BLOCKCHAIN BASED AUDITABLE
MEDICAL TRANSACTION SCHEME FOR
ORGAN TRANSPLANT SERVICES
Gasim Alandjani
Assistant Professor, CSE Department, Yanbu University College,
Royal Commission Yanbu (Saudi Arabia).
E-mail: alandjanig@rcyci.edu.sa
Recepción: 26/07/2019 Aceptación: 18/09/2019 Publicación: 06/11/2019
Citación sugerida:
Alandjani, G. (2019). Blockchain based auditable medical transaction scheme for
organ transplant services. 3C Tecnología. Glosas de innovación aplicadas a la pyme. Edición
Especial, Noviembre 2019, 41-63. doi: http://dx.doi.org/10.17993/3ctecno.2019.
specialissue3.41-63
Suggested citation:
Alandjani, G. (2019). Blockchain based auditable medical transaction scheme for organ
transplant services. 3C Tecnología. Glosas de innovación aplicadas a la pyme. Special Issue, November
2019, 41-63. doi: http://dx.doi.org/10.17993/3ctecno.2019.specialissue3.41-63
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ABSTRACT
Internet of Things have brought exciting changes in the social norms, work
environments and the prospects for future generations. These devices (Things)
have already changed the way our networks are used for communication. With
the introduction of machine to machine communication (M2M), where devices
communicate without human involvement to perform routine day to day tasks.
These tasks on one hand, include services that provide convenience to the device
owners such as setting o alarms, acting as personal assistant for reminders, keeping
track of daily activities etc. On the other hand, there are certain tasks where these
devices perform Transactions on behalf of the owners i.e. nancial transactions/
online ordering etc. These transactional tasks have signicant legal implications if
some problem / dispute arises due to such action performed by these devices on
behalf of the owners. To ensure that these interactions take place under observation
of the owners and to keep track of their occurrence, there is a need to keep record
of all such communication. We propose use of Blockchain for tracking all these
transactions without compromising secrecy of data by keeping its integrity intact for
medico-legal requirements and prevent risk of fraud.
KEYWORDS
IoT Security, Blockchain, Organ Donation, Smart Health, Nodes, Mining, UPRL,
IDoT, M-IOT, P2P.
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1. INTRODUCTION
Since the introduction of bitcoin cryptocurrency by Satoshi Nakamoto (2019)
and implementation of its underlying technology called Blockchain, many diverse
applications of Blockchain have been proposed by the researchers. Apart from
the traditional use of Blockchain that provides distributed, secure, trustable and
anonymous ecosystem to allow cryptocurrency transactions, its use in the eld of
medical record management, counterfeit drugs detection and fraud prevention
is a new area of research. As the economic disparity between the developed and
developing countries is increasing day by day, there is a continuous upsurge in the
demand of organs from third world countries to the advanced countries. This has
increased the potential of human organ tracking and poaching for nancial benets.
Despite, eorts by the governments to formalize the laws regarding organ donation
to prevent mistreatment of donors, there is a dire need of a secure, traceable and
distributed organ management and distribution system. In this paper, a Blockchain
based scheme is proposed to allow auditable medical transactions to prevent organ
tracking and tracking of legitimate organ donors & recipients. This will open a new
eld of Smart Health services based on Blockchain to safeguard the rights of medical
professionals and patients. With the advancement in science and technology, new
techniques have been introduced and humanity is getting benet from these latest
innovations especially in medical eld there came a revolution when transplantation
of human body part took place in recent history. Organ transplantation has been
used as a novel medical procedure that allows grafting of an organ from donor’s body
to replace a damaged or missing organ of the recipient. Due to its eectiveness and
importance as a lifesaving technique, there is an ever-increasing number of patients
waiting for transplant operations. Patients are no more on the mercy of fate to live
their lives with organ disabilities. Now they can easily change them with healthy body
parts of another person. With this level of advancement, it has become a routine
task in some prominent hospitals to transplant organs. According to the American
Transplant Foundation, 113,000 people in the United States are on the waiting list
to receive an organ as of March 2019. Every 12 minutes a new name is added to
the list and an average of 21 persons per day die due to a lack of organ availability.
