The Legal and Ethical Challenges of Human Organ Transplantation

Handina Sulastrina Bakhtiar; Handar Subhandi Bakhtiar

doi:10.30649/jhek.v5i2.269

Authors

Handina Sulastrina Bakhtiar Faculty of Law, Universitas Pembangunan Nasional Veteran Jakarta
Handar Subhandi Bakhtiar Faculty of Law, Universitas Pembangunan Nasional Veteran Jakarta

DOI:

https://doi.org/10.30649/jhek.v5i2.269

Keywords:

Human Organ Transplantation, Health, Commercial

Abstract

Human organ transplantation has become a prominent topic alongside the advancement of law and technology. Through the transplantation process, an individual may obtain an organ from another person. This study aims to examine the debate between humanitarian principles and economic considerations in the practice of organ transplantation, as well as the legal framework governing organ transplantation in Indonesia. This study is a doctrinal legal study employing conceptual and statutory approaches, and using secondary legal materials analysed qualitatively to address the central issues concerning the discourse on organ transplantation in Indonesia. The findings indicate that human organ transplantation remains ethically complex, as economic pressures and poverty often influence consent, leading to exploitation and commercialisation. Despite existing legal prohibitions, the tension between humanitarian objectives and economic necessity persists, revealing gaps in ensuring voluntary donation, fairness, and the protection of human dignity. The Government of Indonesia, through Law Number 17 of 2023 on Health (Articles 124 to 134) and Government Regulation Number 28 of 2024 (Articles 325 to 381), stipulates the procedures, medical requirements, and ethical and legal aspects of organ transplantation for humanitarian and health recovery purposes, while explicitly prohibiting any form of commercialisation.

References

Legislation :

Law Number 17 of 2023 on Health.

Government Regulation Number 28 of 2024.

Journals :

Amahazion, F. (2016). Epistemic communities, human rights, and the global diffusion of legislation against the organ trade. Social Sciences. https://doi.org/10.3390/socsci5040069

Ambagtsheer, F. (2025). Understanding the challenges to investigating and prosecuting organ trafficking: A comparative analysis of two cases. Trends in Organized Crime, 28, 51–78. https://doi.org/10.1007/s12117-021-09421-2

Ambagtsheer, F., Zaitch, D., & Weimar, W. (2013). The battle for human organs: Organ trafficking and transplant tourism in a global context. Global Crime. https://doi.org/10.1080/17440572.2012.753323

Ambagtsheer, J. A. E., Pascalev, A., de Jong, J., Lundin, S., Ivanovski, N., Codreanu, N., Gunnarson, M., Yankov, J., Frunza, M., Byström, I., Bos, M., & Weimar, W. (2014). Trafficking in human beings for the purpose of organ removal: A comprehensive literature review. Transplant Immunology. https://doi.org/10.1016/j.trim.2014.11.201

Andorno, R. (2018). Buying and selling organs: Issues of commodification, exploitation and human dignity. Journal of Trafficking and Human Exploitation. https://doi.org/10.7590/245227717x15090911046502

Aronowitz, A. A., & Isitman, E. (2013). Trafficking of human beings for the purpose of organ removal: Are (International) legal instruments effective measures to eradicate the practice? Groningen Journal of International Law. https://doi.org/10.21827/5a86a79483992

Bakhtiar, H. S., & Maddussila, S. A. (2024). Manipulation of legal regulations in commodification of organ transplants: Indonesia perspective. Journal of Indonesian Legal Studies, 9(2). https://doi.org/10.15294/jils.v9i2.19157

Berwick, D. M. (2020). The moral determinants of health. JAMA. https://doi.org/10.1001/jama.2020.11129

Bowden, J. (2013). Feeling empty? Organ trafficking & trade: The black market for human organs. Intercultural Human Rights Law Review 451 (2013). https://scholarship.stu.edu/ihrlr/vol8/iss1/9

Bradford, T. W., & Boyd, N. W. (2020). Help me help you! Employing the marketing mix to alleviate experiences of donor sacrifice. Journal of Marketing. https://doi.org/10.1177/0022242920912272

Chen, F.-M., Liu, X., Polym, P., & Author, S. (2016). Advancing biomaterials of human origin for tissue engineering. Progress in Polymer Science. 10.1016/j.progpolymsci.2015.02.004

Cohen, L. R. (2017). Increasing the supply of transplant organs: The virtues of a futures market. In Organ and Tissue Transplantation. https://doi.org/10.4324/9781315247571-7

Crowley-Matoka, M., & Lock, M. (2006). Organ transplantation in a globalised world. Mortality. https://doi.org/10.1080/13576270600615310

DeBellis, G. C. (2021). Eradicating Human Trafficking: Culture, Law and Policy. https://doi.org/10.1163/9789004473348

Dierksmeier, C. (2015). Human dignity and the business of business. Human Systems Management. https://doi.org/10.3233/HSM-150830

Duan, Q. (2022). The criminal law regulation of human organ transplantation. International Journal of Education and Humanities. https://doi.org/10.54097/ijeh.v5i2.2114

Fakkert, S., Schwarz, P., & Pruyt, E. (2015). Kidney transplantations in the United States: A system dynamics approach to reduce the waiting list and illegal trafficking. 33rd International Conference of the System Dynamics Society.

