Thai Doctors Breached Medical Ethics in Illegal Harvest of Human Organs by Phairath Khampha 16 February 2000 Method of obtaining kidneys ruled illegal An executive member and a number of doctors at Vachiraprakarn general hospital in Thailand's Samut Prakan Province were found in breach of medical ethics in obtaining kidneys for transplant in what has turned out to be a bizarre case of greed and corruption among Thai doctors. Five doctors at Vachiraprakan General Hospital broke the Medical Council's code of ethics while obtaining kidneys for transplant, the council ruled on February 9, 2000. Four of the doctors had their licences suspended and a fifth, Sirot Kanchanapanchaphol, had his revoked. This is as the hospital was cited for illegal transplants. Nearly 100 illegal kidney and liver transplants took place at Vachiraprakan Hospital from 1996 to 1997, according to the findings of an investigating committee set up by the Law Society. "They may not have killed any patients intentionally, but their method of obtaining organs violated the law and medical ethics," said the source, who is a doctor. The inquiry was ordered by the Medical Council after relatives, who received large sums from the hospital in compensation for the deaths of patients, alleged the hospital had stolen kidneys for transplant. The panel investigated doctors at the hospital who diagnosed patients supposedly as brain dead and who were involved in kidney transplants. The investigation focused on three aspects: the process of diagnosing a person as brain dead; the process of handling donations of body organs; and giving money to relatives of donors following the removal of body organs. Dr Chumsak Phruksaphong, deputy secretary-general of the Medical Council, said doctors in breach of ethics could face punishment ranging from a reprimand to suspension of their medical licence or even revocation. He said the Vachiraprakarn hospital scandal, which broke in July 1999 had led to the Medical Council drafting of a strict regulation to control organ transplantation. All hospitals providing such services would have to register with the Thai Red Cross Society, which was responsible for distributing donated organs without considering the financial status of the patients, he said. Dr Songyos Chaichana, director of the Medical Registration Division, said the Ministry of Public Health had no authority in taking action against the hospital, because the law permits it to look only at the hospital's infrastructure. "We've already checked the hospital, but could not do anything because the hospital has medical staff, equipment and operating theatres for carrying out organ transplants which are up to acceptable standards. "The law does not permit us to look into the behaviour or ethics of the doctors," said Dr Songyos. There is no law to directly govern transplant procedures in the country, though it is presumed that the Organ Donation Centre would act as the centre for distributing the donated organs. Somsak Toruksa, the lawyer for Vachiraprakarn general hospital, on February 9 defended the doctors and the hospital administrators. Doctors punished for unethical transplants Five doctors at Vachiraprakan General Hospital broke the Medical Council's code of ethics while obtaining kidneys for transplant, the council ruled on February 9. Four of the doctors had their licences suspended and a fifth, Sirot Kanchanapanchaphol, had his revoked, said the council's secretary general, Suppachai Khunarattanaphruk. The Medical Council's verdict was announced after a three-hour deliberation of the findings of the inquiry into allegations that staff at the hospital in Samut Prakan province were involved in the kidney trade. The council did not find compelling evidence that the hospital was actively involved in kidney trading, said Arun Phaosawat, chairman of the Medical Council. The hospital gave about 100,000 baht (1 US Dollar = 37.4320 Thai Baht) to relatives of each kidney donor, but the council could not determine whether the money to cover funeral and travel expenses as well as child support was payment for kidneys, said Arun. However, the hospital was found to have mismanaged its kidney transplants because it could not present the council with documents indicating that nine kidney donors and their recipients were either relatives or spouses, Suppachai said. The Medical Council only allows kidney donation and transplants between relatives and spouses. The hospital was found to have made profits from kidney transplants by charging recipients of the organs for the medical expenses of the donors, "financial assistance" for their relatives and kidney transplant expenses, Suppachai said. Sirot, a hospital executive and surgeon, was found guilty of conducting the kidney transplants and managing the kidney procurement, Suppachai said. The council, therefore, agreed that he deserved the harshest penalty it could deliver - the revocation of his medical licence. Surgeon Weeradet Loetdamronglak had his licence suspended for six months for assisting Sirot in the transplants. Nisit Uppararak's licence was revoked for three months for certifying that patients were brain dead without strictly adhering to the Medical Council's regulations. Disturbingly, there were indications that the patients might not have been actually brain dead when their organs were harvested, but because they came from poor families and the organs were to be used in wealthy patients the transplantations were carried out too hastily. Hospital executives Phairat Jaothakasettarin and Sukit Jampa-ngern were found guilty off providing remuneration to relatives of kidney donors. Their licences would be suspended for one year. The Medical Council would seek approval of its verdict from Public Health Minister Korn Dabaransi in March. Following his approval the penalties would be imposed. Hospital cited for illegal transplants Nearly 100 illegal kidney and liver transplants allegedly took place at Vachiraprakan Hospital from 1996 to 1997, according to the findings of an investigating committee set up by Thailand's Law Society. The society filed a police complaint against the hospital, its chairman, Sak Korsaengrueang, told a news conference on February 17. Sak said his society set up a working committee