- Email: [email protected]
Organ and human trafficking in Nepal
Correspondence
I was baffled to read, in Sophie Cousins’ World Report (Feb 27, p 833),1 the stories of people in Nepal who were made vulnerable because of the earthquake and poverty to sell their organs, particularly their kidneys. A substantial proportion of kidney donors (315 [70%] of 452) were unrelated to the recipient, and 94% of kidney transplantations were done in India,2 which has become an international hub for kidney trade.3 Only few scientific publications have so far reported this illegal human organ trafficking, particularly because of the intricacies of tracking these cases. Additionally, frequent news and media reports2 on such trafficking, particularly between Nepal and India, have failed to ask the Nepalese Government to take action against it. Similarly, human trafficking has been reported in Nepal. A systematic review4 in 2012 showed a shocking scenario of human trafficking in Nepal that has been well rooted over the past decades. Apparently, action against these illegal human and organ trafficking seems trivial. The solution to this problem is definitely not straightforward. Among many factors, impunity and poverty are the main contributors to human and organ trafficking. Although legal loopholes seem to be the facilitating factor for organ and human trafficking, a substantial number of people from remote and impoverished communities are often the victims and are mostly allured by financial incentives.2 However, it is arguable if poverty alone could have been the only factor provoking people to sell their organs. More research on these issues is required. Although poverty reduction through sustainable development programmes could reverse these vulnerabilities in the long run, strong legal actions from both countries are required immediately. www.thelancet.com Vol 387 May 7, 2016
I declare no competing interests.
Bipin Adhikari [email protected] Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; and Nepal Community Health and Development Center, Kathmandu, Nepal 1 2
3
4
Cousins S. Nepal: organ trafficking after the earthquake. Lancet 2016; 387: 833. Dulal RK, Karki S. Nepalese kidney transplant recipient in a follow up clinic: related and unrelated living donor. JNMA J Nepal Med Assoc 2008; 47: 98–103. Ivanovski N, Popov Z, Cakalaroski K, Masin J, Spasovski G, Zafirovska K. Living-unrelated (paid) renal transplantation—ten years later. Transplant Proc 2005; 37: 563–64. Oram S, Stockl H, Busza J, Howard LM, Zimmerman C. Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review. PLoS Med 2012; 9: e1001224.
packaging law before the World Trade Organization (WTO), acting in support of tobacco manufacturer Philip Morris. In October, 2015, European Ombudsman Emily O’Reilly criticised the Commission’s failure to comply with FCTC rules regarding tobacco industry lobbying. The Commission has responded by repeating that it “complies in full” with the rules.6 Again, the WHO remains blind and silent, making the Convention worth no more than the paper on which it is written. I declare no competing interests.
Alain Braillon [email protected] University Hospital, 80000 Amiens, France. 1
The Framework Convention on Tobacco Control The unconditional support for WHO’s Framework Convention on Tobacco Control (FCTC) shown by Martin Raw, Judith MacKay, and Srinath Reddy warrants discussion. 1 The World Oncology Forum ranked tobacco control first among its ten priorities,2 but the Convention is one more failure to add to the record of WHO’s bureaucracy.3,4 First, from 1980 to 2004, the annual decrease in the prevalence of daily smoking was on a fast track, reaching 2% in 2004, the year of the Convention. Since then it has levelled off, and the 2012 annual rate of change in prevalence of daily smoking was almost zero.5 Second, WHO claims the FCTC has 180 parties, but exhibits little concern for implementation of the Convention. The sixth session of the Conference of the Convention was held in Moscow in 2014, with 179 countries, 46 of which were essentially tourists as they failed to produce their self-assessment report. WHO took no action. Such soft diplomacy is hardly acceptable when parties such as Indonesia, Dominican Republic, Honduras, Ukraine, and Cuba challenged Australia’s plain tobacco
Howard Davies/Corbis
Organ and human trafficking in Nepal
2 3
4 5
6
Raw M, Mackay J, Reddy S. Time to take tobacco dependence treatment seriously. Lancet 2016; 387: 412–13. Cavelli F. Stop cancer now! Lancet 2013; 381: 426–27. Braillon A. Global health challenges facing bureaucracy: democratization or revolution? Public Health 2014; 128: 1134–35. Lancet. 1 year on—lessons from the Ebola outbreak for WHO. Lancet 2015; 385: 1152. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 2014; 311: 183–92. Corporate Europe Observatory. European Commission complacent on tobacco industry influence. Feb 8, 2016. http://corporateeurope. org/pressreleases/2016/02/europeancommission-complacent-tobacco-industryinfluence (accessed April 11, 2016).