Gallagher, A., & Holmes, P. (2008). Developing an effective criminal justice response to human trafficking: Lessons from the front line. International Criminal Justice Review. https://doi.org/10.1177/1057567708320746

Gardiner, D., McGee, A., & Shaw, D. (2021). Two fundamental ethical and legal rules for deceased organ donation. BJA Education. https://doi.org/10.1016/j.bjae.2021.03.003

Gawronska, S. (2019). Organ trafficking and human trafficking for the purpose of organ removal. New Journal of European Criminal Law. https://doi.org/10.1177/2032284419862387

Gillespie, R. (2022). What money cannot buy and what money ought not buy: Dignity, motives, and markets in human organ procurement debates. In Queer Interventions in Biomedicine and Public Health. https://doi.org/10.1007/978-3-031- 19235-7_8

Greenbaum, J., Bodrick, N., Flaherty, E. G., Idzerda, S. M., Laskey, A. T., Legano, L. A., Leventhal, J. M., Gavril, A. R., Fortson, B., MacMillan, H., Stedt, E., Hurley, T. P., Suchdev, P. S., Chan, K. J., Howard, C. R., McGann, P. T., St Clair, N. E., Yun, K., Antala, S., & Kurbasic, M. P. (2017). Global human trafficking and child victimization. Pediatrics. https://doi.org/10.1542/peds.2017-3138

Han, Y., Kong, Y., Peng, S., & Wang, X. (2022). Effect of attribution training on early postoperative depression of kidney transplant recipients. Current Psychology. https://doi.org/10.1007/s12144-020-00954-3

Handayani, T. (2021). Criminal law functionalization of kidney trafficking for transplant purposes. Jurnal Pembaharuan Hukum. https://doi.org/10.26532/jph.v8i3.13389

Hopper, E., & Hidalgo, J. (2006). Invisible chains: Psychological coercion of human trafficking victims. Intercultural Human Rights Law Review.

Jafar, T. H. (2009). Organ trafficking: Global solutions for a global problem. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2009.08.014

Jones, J. (2019). Is it time to open a conversation about a new United Nations treaty to fight human trafficking? In The Palgrave International Handbook of Human Trafficking. https://doi.org/10.1007/978-3-319-63058-8_129

Jordan, J., Patel, B., & Rapp, L. (2013). Domestic minor sex trafficking. Journal of Human Behavior in the Social Environment. https://doi.org/10.1080/10911359.2013.764198

Jordan, M. C. (2010). Bioethics and “human dignity.” Journal of Medicine and Philosophy. https://doi.org/10.1093/jmp/jhq010

Kastelz, A., Tzvetanov, I. G., Fernhall, B., Shetty, A., Gallon, L., West-Thielke, P., Hachaj, G., Grazman, M., & Benedetti, E. (2015). Experimental protocol of a randomized controlled clinical trial investigating the effects of personalized exercise rehabilitation. Contemporary Clinical Trials. https://doi.org/10.1016/j.cct.2015.10.002

Kierans, C. (2016). Transplantation, organ donation and (in)human experience. In Culture, Bodies and the Sociology of Health. https://doi.org/10.4324/9781315575506-3

King, L. (2013). International law and human trafficking. Human Rights & Human Welfare : Vol. 9: Iss. 1, Article 32.

Kobashigawa, J., Dadhania, D. M., Farr, M., Tang, W. H. W., Bhimaraj, A., Czer, L., Hall, S., Haririan, A., Formica, R. N., Patel, J., Skorka, R., Fedson, S., Srinivas, T., Testani, J., Yabu, J. M., & Cheng, X. S. (2021). Consensus conference on heart- kidney transplantation. American Journal of Transplantation. https://doi.org/10.1111/ajt.16512

Kögel, J. (2024). The public you want, the public you get: Public–science relationships in xenotransplantation debates. Public Understanding of Science. https://doi.org/10.1177/09636625241232098

Langran, I. (2021). Challenges to global health governance from international trade in organ transplants. Global Governance. https://doi.org/10.1163/19426720- 02701002

Leeper, B. J., Grachan, J. J., Robinson, R., Doll, J., & Stevens, K. (2024). Honoring human body donors. Anatomical Sciences Education. https://doi.org/10.1002/ase.2378

Machado, N. (2019). Using the bodies of the dead: Legal, ethical and organisational dimensions of organ transplantation. Routledge. https://doi.org/10.4324/9780429426452

Manara, A. R., & Thomas, I. (2020). Current status of organ donation after brain death in the UK. Anaesthesia. https://doi.org/10.1111/anae.15038

Mohamed, K. A., et al. (2022). Neighborhood poverty and liver transplantation evaluation. Liver Transplantation. https://doi.org/10.1002/lt.26473