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According to the Department of health (DoH) approximately 2,000 new waiting
patients are added into waiting list for organ transplantation in US only, Corneas,
kidneys, intestines, liver, bone marrow and lung, are the most common transplant
needs now a days (Decoded Science, 2019). WHO is working on this but the most
authentic data is from The U.S. DoH & Human Services related to complete Organ
translation process starting from its procurement from black market, selling to
targeted customers and then eventually its transplantation Network have publish a
report, according to this report there are approximately 121,333 organ transplant
are awaiting and kidney is having a very high number with awaiting 100,402 patients
of kidney recipients. Legally only 30,970 transplants took place in 2015 more and
less the same number was issued for 2014. WHO have reported about illegal import
of organs by many developed countries all the way from under developed countries,
USA is one of them and as per internet statistics patients are able to get transplant
of dierent organs starting from range of $70 to till $160,000.00 as per nature
and demand of organ. More than120650 patients waiting for organ transplant in
USA. There always more demand for fresh new organs which has created a perfect
condition for corrupt medics to exploit organs from those who are less privileged
and then sell them to needy people who have much and ultimately in this whole
process they get huge margin of prot (List25, 2019). According to the WHO, an
estimated 10,000 black market operations are being carried out by illegal purchase
of kidneys. Even in this current era of modern technologies still in some part of the
world many people have become victims of forcefully/involuntary organ donation
with the help of black market of pharmaceuticals. There are many international
organizations working to eliminate this illegal trac of organs which include Organ
failure solutions, ESOT and Organs watch, the average male organ donor is about
28.9 years old having a low average annual income of $480 on the recipient side
the average age for a male is about 48.1 years and an annual average income of
$53,000. Considering current situation, Medical experts have a view that based in
long queue due to lengthy procedure for organs retrieval from dead bodies, there is
a need to legalized organ donation by implementing strict and transparent policy in
place. Lack of legal framework on organ donation and poor law enforcement helps
black market where they oer little incentives to needy people and take away their
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organs. A great number of patients go to China, India or Pakistan for surgery can
pay up to $200,000 for a kidney to trackers who harvest organs from vulnerable,
desperate people, sometimes for as little as $5,000. Estimates state that kidneys
make up 75% of the global unlawful trade in organs and because of the rising
rates of diabetes, high blood pressure and heart problems the demand for kidneys
far outstrip supply (Whoin, 2019). According to the Bulletin of the World Health
Organization, Volume 85, Number 12, December 2007, 955-962, Many websites
are online that allow patients traveling abroad to purchase organs for transplants.
The transplant package range in China was as follows: Kidney ($ 70 000), Liver
($ 120 000), Pancreas ($ 110 000), Kidney and Pancreas ($ 160 000) while on
average, same package of Kidney transplant in Pakistan costed around US$17000
(Decoded Science, 2019). As there are many black markets in every walk of life so
is the case with human organs and there exist a black market where you can buy
livers, lungs, Kidney and even hearts based on worldwide failure rate there is more
demand for kidney in black market as compared to any other organ. According to
the World Health Organization, this is the reason that approximately 7,000 kidneys
are illegally harvested sent to their required destination by trackers as per their
black-market network. The prices for the same organ vary from country to country
based on its demand and supply conditions. If we calculate worldwide data for price
of human kidney then an average buyer spends $150,000 to purchase it from black
market depending on his access to any particular black market. On the other side
the average donor only gets an average amount of $5,000. This huge dierence in
prices facilitate the middlemen (commonly known as “organ brokers”) to get huge
margin of prot during this transaction. In this black-market business, the prots are
enormous, and money is used to lure many brokers and even doctors and supporting
paramedical sta and eventually they just cannot resist. In 2010 WHO estimated
about 11,000 organs were obtained on the black market. WHO based on statistical
data and associated ndings also claims that organs are being sold in black market
and continuous supply for organs is available which make to sell organ in almost
every hour 24/7/365.
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Figure 1. International black-market rates for organs.
On a world map you can nd many geographic locations where human organs are
being sold to potential recipients.
Figure 2. Global distribution of Living donor transplantation Activity -2017. Source: (Global Distribution,
2018).
Many international conferences are hosted by WHO and the February 2017 Summit
was one of them. This summit was organized on topic of Organ Tracking in Vatican
City, this summit also shared research and ndings on the state of the organ trade.
