Rowman & Littlefield Publishing Group

Shopping for an Organ Transplant?: The Pitfalls of Medical Tourism

By Katrina A. Bramstedt

In the US, thousands of patients are waiting for a kidney or liver transplant. Sometimes, they get so desperate, they contemplate traveling to a foreign country to buy an organ. In their desperation, patients often don’t think about the pitfalls and ethical problems of organ tourism, and there are many. Some organs are known to come from prisoners who did not give informed consent. Some organs are taken from women who are forced by their husbands to “donate” a kidney or liver tissue to pay a debt. Is this the setting for ethical medical care?

Other problems with organ tourism are issues such as the lack of medical records, or records which are written in a foreign language and unhelpful upon return to the US. Organs are sometimes also contaminated with viruses such as HIV and hepatitis. And what about these medical complications? Who pays for the treatment? What if there is malpractice? Can the patient obtain any recourse? The complexity of organ tourism is immense, clinically, ethically, and legally. So is there another option for patients who need a kidney or liver transplant?

Enter the Good Samaritan. These are people, right here in USA, who are ready and willing to give an organ to a stranger. They have no goal other than “to help”. Their organ gifts are “no strings attached” and often, they never even meet the person who receives their organ. For the Good Samaritan, all that matters is that they have something extra and they want to share it with someone who needs it. In the new book, The Organ Donor Experience: Good Samaritans and the Meaning of Altruism, 22 donors were extensively studied to learn their personalities and motivations for organ donation. In general, these givers are normal, everyday folk, of average means, with a genuine desire to serve their community. Often, they have a lengthy history of volunteerism and their parents did as well. They originate from all fields, law, law enforcement, health care, education, you-name-it. A Good Samaritan could be your neighbor down the street, the clerk at the grocery store, a local taxi driver, or even your bank teller. These people want to give, and with medical, surgical, and psychosocial screenings, they can be lifesavers.

References:

• Bramstedt K.A., Xu J. Checklist: passport, plane ticket, organ transplant. Am J Transplant. 2007 Jul;7(7):1698-701.
• Bramstedt K.A. Ethical minefields in medical tourism. Sonoma Medicine 2011.
• Bramstedt K.A. Steering clear of organ tourism. Kidney Review 2007.

Dr. Katrina A. Bramstedt is a noted medical ethicist associated with California Transplant Donor Network in Oakland, California. She also has a private practice in Marin County where she has performed over 800 ethics consultations and published over 75 articles in medical and bioethics journals. She lectures nationally and internationally and has made numerous appearances on television and radio discussing transplantation and donation. She is the co-author of The Organ Donor Experience: Good Samaritans and the Meaning of Altruism.

Let’s Create a New Month for Breast Cancer

By Sabrina McCormick, PhD

In a few days, National Breast Cancer Awareness Month (NBCAM) will be over. Thank goodness.

I suppose I shouldn’t say that, but the endless reams of pink products get on my nerves. This might seem insensitive and even cruel. It’s not. In fact, it stems from a respect for the struggle that women have against a horrid disease, and the history of the Month that in no way gives those women the respect due to them.

My annoyance starts with my distaste for the marking of women who have breast cancer with girlish femininities. That is hardly where it ends. Rather, every time I see a pink teddy bear or banner about a fundraising walk, I remember who owns the month and therefore who is telling the world, yes, I mean the world, what to think about breast cancer.

Most people don’t realize that one of the world’s largest pharmaceutical companies owns NBCAM. In 1984, the Executive Directors of Imperial Chemical Incorporated, Cancer Care, Inc., and the American Association of Cancer Care Physicians met to discuss the growing breast cancer crisis, and how to educate Americans about detection and treatment. More and more women seemed to be succumbing to the disease, but few were using mammography, the only medical test for detection. In addition, the Company had taken a turn for the worse in the late 1970s thanks to over-investment in petrochemicals, plastics and agricultural goods. It reported that even after reorganizing and streamlining, it had to “make greater levels of profitability and market penetration, and change its product profile (Pettigrew 1985).” Pharmaceuticals were the next venture, and it would need a consumer base. That is when the first National Breast Cancer Awareness Week was founded.

Over the years, Imperial Chemicals became AstraZeneca, one of the world’s largest pharmaceutical companies, and the owner of the NBCAM logo. Over those same years, the Month grew in popularity and consumption of pharmaceuticals grew. Today, Astra is a multi-billion dollar venture.

Here is my biggest problem with this scenario: women are still dying en masse. 40,170 women died in 2009, to be exact. Mortality is decreasing, but at what cost? 254,650 women got breast cancer last year. My film and book, No Family History, show the tremendous pain and suffering in the lives of women and their families even when women survive.

We need to take a new approach to this disease.

And so, I propose an alternative: National Breast Cancer Prevention Month. We are aware of breast cancer. Now, let’s prevent it. The idea is simple. During this month, we stop exposing ourselves to chemicals, toxins, and unhealthy living that leads down the road to cancer. During this month, we start to change what we consume, and so indicate to the companies making these chemicals that we will not support them. We spend this month telling our legislators we will not vote for them unless they protect us from these chemicals.

Let’s keep our daughters safe. Let’s stop breast cancer before it starts. Let’s stop buying pink and start thinking green.

Sabrina McCormick is a Science and Technology Policy Fellow of the American Association for the Advancement of the Sciences working in the Environmental Protection Agency, and she is also research faculty at the George Washington University School of Public Health and Health Services, and the author of No Family History: The Environmental Links to Breast Cancer.

Philanthropy and Your Friendly Neighborhood Supermarket

By Joel J. Orosz

“BECOME A SUPERMARKET MANAGER IN JUST SIX MONTHS!” The block letters of this notice, tacked up on a bulletin board at Grand Valley State University, recently caught my eye. A well-known national grocery chain was willing to train anyone who could dedicate half a year of their lives to learning this trade. It struck me as a reasonable proposition—a modern supermarket is a complicated business—but it also struck me as sad, because I teach at The Grantmaking School of Grand Valley State University, and it occurred to me that it takes six months longer to learn how to run a grocery store than to learn how to run an international charitable foundation.

Of course, that really isn’t true—learning how to make grants, how to manage a giving program, how nurture social change, how to affect public policy, and how to work with a foundation’s board of trustees is a tough education for those forced to learn on the job—but in the world of philanthropy, we have always pretended that smart people, with experience in other fields, can just waltz in and make a grantmaking foundation hum. On rare occasions, someone like John Gardner will come along, and pull the bunny out of the hat. Far more often, smart people make a hash out of the charitable program that they are totally unprepared to lead, and many conclude otherwise brilliant careers with the taste of ashes in their mouths.

I have been writing about good practices in grantmaking for seven years, and teaching in The Grantmaking School for three years. During that span, I have talked with literally hundreds of people who provide leadership to foundations as CEOs, members of boards of trustees, program directors, and program officers, and the comment I hear over and over again is: I wish I had known this when I started out in foundation work. Indeed. And now I add this thought to their sentiment:  I wish that charitable foundation boards were as serious about training their key employees as grocery chains’ boards are about training theirs.

Joel J. Oros is former Executive Assistant to the CEO, and Program Director in Philanthropy and Volunteerism at the W.K. Kellog Foundation. In 2004 he founded The Grantmaking School, the first university-based training program for grantmaking professionals located at Grand Valley State University. His book, Effective Foundation Management: 14 Challenges of Philanthropic Leadership—and How to Outfox Them (AltaMira Press, Sept. 2007), is now available for preorder.