam (about more 70%), which is kidney. The informations and statistics were collected from many sources such as internet, articles, text books and survey. The survey was performed by asking 9 questions about the current human organ market in Viet Nam including: legalization of this market and what solution will be best fit for Viet Nam. The survey is created using surveymonkey.com both in English (http://www.surveymonkey.com/s/F63C8LK) and Vietnamese (http://www.surveymonkey.com/s/R7HGGC8) then, sent to 3 Vietnamese websites and many friends to collect responses. Also, the survey is printed out in hard copy and distributed to 50 selected people, who have knowledge about this market, to achieve the final goal of at least 100 responses.
Conclusion: Analyzing data revealed that the current human organ market in Viet Nam is at disequalibrium where the supply is low and cannot meet the demand because the market is illegal. Therefore, it is controlled by third party that keeps on growing because of people’s low education, income and lax law which make this market becomes chaotic. So, the immediate solution is to legalize this market to increase its supply and give back the control to the government. However, there are many downsides to this solution that make it is even more dangerous to do so. Fortunately, there is a way to solve this problem safely and permanently by “increase supply in a humane and ethical way”. Therefore, this paper also closely examinates some solutions that have been debated, tried and succeed in many developed countries and evaluates which solution(s) is/are fit for Viet Nam. After analyzing, it seems like most of the solutions are not doable near the future, but they all have high potential of solving the problem. Specifically, there two solution that can be done immediately to stabalize the market which are education and reward. While, other two solutions which are raise people standard of living and subsidy medical technology, can solve this problem permenantly but need time and effort from the government to achieve it.
To sum up, the data and evidences suggest that Viet Nam should not legalize human organ market despite the chaotic situation. Instead, Viet Nam should exanimate some of the solutions that other foreigner countries tried and succeed and make progress toward them to solve the problem.
Table of Contents
Abstract ………. 1
Introduction: ………. 4
Hypothesis: ………. 5
Method of Collecting Data: ………. 5
Data analysis: ………. 6
I: Human Organ Market Current Situation in Viet Nam: ………. 6
II: What If human organ market is legalized?……….. 9
III: Solutions for human organ market in Viet Nam: ………. 11
Conclusion: ………. 15
Bibliography ………. 16
Appendix: ………. 17
Firstly, I will define economically what is organ and what is human organ market, so they will be clear, condense and focus throughout the essay.
Currently, human organ is seen as a demerit good that has many negative externalities such as: reduces people productivity, increases income for criminal organizations and raises humane and ethical cresses, therefore, it is illegal around the world.
Human organ market is an illegal and unethical market, that trades certain human organs such as: kidney, lung, heart,… for financial good, mostly money, and always needs third party that has specailization in medical to join in the transaction such as: hospital, doctor, broker… It is also an unique market since even there is demand but supply is not always available and reverse.
According to World Health Organization (WHO) states in 1991: “The human body and its parts cannot be the subject of commercial transactions. Accordingly, giving or receiving payment (including any other compensation or reward) for organs should be prohibited.” Despite this law, the demand is still extremely high while there is limited supply which leads to a creation of black market around the world. Furthermore, this black market has become more of a noticeable problem for every countries, especially, low developed and developing countries such as China, India and Pakistan. Even though it is illegal and unethical, it is still a valuable market of 75 billion dollars per year. Unfortunately, this large amount of income has always been taken by unofficial organizations, or criminal organizations. They unethically collect organ from poor people who are in desperate situation with a cheap price and sell back at 20-40 times more, even worse, they sometimes do not fully pay or not pay anything to the victim. Though, many countries have frequently debated to legalize this market to collect and control its huge income while reduce the crime rate. The result is, it still remains illegal because humane and ethical reasons.
So, to evaluate this potential market and its behavior in my small, low developing country, Viet Nam, the question “should human organ market in Viet Nam be legalized?” was formed.
