Failure of Informed Consent in Compensated Non-Related Kidney Donation in the Philippines

A s i a n B i o e t h i c s R e v i e w J u n e 2 0 0 9 Vo l u m e 1 , I s s u e 2 138 Failure of Informed Consent in Compensated Non-Related Kidney Donation in the Philippines T S U Y O S H I AWAYA , L A L A I N E S I R U N O , S A R A H J A N E T O L E D A N O , F R A N C I S A G U I L A R , YOSUKE SHIMAZONO, AND LEONARDO D. DE CASTRO This paper reports selected aspects of the findings of research undertaken on economic and social consequences of compensated non-related kidney donation in the Philippines. The study was conducted on Filipinos who donated transplant organs for material consideration in medical institutions in the Philippines. Specifically, the study sought to find out where organ donors came from, where the transplants were done, how the donors were recruited, how much information they were given about the procedure and its possible consequences, the medical care they received, the manner in which they were treated, and the outcome of the experience for them in terms of self-assessed social and economic indicators. The donors were asked to report their own perception and assessment of their situation. They were not provided an objective scale for assessment. For the purposes of this paper, specific findings related to the validity of informed consent have been selected. These findings have to do with elements that ought to be present in order to render a patient’s consent valid. The selection was made to draw attention to the failure of informed consent and in order to encourage measures to curb the exploitation, and improve the situation for organ donors. Methodology The study was undertaken in several communities in the Philippines between May 2007 and March 2008. The researchers identified the places known for F I N D I N G S 138–143 Asian Bioethics Review June 2009 Volume 1, Issue 2 139 kidney selling on the basis of television and radio programs, newspaper reports, and statements made by key informants. The key informants included kidney vendors, middlemen, community leaders, local government officials, physicians, nurses, and ordinary persons. Once the communities were identified, the researchers sought the permission of community officials and leaders before approaching key informants. Respondents were individually briefed on the purpose of the research and consent was taken before proceeding with the interviews, which were recorded and documented in writing and by photography. Interviews were conducted by reading from prepared questionnaires. Relying on snowball sampling, the research team requested respondentdonors and other key informants for referrals to other organ donors. Attempts were made to trace all referrals until they were confirmed and interviewed or were irretrievably lost to follow up. It was through the referrals of the respondents from each of the research sites that the researchers were able to identify other areas in the country where money was being used to recruit donors. The house of a local official in an economically disadvantaged community in the City of Manila served as the venue for the first interviews to be conducted. Similar private places were sought for subsequent interviews that were conducted in the cities of Mandaluyong and Caloocan, and the provinces of Rizal, Quezon and Surigao. In all the sites, the researchers got prior permission from community authorities to conduct the survey. The initial respondents referred fellow organ donors to the researchers. It was through the referrals of the respondents from each of the research sites that the researchers were able to identify the other areas in the country where money was being used to recruit donors. The Respondents During the study period, the researchers were able to interview 311 respondents , consisting of 292 males and 19 females. When asked to indicate their jobs, 72 (23.2%) said they did not have any. Others mentioned jobs that could not be relied upon for regular pay. A total of 69 (22.2%) said they were drivers, 33 (10.6%) said they were...