Organ trade
Organ trade (also known as the blood market or the red market) is the trading of human organs, tissues, or other body products, usually for transplantation. According to the World Health Organization (WHO), organ trade is a commercial transplantation where there is a profit, or transplantations that occur outside of national medical systems. There is a global need or demand for healthy b
Overview
Organ trade (also known as the blood market or the red market) is the trading of human organs, tissues, or other body products, usually for transplantation. According to the World Health Organization (WHO), organ trade is a commercial transplantation where there is a profit, or transplantations that occur outside of national medical systems. There is a global need or demand for healthy body parts for transplantation, which exceeds the numbers available. Commercial trade in human organs is currently illegal in all countries except Iran. Recent bans on the commercial organ trade (e.g. India in 1994 and the Philippines in 2008) have increased the availability of transplants and the safety of the procedures. Despite these prohibitions, organ trafficking and transplant tourism remain widespread (however, the data on the extent of the black market trade in organs is difficult to obtain). The question of whether to legalize and regulate the organ trade to combat illegal trafficking and the significant global organ shortage is greatly debated. This discussion typically centers on the sale of kidneys by living donors, since human beings are born with two kidneys but need only one to survive.
History
The first scientific report of the phenomenon dates back to a publication in The Lancet in 1990. The study tracked 131 patients from the United Arab Emirates and Oman who underwent kidney transplants in Bombay and who reportedly experienced numerous post-operative problems. In its report on organ trafficking in Europe, the Social, Health and Family Affairs Committee of the Council of Europe wrote: "On a global scale, organ trafficking is not a new problem. In the 1980s, experts began to notice a practice that was later dubbed 'transplant tourism': wealthy Asians traveled to India and other parts of Southeast Asia to obtain organs from poor donors. Since then, other destinations have emerged, such as Brazil and the Philippines. According to some allegations, China is involved in the trade of organs taken from executed prisoners. Organ sales continue in India despite new laws in the country that make this practice illegal in most regions. While current estimates suggest that the illicit organ trade remains relatively modest in Europe, this problem does not lose any of its seriousness, as it is very likely that with new medical advances, the gap between supply and demand for organs will continue to widen."
In Iran
Iran is the only nation that allows organs to be bought and sold. Due to lack of infrastructure to maintain an efficient organ transplant system in the early 1980s, Iran legalized living non-related donation (LNRD) of kidneys in 1988. The Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) control the trade of organs, with the support of the government. These nonprofit organizations match donors to recipients, setting up tests to ensure compatibility. Donors receive tax credit compensation from the government, free health care insurance, and often direct payment from the recipient with the average donor being paid $1,200. Some donors are also offered employment opportunities. Charity organizations support recipients that cannot afford the cost of the organ. Iran does place restrictions on the commercial organ trade in an attempt to limit transplant tourism. The market is contained within the country; that is, foreigners are not allowed to buy the organs of Iranian citizens. Additionally, organs can only be transplanted between people of the same nationality. Proponents of legalized organ trade have hailed the Iranian system as an example of an effective and safe organ trading model. In addition, the LNRD model is compatible with the social climate in the country. Religious practices in Iran stymies donation culture in the country as organ donations is often viewed as taboo. In 2017, from a possible 8,000 cases of brain death, 4,000 organs were viable, but only 808 were transplanted due to lack of consent. The Iranian system has been criticized as coercive, as over 70% of donors are poor. There is no short-term or long-term follow-up on the health of organ donors. There is evidence that Iranian donors experience highly negative outcomes, both in terms of health and emotional well-being. In 2023, reports from regional sources have shared details on how Iran began accepting bartered payments for organs in poor rural areas in lieu of traditional payments, in some cases even accepting goats as payment. In Iran's legal markets, the typical price paid to donors on the black market is about US$5,000, but some donors receive as little as US$1,000. In addition, black market transplants are often dangerous to both the donor and recipient, with some contracting hepatitis or HIV.
Government compensation for donors
Australia and Singapore have legal monetary compensation for living organ donors. Proponents of such initiatives say that these measures do not pay people for their organs; rather, these measures merely compensate donors for the costs associated with donating an organ. For example, Australian donors receive nine weeks' paid leave at a rate corresponding to the national minimum wage. Kidney disease advocacy organizations in both countries have expressed their support for this new initiative. Although United States federal law prohibits the sale of organs, it does permit state governments to compensate donors for travel, medical, and other incidental expenses associated with their donation. In 2004, the state of Wisconsin took advantage of this law to provide tax deductions to living donors to defray the costs of donation.