It was hypothesized that human organ market in Viet Nam should not be legalized. The proposition was based primarily on these facts: Viet Nam’s GDP per capital is low, around 1200$/year, therefore it is unethical for people to sell their organs in a desperate situation causes by financial problem. Also, the current medical technology is not advance enough to perform this transplant safely. In addition, Viet Nam’s law cannot ensure both supply and demand sides are safe in the transaction therefore cannot control the market if it is legalized.
Method of Collecting Data:
To investigate the research question, a survey was created using the website Surveymonkey.com, both in Vietnamese and English and send to three websites and friends to collect response. The survey was opened from Aug 1st to September 1st. A survey included 9 questions asking about their opinion toward the current situation and what solution will be best for Viet Nam. Also, to have more respondents for better analyzing, 50 hard copies were printed out and distributed to selected people who have knowledge about human organ market in Viet Nam. The goal is to have the total 100 responses and more ideas to the topic. The survey data are on Appendix, including 9 questions with the percentage of people’s answer on each question. Even though, some people do not have much knowledge about this topic and may randomly answer, I still try to minimized this problem by only send to selected people who are over 18 with significant amount of knowledge about this topic and I will take out any response that has a pattern of ticking or illogical answers.
In addition, secondary data were collected from internet, newspaper, online newspaper and articles inside and outside the country.
I: Human Organ Market Current Situation in Viet Nam:
Currently, the human organ market in Viet Nam is chaotic because varies reasons. Acorrding to Viet Nam’s law section XI part 34 about donate, transplant and receive human cell or part; donate or take dead body, issued on 29-11-2006, states: “Foreigner, and Vietnamese locates outside the country is permitted to receive part of body from Vietnamese, in only condition that they have same cognition in 3 generations” and that “Vietnamese can only go to foreigner country to donate his/her part of body when the receiver has same cognition in 3 generations”  (Vietnamese translated). Viet Nam also has demand for organs outstrips supply because “total supply only meet 10% of demand” since 6000 people are on waiting list and only 600 transplanted are performed. Not only the demand inside the country is high, but also outside the country with more than 200,000 people. Therefore, black market is created to take over the supply and growing rapidly which become a big problem for Viet Nam as Dr. Caplan (WHO’s doctor) says “A quarter of total amount kidney transplant around the world has a illegal source.”
The illegal market means the government tries to erase its supply by setting the price ceiling to 0, which creates a shortage causes market failure therefore the underground supply is created and so does black market. This black market is controlled by outlawed brokers or criminal organizations, therefore the market’s income, these organizations collect while leaving consequences to society. They perform this transaction by first, travel to poor areas in the country and take advantage of poor and uneducated people by convince them to sell their kidney at a low price as 3,000-5,000$ and say it helps to pay their debt, while saving others and it is safe to doing so. Secondly, they make a certificate that the victim and the buyer are relatives, so that it is legal for them to give organ to another. Thirdly, they send their victim to other countries, like China, to sell their kidney; or the buyer will come to Viet Nam and performs the transplant. This way of trading is known globally as “transplant tourism”, and mostly result badly for the victim like paralyze or even death from not having proper medical care. For example, the case of To Cong Luan, a second year university student of industry economic in Viet Nam. He desperately needs money for university, therefore agreed with a broker to do “transplant tourism” in China and sold his kidney for 5000$. Even though, his buyer knows Luan has hemophilia, a disease that make the body cannot stop bleeding, which has a extremely high percentage of death when operate, his buyer still proceeds to transplant Luan’s kidney, result in Luan’s death in 4th May 2010 without Luan receives any money. This case is able to happen without any charge because Viet Nam’s lax law makes it is too easy to certify two people are relative without deeply analyze. Therefore, the government cannot punish the broker neither the buyer. Sadly, this is just one typical case of an average one illegal transplant per hour in Viet Nam.
