A prominent Lebanese organ transplant surgeon is facing charges of ethical misconduct for using unrelated living organ donors in three studies that were retracted from an international medical journal earlier this month.
The editorial board of the Turkish-based Experimental and Clinical Transplantation Journal pulled the papers published between 2009 and 2012 by Maroun M. Abou Jaoude, a surgeon at Sacre-Coeur Hospital, from their website after they were notified that he used kidneys from unrelated donors in the majority of his research, violating the ethical transplant standards all authors are required to comply with and quite possibly Lebanese law.
Abou Jaoude told The Daily Star he was in the process of formulating a response “that will show that all the rules and ethical guidelines were respected.” But he refused to elaborate on the relationship between the kidney donors and the recipients in the three retracted studies; whether money was exchanged with donors; or whether he received special approval from Lebanese authorities to do living, unrelated organ transplants in his research, as required by Lebanese law.
Two members of the journal’s editorial board said that Abou Jaoude’s articles were retracted because of “lack of conformity with the guiding principles of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism,” a 2008 agreement that established a set of transplantation standards to combat the growing problem of “organ commercialization” in which vulnerable citizens of resource-poor countries are paid to donate their organs to recipients in the developed world.
A growing global organ shortage and the unpopular reputation of cadaverous transplants has caused the illicit international organ trade to spiral in the past decade, according to the World Health Organization, as an increasing number of patients from developed countries pay upward of $120,000 for liver, kidney and tissues from poor citizens in the global south.
According to the associate editor of The Experimental and Clinical Transplantation Journal, Marwan Masri, the board first began to investigate Abou Jaoude’s research methods further after they were notified that his 2012 post-operative study about how iron levels impact the survival rates of transplant patients contained uncited, duplicated data from an earlier submission.
Though the Istanbul Declaration requires surgeons to abide by the transplant laws in their own countries, further alarm bells rang when the editorial board realized that Abou Jaoude disclosed the use of unrelated living organ donors in the text of the article, since the practice is restricted or banned by many governments. They contacted him on two separate occasions for an explanation and he failed to respond.
“The moment we saw that, we said please explain to us what do you mean by unrelated and what are the laws of your country governing unrelated donors,” Masri said. “When I see a paper from China for instance that says it uses unrelated donors, we ask the authors where did you get these donors? Were they prisoners? Was it altruistic?
“If [the use of unrelated donors] happened in Iran it would pass because the Iranian law permits organ donation from unrelated donors and medical research using unrelated donors is financed by the government.”
Like many Lebanese laws, the rules governing organ transplants from unrelated donors are vague.
“To my knowledge the law of the land dictates that [transplanted organs] either have to be cadaveric or from someone who is related,” says Assem al-Hajj, a surgeon at the Clemenceau Medical Center. “If you allow unrelated donors, the concern is that people would pay money to poor people for their organs.”
He said the unrelated donor law is strictly enforced in all major Lebanese hospitals, including his own. “If any flaw occurs it would be in faraway district hospitals.”
Former Lebanese Health Minister Karam Karam said that unrelated liver donations are permitted if they are approved by the ethics committee of the Lebanese Order of Physicians.
Neither the president of the Order of Physicians, Sharaf Abu Sharaf, nor one of the members of the Order’s Ethical Committee would comment on whether Abou Jaoude had received approval to use unrelated kidney donors in the studies, whether the allegations of ethical misconduct were being reviewed, or whether it had taken action against any doctors found guilty of unethical organ transplantation since it was created in 1999.
If Abou Jaoude can demonstrate he obtained prior permission from the Health Ministry and the Ethics Committee then the journal will republish the article, Masri said.