Morley, J., Machado, C. C. V., Burr, C., Cowls, J., Joshi, I., Taddeo, M., & Floridi, L. (2021). The ethics of AI in health care. In Philosophical Studies Series. https://doi.org/10.1007/978-3-030-81907-1_18

O’Neill, M. (2024). Trafficking and organs, tissues, and cells. European Journal of Crime, Criminal Law and Criminal Justice. https://doi.org/10.1163/15718174-bja10051

Obani, P., & Okunrobo, H. (2022). Critical reflections on combating trafficking in human organs in Nigeria. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4269681

Paminto, S. R. (2017). Dehumanisasi penjualan organ tubuh manusia berdasarkan hukum positif. Jurnal Wawasan Yuridika, 1(2), 174–190. https://doi.org/10.25072/jwy.v1i2.155

Robertson, J. A. (2017). Organ donations by incompetents and the substituted judgment doctrine. In Organ and Tissue Transplantation. https://doi.org/10.4324/9781315247571-19

Rowley, J., Richards, N., Carduff, E., & Gott, M. (2021). The impact of poverty and deprivation at the end of life: A critical review. Palliative Care and Social Practice. https://doi.org/10.1177/26323524211033873

Rudge, C., Matesanz, R., Delmonico, F. L., & Chapman, J. (2012). International practices of organ donation. British Journal of Anaesthesia. https://doi.org/10.1093/bja/aer399

Ruslan A G, Y. A. (2016). Penegakan hukum kasus jual beli organ tubuh di Indonesia. Jurnal Fenomena.

Salmah, H., Tongat, T., & Isrok, M. (2021). Transactions of human organs according to Islamic law, positive law and health law. https://doi.org/10.4108/eai.1-7- 2020.2303623

Sari, A. G. (2021). Kejahatan perdagangan organ manusia ditinjau dari hukum positif. Jurnal Transparansi Hukum, 4(2), 1–24.

Sever, M. S., Van Biesen, W., Vanholder, R., Mallick, N., London, G., Schena, F. P., Nagy, J., Buturovic-Ponikvar, J., Heering, P., Maggiore, U., Mariat, C., Watschinger, B., Oniscu, G., Peruzzi, L., Gandolfini, I., Hellemans, R., Abramowicz, D., Pascual, J., & Hilbrands, L. (2022). Ethical and medical dilemmas in paid living kidney donor transplantation. Transplantation Reviews. https://doi.org/10.1016/j.trre.2022.100726

Shaw, R. M., & Bell, L. J. M. (2015). “Because you can’t live on love”: Living kidney donors’ perspectives on compensation. Health Expectations. https://doi.org/10.1111/hex.12310

Shekhani, S. S., & Lanewala, A. A. (2021). Ethical challenges in dialysis and transplantation. Seminars in Nephrology Volume 41 Issue 3. https://doi.org/10.1016/j.semnephrol.2021.05.002

Sulistyo, I., Wiranata, I. J., & Lestari, S. I. (2022). A review of theories, concepts, and international legal instruments for research on transnational organized crime. ULICoSS 2021 Proceedings. https://doi.org/10.2991/assehr.k.220102.006

Suparman, R. (2020). Perlindungan hukum dan tanggung jawab rumah sakit terhadap dokter dalam sengketa medis. Syiar Hukum: Jurnal Ilmu Hukum. https://doi.org/10.29313/shjih.v17i2.5441

Susanto, A. (2019). Reformulasi kebijakan tentang transplantasi organ ginjal manusia. Jurnal Ilmiah Dunia Hukum, vol. 3, no. 2, 7 Apr. 2019, pp. 114-131. https://doi.org/10.35973/jidh.v3i2.1366

Vigar, R. J. (2020). Review of Trafficking Culture. Antiquity. https://doi.org/10.15184/aqy.2020.26

Wulandari, O., Imron, A., Ernawati, B., & Nurdin, N. (2020). Presumption of innocence against criminal offenders in the police: A critical study. Walisongo Law Review (Walrev). https://doi.org/10.21580/walrev.2020.2.1.5506

Yang, F. C., Chen, H. M., Huang, C. M., Hsieh, P. L., Wang, S. S., & Chen, C. M. (2020). Difficulties and needs of organ transplant recipients during postoperative care at home: A systematic review. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17165798

Books :

Cohen, L. R. (2017). Organ and Tissue Transplantation. (Chapter reference mentioned in citation).

Kierans, C. (2016). Transplantation, Organ Donation and (In)Human Experience. Routledge.

Website :

Administration Health Resources & Services. (2025). Organ Donation Statistics. Organdonor.gov. https://www.organdonor.gov/learn/organ-donation- statistics

Maginn, S. (2023). Organ trafficking facts. The Exodus Road.

Report :

May, C. (2017). Transnational crime and the developing world. Global Financial Integrity. https://gfintegrity.org/wp-content/uploads/2017/03/Transnational_Crime-final.pdf