Despite of this dolorous case, a lot of Vietnamese people advertise their kidney on internet, which is not legal by the world and Viet Nam’s law, at a cheap price as 25,000 – 50,000 dollars with varies emergency reasons such as pay hot loan, save their relative from dying, … Unfortunately, the most beneficial side from this transaction is the broker who sale the kidney at 100,000$-200,000$. Also, the doctor who performs this transplant get an average of 2,500$ and the rest goes to the broker hand. Furthermore, these brokers mostly are, or have a close relationship with, criminal organization that has enough power to make sure that their network is safe by bribing corrupted government and judges. These organizations are able to earn supernormal profit because human organ market is an oligopoly market with a few dominant competitors since this market is illegal so the barriers to entry are really high. Furthermore, the demand is inelastic due to the buyer is sick which needs organ as soon as possible therefore, accept to pay highest price which allow the brokers to earn maximum profit. This profit allows criminal organization to expand and causes fatal damage to society and makes it becomes chaotic.
The brokers are not always the one who start these transaction, but it is the buyer instead. Some of the rich people are ready to pay 50,000$ for a kidney to replace, but finding a suitable one is hard. Therefore, they nourish many organ hunter teams to find the suitable kidney around the country with the price 100$/month/team, yet it still takes years to find one. Unfortunately, when they locate the target, they will use every possible ways to make the target sell their kidney like tricking, pushing them to desperate situation, bribing government to make the target’s life difficult,… which are inhumane and merciless.
Another reason that causes the human organ market in Viet Nam chaotic is the technology and doctors’ skill, since “Viet Nam technology in kidney transplant is half a century behind other countries in Asia” Dr. Pham Gia Khanh says. For example, only less than 10 hospitals in Viet Nam can safely transplant kidney. In 2010, only “Hospital 103” could successfully perform the first heart transplant. However, there are too many transactions happen each year that lead to unskilled doctors have to transplant illegally in a non-well equipped hospital lead to many dolorous cases. For example, in 2011, at Can Tho city, there was a case of Mrs. Hua Cam Tu. She is 37 years old and has kidney disease and needs to be operated to take out her left kidney. After the operation, her face swelling hard so she does endoscopy and realizes she has no kidney left. After that, the doctor admits that he has accidently cut her veins near the right kidney and cannot hold the blood so he has to cut another kidney to prevent her bleeding to death in the operation. Result in her paralyzes and unable to work the rest of her life while her family must take care of her.
To sum up, Viet Nam human organ market is really chaotic and unlawful because it is corrupted by brokers that cannot be punished by the current lax law. Also the technology and doctor’s skill are not strong enough to safely perform this operation.
II: What If human organ market is legalized?
The fact shows if demand is real but the transparency supply cannot satisfy the demand because market is illegal, black market will be created to bring the market goes back to equilibrium but leaving many consequences. Therefore, legalize this market is an immediate solution that has been out for a long time as “Writing in the British Medical Journal in November 2006, Amy L Friedman, a transplant surgeon from the United States, argued that payment of live unrelated donors — which is forbidden under the WHO Guiding Principles and illegal in most countries — should be legalized to increase organ supplies and eliminate a black market in organs, thus making such procedures safer for all involved.” The supply is able to increases when the market is legalized due to the reduction of barriers to entry since the government does not try to stop them. Furthermore, since the market has more suppliers, they will start to compete with each other which make their goods and service better and safer. Also, the government can intervene this market by making laws to protect both the producer and the consumer and possibly tax them enough to have the money to solve negative externalities caused by this demerit goods. However, since the seller is the poor people and the buyer is the sick people, government should not tax this market because of ethical and humane reason. Furthermore, the most beneficial from legalize this market is that, the government can eliminate the third party that take up to 90% of the income therefore reduce the crime rate overall, while increase jobs and income for hospital since they become the third party. All of the benefits above shows that legalize this market will solve many problems that the current market has and stabilize it, therefore it is a good solution to be evaluated.
