As part of extensive testimony before the US Congress, researcher Maria Werlau has denounced the Cuban State for its involvement in human trafficking in many aspects.
The information from the Cuba File indicates that in 2005 the Cuban Government began to engage in mysterious exports to Brazil, under the administration of Lula da Silva, of human tissue and other glands and human body parts of unknown origin. Sales grew very rapidly, topping out at $88.4 million in 2013. Meanwhile, reports began to arrive from Cuba of suspicious deaths and the plundering of human body parts, which seem to suggest the hand of the State, meriting serious investigation.
The issue of the marketing of separate human body parts is well known and of interest to many countries, not exclusively applying to Cuba. What complicated this was that, in the case of Cuba, the question of secrecy (confidentiality?) arose when the Brazilian representative Arolde de Oliveira requested information from Brazil's Minister of Health, Arthur Chioro, and he refused to disclose it, violating the applicable federal law.
At this point we might ask: what are the governments of Brazil and Cuba hiding in relation to the transfer of biological products?
Trade in separate parts of the human body is now a global business, and employs Internet communication mechanisms to offer a varied range of products, used not only as organs and tissues for transplantation, but also in areas such as research and the development of new medical techniques.
A body of regulations and legal procedures is being developed to govern the acquisition and use of human body parts, a lucrative and important business worth billions of dollars. Human body parts are used to develop medical equipment, improve surgical techniques, and even to create cosmetics. Doctors use them for complex surgical procedures. This being the case, the obvious question is: how are these parts obtained, processed, marketed and used?
This issue has been addressed by journalist Annie Cheney in her book Body Brokers: Inside America's Underground Trade in Human Remains. The author points out the complicated network underlying these practices, which have become a thriving business, protected by legal vacuums where profit is the main goal, oversight is nonexistent, and corruption is rampant. In the US the Government regulates the acquisition of transplantable organs and tissues, but not human body parts used for educational and research purposes, and this is where it all starts.
If this is the case in the US, one can imagine the surprising things occurring in Asian countries. Trafficking in organs and tissues in Asia is an increasingly thriving and horrendous business. While seeking mechanisms to prevent "transplant tourism," no one can guarantee that the same mechanisms developed to provide organs for transplants are not used for trade in separate parts of the human body for other purposes.
One shocker was a newspaper article about a medical institute in Ukraine selling body parts of fetuses on its website, arguing that otherwise the parts would simply be discarded. The products on offer included: "fetal spleen cells, fragments of fetal backbones, fetal liver cells ..." . The demand for fetal body parts stems from the growing interest in stem cell and cosmetic research, and is a very sensitive issue that involves not only ethical considerations related to the handling and use of fetuses for such purposes, but also interests a large part of the population who, out of religious convictions, are committed to the prolife movement.
The scandal sparked by the marketing of fetal tissues by the organization Planned Parenthood reveals how delicate this issue is.
The case of Cuba
In Cuba the use of fetuses, or parts of them, in research carried out at the International Center for Neurological Restoration (CIREN) has been the subject of much controversy. Apart from the merits of attempts, deliberate or not, to impugn the reputations of those who have participated in these studies, the fact is that parts of human fetuses were used for research purposes and the development of treatments, which appalled many.
I do not doubt the Cuban State's widespread trafficking in separate parts of the human body in order to use them in biological research programs being carried out in Cuba, and also marketing to other countries, as is done with Brazil through an agreement that is kept secret.
There is an entire infrastructure in Cuba, encompassing hospitals, forensic services, research institutes and biopharmaceutical companies, along with highly qualified personnel. In the year 2011 alone 18,765 autopsies were performed, representing 53.3% of deaths in the country. To this can be added the parts obtained from abortions in a country in which 27 out of every 1,000 women have one. But there are many more sources of human parts, and procedures we may not know to obtain them. If there are some misgivings about all this, and there is no legislation in this respect, there is the argument of the US "blockade" to justify everything.
To prevent trafficking in human material, the World Health Organization (WHO) has established a set of guiding principles. We must remember that this trafficking in human body parts is aimed primarily at obtaining cells, tissues and organs for transplants. The parts that can be used to obtain biological products (for cosmetic purposes, for example) are not considered.
We wanted, at least, to cite the guiding principle that addresses considerations on the sale of human body parts. Guiding Principle 5 states that cells, tissues and organs should only proceed from voluntary, non-compensated donations. The purchase, or offering for purchase, of cells, tissues or organs for transplantation purposes, as well as their sale by individuals, or relatives of deceased persons, should be prohibited. The prohibition on the sale or purchase of cells, tissues and organs does not preclude defraying reasonable and verifiable expenses that may be incurred by donors, such as lost income, or the coverage of costs incurred by the acquisition, processing, conservation and provisioning of cells, tissues or organs for transplantation.
These WHO guiding principles are subsequent to the only binding law in Cuba governing the acquisition and use of cells, tissues and organs; that is, the regulation of the Public Health Law, Decree 139 of 1988.
A comparative study of legislation for Latin American countries, drafted by the Pan American Health Organization (PAHO) , shows that Cuban legislation is not consistent enough in these respects. However, we can point out some problematic aspects of said legislation with regards to trafficking in human body parts.
In Cuba the will of the deceased donor is respected, and no family member or individual can revoke a donation endorsed during one's life. This consent is indicated on one's donor ID card. Persons older than 18 years of age can donate their organs and tissues without so indicating on their identity cards. Parents or legal guardians may authorize the removal of organs and tissues from minors and those who are legally incapacitated.
However, there is a murky gap between what has been legislated and can be legislated, and what is done or is usually done. In practice, more than a few autopsies are carried out without the consent of the deceased patient or his family. The material obtained can be sent to other places and used for other purposes that are not necessarily diagnostic. The law is very general and vague, as it dates back to the 80s. Since then this field has grown far more complicated, involving issues like the handling and possible commercialization of cells, cell lines, stem cells, blood, organs, substances, proteins , enzymes, hormones, antibodies, tissues and genetic material, making the human body a source of raw material for industry.
Taking into account all the scientific resources available, and the commercial opportunity at stake, it does not surprise me that Cuba negotiated with Brazil for the sale of more than 80 million dollars in body parts in just one year, but we cannot know how this raw material was obtained.
Dictatorships legislate, but there is no transparency, and certainly no dedication to governing in accord with the law; the dark intricacies between what is right and what is demanded are confused, and never take into account the common good. It should be noted, however, in order to salvage a positive assessment, that the Cuban scientific community, professionals who work with dedication, defined by their decorum and nobility, usually agree to do their job in an honest way.
The Cuban government should reconsider its policies and adapt its legislation to bring it into line with the guiding principles established by the WHO. It should draw upon comparative jurisprudence and, above all, recognize that trafficking in body parts, though some might not wish to concede it, should never be a road to riches.
What is in the best interest of health and the development of medical research, and human dignity is what should and must engage the attention and efforts of not just the health authorities, but also the professional community forming part of this scenario.
Dr. Eloy A. González (Buenavista, Villa Clara, 1949) is a specialist in Oncology and was a Professor of Pharmacology at the University of Havana. He is the author of El Blog de Medicina Cubana.