San José, Costa Rica, since 1956

New organ donation law in the wings as Costa Rica's Caja distances itself from private transplants

After the arrest of Dr. Francisco José Mora in San José on Tuesday as part of a Judicial Investigation Police (OIJ) probe into his involvement in an international organ trafficking operation, legislators scrambled to draft an updated organ donation law as the Costa Rican Social Security System, or Caja, tries to distance itself from the world of private organ transplants.

Pushed to the front of the line after international denouncements of organ trafficking and Mora’s arrest, a 2011 reform bill that has been wending its way through the legislature has taken on new urgency.

Under the current law, which dates back to 1994, it is illegal to pay someone for his or her organs in Costa Rica. Bill 18,246 would prohibit any form of compensation or cash in kind as well as any “social or psychological” pressure from the donor, recipient or another individual to provide an organ. It would also outlaw any kind of advertising for the need or donation of an organ or human tissue by individuals or institutions. 

One of the bill’s more controversial provisions would prohibit organ donations from non-relatives except in cases where the donor is found to offer the organ voluntarily and in a spirit of altruism. It would also outlaw organ or tissue donations from minors, except in the case of bone marrow.

According to National Liberation Party lawmaker Elibeth Venegas’ office, the bill would also strengthen institutional controls and grant officials greater powers to investigate organ donations. The bill was sent to the floor, where legislators have the opportunity to propose amendments during the next four sessions. 

Meanwhile, in an interview with the daily La Nación on Thursday, Caja President Ileana Balmaceda denied that the institution is involved in organ trafficking and defended Caja protocols.

The president added that she could not comment on whether or not there were more public health care system doctors possibly involved in this or other organ trafficking operations. Besides his private practice, Mora was head of nephrology at the public Calderón Guardia Hospital, in San José, run by the Caja. Yesterday, a judge approved six months of preventative detention for the suspected organ trafficker, according to La Nación.

When asked about evidence presented by the Prosecutor’s Office from a nurse alleging that equipment from public hospitals was used in the operations in question, Balmaceda stressed that such behavior violated institution policy and offered stricter protocols as a possible solution. “What more can we do?” she asked in the interview.

José Mairena, a representative from the Caja, told The Tico Times that the majority of the organs used in operations performed by public hospitals come from victims of accidents registered as organ donors upon their death, or voluntary donations from friends or family of the recipient. 

According to a statement from the Caja, 60 percent of the kidney transplants performed at Hospital Mexico originate with living willing donors, often family members.

In 2012, the Caja performed 454 transplants, including 115 kidney transplants. According to figures from the health organization, there are 156 people in Costa Rica currently registered with the Caja to receive a kidney when one becomes available. Mairena added that each case is different and that there is no preference given when a kidney becomes available for transplant. 

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