On the other hand, there are still many downsides to this solution. For example, a patient needs to pay an average of 10,000$ (kidney transplant case) to get a proper medical attention but compare to Viet Nam average GDP is about 1200$ per year, this is a large amount of money. Furthermore, after the operation, the patient needs to buy medicine that allows the body to adapt with the new organ which cost around 2400-4800$ per year while the patient cannot work therefore no income and without any health care or pension, from the government. These costs are huge and not viable for any poor or average person in Viet Nam which are 80% of the population. Therefore, even the government legalizes the market, sick people may not get treated and government cannot stop people scarify their safety seeking for a cheaper operation.
Furthermore, Viet Nam’s law cannot eliminate the third party if the government legalizes it. Therefore, the consequence will be desperate such as it will be easier for the brokers to buy, sell and take advantage of Vietnamese low education (universal primary education) to maximize their profit and leave the victim and buyer with many consequences for society to clean up. For instance, low productivity or even death of the victim and buyer, because the broker does not provide enough medical attention. This shows that the current market is dangerous and will get even more dangerous if it is legalized under government’s lax law.
Yet, the biggest problem that make human organ market cannot be legalized, not only Viet Nam but around the world is ethical issue. “Human organs are not spare parts,” said Dr Howard Zucker, WHO Assistant Director-General of Health Technology and Pharmaceuticals. “No one can put a price on an organ which is going to save someone’s life.” However, even though the citizens acknowledge that “organs are not spare parts”, they still risk to sell them in a desperate situation. In those situations, people do not think clearly what they do and acknowledge its consequence, therefore, it is unethical and inhumane to legalize the market. “Non-existent or lax laws on organ donation and transplantation encourage commercialism and transplant tourism,” said Dr Luc Noel (WHO’s MD. Coordinator, Clinical Procedure). Currently, Viet Nam’s law are still weak and unsecure that cannot well control the market which like Dr Luc Noel says will increase “commercialism and transplant tourism” because when we legalize the market we accidently encourage poor people to sell their organs for income instead of working. This decreases people’s productivity and increase health problems which dramatically decrease the country growth and development. Therefore, it is not viable and ethical for Viet Nam to legalize the human organ market.
III: Solutions for human organ market in Viet Nam:
So, legalizing human market is not a viable solution so, Viet Nam like other countries “face a dilemma: how they can increase the supply of organs in a manner that is ethical and humane. ” say Dr Luc Noel. Unfortunately, there are not so many solutions that have been debated, tried and even succeed that fit for Viet Nam’s economic. These solutions of increasing supply, solve the problem by decrease the price overall therefore discourage people from selling their organ which will eliminate the third party while it is ethical and humane so that people is encouraged to do it voluntary not for financial objective. From there, the market will first be stabilized and then will be solve permanently.
The most and common solution that not only in Viet Nam, but around the world is using is “donations from deceased persons eliminate the problem of donor safety and can help reduce organ trafficking.” says Dr Luc Noel. First of all, this solution will increase the supply dramatically because every parts of the body, including heart and brain that cannot be donated by living donor, will be given which worth total of more than 300,000$ per person in black market. This way, it is not only humane but efficacy since there are some parts of the body cannot be donated while person is alive such as brain and heart, also deceased person and their family are honored while their body save many people. Secondly, it is safe because the donor is already gone, and receiver does not worry about the donor has infectious diseases. Yet it is not suitable for Viet Nam yet, since there is no facility to keep the organ fresh therefore cannot encourage people to donate. Luckily, the government intends to build one in the next one or two years. So, this solution cannot be done immediately but need time and money therefore not a best solution.
Another solution is propaganda, advertising and rewards that attract people to donate their organs. Such as, advertising on TV that if a person donate his organ, he/she will get, free medical care throughout and after the operation, a good amount of money that cover the time he/she cannot work, priority when he/she applies for work, cheap air fare and more days off from work, … This way the government can attract people who sell or going to sell their organ to the third party, will switch to the government instead because it is transparency and safe which helps the government control the market easier and shrink the third party. This solution is good and should be done immediately to stabilize the current chaos market.