to look into allegations of trading in organs at Vachiraprakan Hospital in Samut Prakan province in October in 1999 after receiving a series of complaints. The committee, headed by Law Society secretary-general Wanchai Sornsiri, concluded that the hospital appears to have broken the law by having it staff fill up legal documents signed by other persons, Sak said. Tampering with the documents, which authorised major medical procedures to be carried out on patients, may have endangered their lives by also naming them as organ donors, Sak said. Wanchai said that from 1996 to 1997, his society received information about 98 cases of kidney and liver trading at Vachiraprakan Hospital. Relatives of organ donors were given between 20,000 Baht and 100,000 Baht (1 US Dollar = 37.6900 Thai Baht) as kickbacks. The hospital called the payments financial assistance to avoid legal action, he said. Wanchai raised the case of Charoen Deeyotha, who had sought legal assistance from the Law Society, as an example. Charoen's daughter was injured in an accident and rushed to the hospital. When he arrived at the hospital, a doctor told Charoen his daughter needed an urgent operation, and that he had to sign some documents allowing the hospital to perform the operation. Not being well informed about the situation, Charoen signed the documents without reading the contents, Wanchai told reporters. The next day, his daughter was pronounced dead, and Charoen was told he had donated his daughter's organs to the hospital. Charoen insisted he had never signed such a document. When he examined the document, he found a sentence stating that he had agreed to donate his daughter's kidneys. The sentence was written in someone else's handwriting, said Wanchai. Sak said the Law Society sent copies of its findings regarding the hospital to the national police commissioner and a secretary of the interior minister. It had also filed a complaint with the Crime Suppression Police commander. Pol Maj Gen Aswin Khwanmueang, commander of the Crime Suppression Police, said he had received the complaint filed by the Law Society. Aswin said he has assigned Pol Col Thawee Sordsong, Crime Suppression 2 superintendent, to lead an investigation into the society's complaint. The Crime Suppression Division had been tipped off that other Thai hospitals are involved in illegal organ trading similar to that alleged at Vachiraprakan Hospital and had been gathering information about those hospitals, Aswin said. Meanwhile, Samut Prakan police were searching for three disposal contractors who were suspected of dumping human organs in Tambon Samrong Nuea in Samut Prakan's Muang district, the assistant commissioner of Provincial Police Region 1 said. Pol Maj Gen Somjai Phodaphol said the human organs found at a local dump in Tambon Samrong Nuea on February 14 would be sent to the Institute of Forensic Medicine. The institute would examine the organs for the presence of infectious diseases. If the organs were found to carry infections, those involved in the dumping could face serious legal action, Somjai said. Patient's father tells of 200,000 Baht bribe - Told to deny theft of daughter's organs The father of a supposedly brain-dead patient whose kidneys and liver were removed without consent claimed on February 22 he was offered 200,000 baht to deny publicly that his daughter's organs had been stolen. "Two people came to me and offered 200,000 baht late last year [1999]. They told me to keep the money and tell the press I had donated my daughter's organs, or I would be in danger," said Charoen Deeyotha, 62. Before then, Mr Charoen had never said anything in public about the bribe offer or the threat against him. Mr Charoen said he was both angry and afraid. "Now I feel very scared whenever reporters or anyone else come to my house, because I don't know who is who. "A police team from the Crime Suppression Division also visited him the week before, he added. The police were told about the visit by a man and a woman who claimed to represent Vachiraprakan General Hospital where Mr Charoen's daughter Ladda was declared brain-dead. Her kidneys and liver were then removed for the hospital's transplant programme. Mr Charoen insisted his daughter's organs were removed without his knowledge. The woman was pregnant when she was hit by a car and sent to the hospital in Samut Prakan province. Mr Charoen said he was asked to sign two documents indicating his daughter would be operated on. Dr Vichai Chokevivat, of the Medical Council, on February 23 said the documents confirmed Mr Charoen's daughter was pronounced brain-dead before her organs were removed. Dr Vichai yesterday stressed that the council decided to have the five doctors' licences revoked or suspended because they were considered to have seriously violated medical ethics. It was not because they had intentionally caused patients to become brain-dead so the patients' organs could be removed for the hospital's transplant program. Suspicion over death of nurse Thailand's Crime Suppression Division reopened an investigation into the death of a nurse at the hospital at the centre of the illegal trade in human body parts. The death, which had been judged accidental, was now suspected of being a murder, a senior official with the division said. Witnesses in the case against the Vachiraprakan Hospital told police that Wanna Rakakit, a part-time nurse in the hospital's emergency unit, had been killed because she knew too much about illegal trading in organs, said Pol Col Sophon Pisuthipong, the division's deputy commissioner. This is common pratice in Thailand. People who know too much about corruption and illegal activities perpetrated by government officers, the military or members of the economic and political elite routinely are murdered so that they accidentally or on purpose may not tell the truth. In Thailand it is dangerous to be either honest or ethical in one's endeavours. In fact, it is often a fatal attitude. Wanna died after being hit by a motorcycle in early 1999 in front of the hospital in Samut Prakan. The scandal over the hospital's methods for acquiring organs for transplants broke out late in 1999. The division contacted local police for further information about Wanna's death Sophon said.