Sugary drinks tax: response from the Institute for Fiscal Studies In their Correspondence (March 19, p 1162), 1 Peter Scarborough and colleagues correctly quote us as saying that “the efficacy of [a sugary drinks tax] will depend on what products [consumers] switch to and how firms change their prices”, stating that we “based [our] conclusions on economic theory without reference to the evidence”. We agree that the magnitude of consumer response is an empirical question. Our Green Budget chapter2 neither supported nor opposed the 1907
I was baffled to read, in Sophie Cousins’ World Report (Feb 27, p 833),1 the stories of people in Nepal who were made vulnerable because of the earthquake and poverty to sell their organs, particularly their kidneys. A substantial proportion of kidney donors (315 [70%] of 452) were unrelated to the recipient, and 94% of kidney transplantations were done in India,2 which has become an international hub for kidney trade.3 Only few scientific publications have so far reported this illegal human organ trafficking, particularly because of the intricacies of tracking these cases. Additionally, frequent news and media reports2 on such trafficking, particularly between Nepal and India, have failed to ask the Nepalese Government to take action against it. Similarly, human trafficking has been reported in Nepal. A systematic review4 in 2012 showed a shocking scenario of human trafficking in Nepal that has been well rooted over the past decades. Apparently, action against these illegal human and organ trafficking seems trivial. The solution to this problem is definitely not straightforward. Among many factors, impunity and poverty are the main contributors to human and organ trafficking. Although legal loopholes seem to be the facilitating factor for organ and human trafficking, a substantial number of people from remote and impoverished communities are often the victims and are mostly allured by financial incentives.2 However, it is arguable if poverty alone could have been the only factor provoking people to sell their organs. More research on these issues is required. Although poverty reduction through sustainable development programmes could reverse these vulnerabilities in the long run, strong legal actions from both countries are required immediately. www.thelancet.com Vol 387 May 7, 2016
I declare no competing interests.
Bipin Adhikari [email protected] Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; and Nepal Community Health and Development Center, Kathmandu, Nepal 1 2
3
4
Cousins S. Nepal: organ trafficking after the earthquake. Lancet 2016; 387: 833. Dulal RK, Karki S. Nepalese kidney transplant recipient in a follow up clinic: related and unrelated living donor. JNMA J Nepal Med Assoc 2008; 47: 98–103. Ivanovski N, Popov Z, Cakalaroski K, Masin J, Spasovski G, Zafirovska K. Living-unrelated (paid) renal transplantation—ten years later. Transplant Proc 2005; 37: 563–64. Oram S, Stockl H, Busza J, Howard LM, Zimmerman C. Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review. PLoS Med 2012; 9: e1001224.
packaging law before the World Trade Organization (WTO), acting in support of tobacco manufacturer Philip Morris. In October, 2015, European Ombudsman Emily O’Reilly criticised the Commission’s failure to comply with FCTC rules regarding tobacco industry lobbying. The Commission has responded by repeating that it “complies in full” with the rules.6 Again, the WHO remains blind and silent, making the Convention worth no more than the paper on which it is written. I declare no competing interests.
Alain Braillon [email protected] University Hospital, 80000 Amiens, France. 1
The Framework Convention on Tobacco Control The unconditional support for WHO’s Framework Convention on Tobacco Control (FCTC) shown by Martin Raw, Judith MacKay, and Srinath Reddy warrants discussion. 1 The World Oncology Forum ranked tobacco control first among its ten priorities,2 but the Convention is one more failure to add to the record of WHO’s bureaucracy.3,4 First, from 1980 to 2004, the annual decrease in the prevalence of daily smoking was on a fast track, reaching 2% in 2004, the year of the Convention. Since then it has levelled off, and the 2012 annual rate of change in prevalence of daily smoking was almost zero.5 Second, WHO claims the FCTC has 180 parties, but exhibits little concern for implementation of the Convention. The sixth session of the Conference of the Convention was held in Moscow in 2014, with 179 countries, 46 of which were essentially tourists as they failed to produce their self-assessment report. WHO took no action. Such soft diplomacy is hardly acceptable when parties such as Indonesia, Dominican Republic, Honduras, Ukraine, and Cuba challenged Australia’s plain tobacco
Howard Davies/Corbis
Organ and human trafficking in Nepal
2 3
4 5
6
Raw M, Mackay J, Reddy S. Time to take tobacco dependence treatment seriously. Lancet 2016; 387: 412–13. Cavelli F. Stop cancer now! Lancet 2013; 381: 426–27. Braillon A. Global health challenges facing bureaucracy: democratization or revolution? Public Health 2014; 128: 1134–35. Lancet. 1 year on—lessons from the Ebola outbreak for WHO. Lancet 2015; 385: 1152. Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 2014; 311: 183–92. Corporate Europe Observatory. European Commission complacent on tobacco industry influence. Feb 8, 2016. http://corporateeurope. org/pressreleases/2016/02/europeancommission-complacent-tobacco-industryinfluence (accessed April 11, 2016).
Sugary drinks tax: response from the Institute for Fiscal Studies In their Correspondence (March 19, p 1162), 1 Peter Scarborough and colleagues correctly quote us as saying that “the efficacy of [a sugary drinks tax] will depend on what products [consumers] switch to and how firms change their prices”, stating that we “based [our] conclusions on economic theory without reference to the evidence”. We agree that the magnitude of consumer response is an empirical question. Our Green Budget chapter2 neither supported nor opposed the 1907