Education is always a good solution for many problems especially this one. “Teach student about a donation organ when they don’t need them. As a civic gesture it should be taught at school. It is all a matter of realizing the community needs to care for its citizens, its residents.” This is a great idea from a British reporter. This idea will contribute in increasing the supply and sustain it in a humane and ethical way. It also helps children learn, respect and even idolize living donors which have an universal effect of encouraging more donor. This solution should also be done side by side with the previous solution for the best outcome to stabilize the market.
One of the best solution around the world is switch the supplier which are “organ grow from steam cells” or “animal organ transplant to human” or “artificial organs” technology. Since it does not make anyone suffers for another’s good therefore it is ethical to do so. Furthermore, these organs grow from steam cells therefore the supply can be unlimited which can solve this market problem permanently in the future. However, this technology is still under researched and developed therefore the supply is not safe and limited with a high price. Even though the price is high, they buyer should still buy it and government should subsidy to bring the price down and increase the supply for everyone. Yet, the main reason to do subsidy and buy it, is to give the money to the supplier so that can develop that technology better, safer and cheaper for anyone and by then the problem about organ market will be solved. Even though that solution seems viable but it is not near the future especially with Viet Nam’s technology and income.
So to solve the current situation, Viet Nam needs to do what other developed countries did already: raise people standard living by increase country development and growth. Since in developed countries, their standard of living is so high and the law is so well protect the citizens, that their citizen cannot, need or neither want to trade organs. They cannot trade organs because the government creates a complete solid law so there is no hole to pass and the penalties are high such as death penalties or life sentence. Even though the law is solid but if the citizens really need to sell their organ for money they still break the law. Yet it is not happen since their citizens never fall in the desperate situation where they must sell part of their body to pay the debt. Sometime even if the people cannot and does not need to sell their organ, they will still want to sell them for extra money such as: blood and skin. However, their living standard is so high and the money earn from selling blood or skin just become so small compare to their income therefore they unlikely want to sell. As same as the broker, they cannot trade organ because the law, neither need to trade because their living standard is high nor want to trade them since the penalties are high and they affair of losing their stable life. Unlike Viet Nam, where the people’s income are low and the law is loose and without allowance when the person is unemployed, neither free medical care, or free education until high school which are the most needed for poor people so they do not have to risk their life to sell their organ even though they know its consequence. Unfortunately, it seems like these problems will not be solved near future due to the GDP of Viet Nam is low and lack of growth in the last 4 years. Therefore, even though this solution is good but it still needs time and effort from the government to accomplish but it can solve the problem permanently.
Currently, the human organ market in Viet Nam is illegal therefore a black market is created and growing fast. This market has a strong and frequency activities of the third parties that take all the income and leave consequence to society. Unfortunately, the lax law combines with low education and income, create a unlawful and inhumane characteristics of this current market.
Since the problem is the supply does not meet the demand because the market is illegal, so to make the market return to equilibrium, legalization is a immediate solution that need to be looked at. Even though the supply does satisfy the demand which solves many problems like eliminate third parties and government can control the market, yet there are many limitations to that solution. Such as Vietnamese people cannot afford the current price, the lax law and primitive technology combines with unskilled doctor make the transplant unsafe and not viable for many people. Furthermore, since Viet Nam has low income, legalize this market accidently encourages people to sell their organ for income instead of working which will decrease economic growth and development of the country.
Therefore legalize this market is also not a viable solution since it does not solve the problem and even make it worse. Therefore, “increase supply in a humane and ethical way” is the theme to solve this problem. Yet there is limited solution and all of them need to be closely exanimate to choose the best fit. Fortunately, there are two immediate solutions that needs to be done side by side which are education and rewards, to stabilize the current market and buy more time for permanent solutions. After that, priority budget for medical technology and raise people standard of living are the best two solutions that the government should invest and develop to solve this market permanently.