Even with this much technology advancement still the extent of organ tracking
and their transplantation with success and failure rate is not precisely known. Which
further complicate human tracking due to demands of their organs in black market.
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In order to eectively combat organ tracking there is need to increase its visibility
by complete tracking record of organs starting from donor till recipients, every step
should be documented with some reference number, fully hashed with time stamp
and unchangeable. This will help to reduce this kind of organized crimes, there
should be eective engagement of public-private partnerships including healthcare
and insurance companies for complete success to get rid of these kind of crimes
(Alarming Facts, 2019).
The solution lies in secure, track able recipient/donor proles and historical integral
information system. Which ultimately means ensuring security of patient’s medical
data and personal information is of utmost importance for any application in medical
domain. Consider a patient with wearable sensors that record any change in the
patient health-such as-high blood pressure, heart attack, faintness, blood sugar level
etc. The sensors send the information to cloud storage, where analytical procedures
are built, and other data related to the patient such as his medical history is already
saved. Real-time data from the sensors and the historical data from the cloud is used
to conduct classication and predication of the patient’s case. These ndings are sent
to a monitoring doctor that can get alert of the changes in condition of that particular
patient. It works in a reverse order to keep track of all the all phases during from start
till current status of transaction. Before going to implement Blockchain solution we
present Blockchain internal architecture, its working and essential components which
play important role in building a secure Blockchain solution for organ donation
through a track able, secure and unchangeable solution.
2. BLOCKCHAIN HISTORY AND ARCHITECTURE
The history of Blockchain Technology started with in 2008 when Nakamoto
introduced E-currency platform which is commonly known as cryptocurrency for
Bitcoin. In technical terms it is considered as a distributed database for storing a
constantly developing detail of records stored in the form of list in the same database
also known as blocks. A Blockchain is redundant yet veried list of records which
manipulate as result of dierent transactions in a peer-to-peer network of nodes,
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with the condition that each node will be having a copy of all records in the form
of a mirror image of the whole database. Blockchain devices connect to each other
in sequential list of blocks since each block except rst block which is also known as
the Genesis Block in blockchain terminology, contains information about and also
a link to the previous block and considered as a hash of the previous block. Every
block in a Blockchain is also containing a time stamped which in a way dierentiate
them from other blocks. Blockchain provides a decentralized peer-to-peer platform
for tracking all transaction related to any process without the need of a trusted third
party. Using Blockchain for medical domain is a relatively new area of research.
In this paper, we propose using Blockchain for tracking organ donation process for
secure, safe and auditable operation. Following series of gures (3-6) are explaining
step by step procedure starting from formation of block its entry in the chain and
then its functionality.
Figure 3. Formation of a Block.
Figure 4. Adding of Blocks in a chain series.
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Figure 5. Block Addition with Hash Numbers.
Above gure5 is showing how blocks are connected to other blocks and keeping its
own hash tag and pointing to hash tag of previous block it will reject the entry into
block if hash is not matched as given in Figure 6 below.
Figure 6. Denial of Block based on incorrect hash Number.
Blockchain works as distributed ledger using blocks of data. Each block contains
multiple transactions by hashing them and each transaction will have the network
timestamps on it. When a new block is created it will be added to the previous
written blocks and the process goes on and on to complete the chain of blocks.
Then all blocks and details of all previous transaction are stored in the user disc
storage named node. The information held inside of nodes will be used to verify
new transaction so new nodes will be added to the user chain or will be aborted.
This technique is called mining which insures proof-of-work feature (Diawar, 2019)
Blockchain technology can be utilized in many elds of life i.e. Supply chain, Real
Estates, Automobiles, Digital identity, Governance etc. Let’s consider a use-case of
Blockchain in healthcare services.
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Figure 7. Complete Workow diagram of Blockchain.
3. USE OF BLOCKCHAIN IN SERVICES
Blockchain technology is incorporated in various domains due to its compelling
benets in improving systems eciency, transparency, safety and integrity. A wide
range of domains are utilizing Blockchain approach including health, nancial,
manufacturing, business, governmental, and educational domains. With respect
to healthcare domain, several applications and ongoing systems are utilizing
Blockchain for improving medical record management, enhancing insurance claim
process, and accelerating clinical research (Ivan, 2016). Adopting Blockchain for
storing patient’s health record data and management of medical records will enable
patients to control access to their healthcare data. This will eliminate the need
to acquiring copies of the healthcare data or sending data to another healthcare
provider. Numerous companies are involved in adopting Blockchain technology
such as Healthcare Data Gateways (Snow, Deery, Kirby, & Johnston, 2015). Guard-
time, a well-known company, is using a Blockchain-based system to secure 1 million
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health records in Estonia (Williams-Grut Technology Behind Bitcoin, 2019). Due
to the transparency and immutability of Blockchain technology, it is used in some
of the governmental services. For example, Danish political party deployed the rst
Blockchain voting application for internal elections in which every vote is recorded in
a secure environment and stakeholders can participate and observe other votes (Millet,
2019; Ojo, n/d). In nancial domain, numerous applications have been introduced
for employing Blockchain technology. One of the most popular Blockchain-based
application in nancial area is cryptocurrency. It guarantees a secure environment
for nancial transactions in virtual currencies such as Bitcoin, Ripple, Litecoin, and
Monoro. Various Blockchain applications are related to stock markets services such
as securities exchange, smart contracts, trading and settlement, and payments and
remittance. Generally, these applications aim to simplify and speed up the traditional
process. Even in educational domain, Blockchain technology is used in dierent
scenarios. Several educational institutions have adopted Blockchain for various
problems. For example, the National University of La Plata (UNLP) developed a
Blockchain-based framework that veries students’ academic achievements and
accordingly issues the diploma. In 2015, a school in San Francisco started to utilize
Blockchain in order to assist employers to validate the academic credentials. Shahbaz
Pervez (2018) explains that in current technological era, everything revolves around
technology and technology rotates around cloud applications and communication
over internet. Security of data and associated applications is of great importance
which can result into drastic results if there is any negligence from programmers over
the security issues, SDLC cycle.
3.1. USE OF BLOCKCHAIN IN HEALTH INDUSTRY
Today’s healthcare industry is awfully multifaceted with a range of stakeholders, which
is a public private partnership of government agencies and private organizations
including insurance companies, pharmaceutical manufacturer and end users of
these medical products. There is a huge gap between healthcare providers and end
users because of non-transparent information exchange which ultimately aects the
entire healthcare including medical system. In the healthcare industry, collaboration
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for stakeholders is always dicult based on their particular business goals, intentions
and even approached to address all these issues and their solutions. The goals are
not properly aligned which result into fragmentation and unproductive services for
patients. Based on varied stakeholders and their business goals, conict of interest
is inevitable, there is a great need that healthcare system should have eective
collaboration, transparent processes and track able communication channels. But in
real world still there need to x some data handling and communication aws with
appropriate ow of information and its process audits which are extremely costly
and eventually resulting in slowing down of healthcare services. Governments and
health Insurance companies are major stakeholders which participate in drafting
and implementing healthcare policies with the help of paramedics. Blockchain helps
in several ways to ensure the integrity of data with proper tracking details of all
transactions right from start of Blockchain enabled UPRL. Government agencies
and international organization working in health sector, including WHO could have
the liberty to access real-time data from any hospital for research purposes and to
study dierent used cases based on this data which would help to determine the
health conditions of people living in specic area and even in a broader case over
all national health condition of a country. It will also help government agencies in
tracking of any infectious disease, their causes based on lifestyle of people and to
provide better health services with eective and more transparent way. This will
also help the insurance companies to solve the long-awaited problem by tracking all
transactional records which will ultimately prevent frauds, which is costing US only
about $68 billion per year ( The National Heath Care Anti-Fraud Association, 2018).
Use of Blockchain technology enables scientists, research organization, Universities
and even pharma companies. Through this technology they will get better access to
data without having fear for compromise on security of data and privacy of patients
which will eventually contribute for research. Paramedic’s sta including doctors and
other medical sta including doctors and nurses will also get advantage of Blockchain-
based systems in performing their day to day routine tasks with more eciency and
peace of mind. By accessing Universal Patient Record ledger, will reduce ambiguities
related to recovery or reaction of any medicine on any particular patient or group
of patients in some particular situation. If the UPRL is also connected with latest