Kidney paired donations
Although all nations apart from Iran prohibit financial transactions for organs, most permit "paired donations" or kidney swaps across multiple parties. Paired donations address the problem of tissue compatibility in organ transplants. For example, person A may wish to donate a kidney to their spouse but cannot due to antibody incompatibilities. However, their kidney may be a good match for a stranger (person B) married to someone whose kidney would be compatible with person A's spouse. In a paired donation, person A would agree to donate their kidney to person B, in exchange for person B's spouse promising to donate a kidney to person A's spouse. Such paired donations are arguably a form of organ sale – instead of purchasing a kidney for a loved one with cash, a person pays for it with their own kidney. In fact, in the United States, the spread of kidney paired donations was initially stymied due to language in the National Organ Transplantation Act barring the transfer of human organs for "valuable consideration".
Illegal organ trade
According to the World Health Organization (WHO), illegal organ trade occurs when organs are removed from the body for the purpose of commercial transactions. Despite ordinances against organ sales, this practice persists, with studies estimating that anywhere from 5% to 42% of transplanted organs are illicitly purchased. Countries reported to have growing illegal organ markets include, but are not limited to Angola, Brazil, Canada, China, Colombia, Costa Rica, Egypt,Georgia, Haiti, Israel, Libya, Mexico, Peru, Philippines, Russia, South Africa, United Kingdom, and the United States. Though claims of organ trafficking are difficult to substantiate due to lack of evidence and reliable data, cases of illegal organ trade have been tried and prosecuted. The persons and entities prosecuted have included criminal gangs, hospitals, third-party organ brokers, nephrologists, and individuals attempting to sell their own organs. Poverty, corruption, and insufficiencies in legislation and enforcement drive the prevalence of the illegal organ trade. These factors also pose difficulties in tracking accurate statistics of the trade and market forces across countries. In 2023, Nigerian politician Ike Ekweremadu, his wife, and a physician were convicted and sentenced in the United Kingdom of conspiring to exploit a Nigerian man for his kidney under the UK's modern slavery laws.
Transplant tourism
The United Network for Organ Sharing defines transplant tourism as "the purchase of a transplant organ abroad that includes access to an organ while bypassing laws, rules, or processes of any or all countries involved". The term "transplant tourism" describes the commercialism that drives illegal organ trade, but not all medical tourism for organs is illegal. For example, in some cases, both the donor and the recipient of the organ travel to a country with adequate facilities to perform a legal surgery. In other cases, a recipient travels to receive the organ of a relative living abroad. Transplant tourism raises concerns because it involves the transfer of healthy organs in one direction, depleting the regions where organs are bought. This transfer typically occurs in trends: from South to North, from developing to developed nations, from females to males, and from people of color to whites. In 2007, for example, 2,500 kidneys were purchased in Pakistan, with foreign recipients making up two-thirds of the buyers. In the same year, in Canada and the United Kingdom, experts estimated that about 30 to 50 of their transplant patients illegally purchased organs abroad. The kidney is the most commonly sought-after organ in transplant tourism, with prices for the organ ranging from as little as $1,300 to as much as $150,000. Reports estimate that 75% of all illegal organ trading involves kidneys. The liver trade is also prominent in transplant tourism, with prices ranging from $4,000 to $157,000. Though livers are regenerative, making liver donations non-fatal, they are much less common due to an excruciating post-operative recovery period that deters donors. Other high-priced body parts commonly sold include corneas ($24,400) and unfertilized eggs ($12,400), while lower-priced bodily commodities include blood ($25–337), skin ($10 per square inch), and bones/ligaments ($5,465). While there is a high demand, and correspondingly a very high price, for vital organs such as hearts and lungs, transplant tourism and organ trafficking of these parts is very rare due to the sophisticated nature of the transplant surgery and the state-of-the-art facilities required for such transplants.
Global reaction
The international community has issued many ordinances and declarations against the organ trade. Examples include the World Medical Authority's 1985 denouncement of organs for commercial use; the Council of Europe's Convention on Human Rights and Biomedicine of 1997 and its 2002 Optional Protocol Concerning Transplantation of Organs and Tissues of Human Origin; and the Declaration of Istanbul on organ trafficking and transplant tourism. The Declaration of Istanbul defines transplant commercialism, organ trafficking, and transplant tourism. It condemns these practices based on violations to equity, justice, and human dignity. The declaration aims to promote ethical practices in organ transplantation and donation on an international level. It is nonbinding, but over 100 transplant organizations support its principles, including countries such as China, Israel, the Philippines, and Pakistan, which strengthened their laws against illegal organ trading after the declaration's release. The World Health Organization (WHO) has also played a prominent role in condemning the illegal organ trade. The WHO first declared organ trade illegal in 1987, stating that such a trade violates the Universal Declaration of Human Rights. It also condemns the practice on the grounds that it "is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and human trafficking." In 1991, at the 44th World Health Assembly, it approved nine guiding principles for human organ transplant. The principles clearly stated that organs cannot be the subject of financial transactions. On May 22, 2004, these guidelines were slightly amended at the 57th World Health Assembly. They are intended for the use of governments worldwide. These global initiatives have served as a helpful resource for establishing medical professional codes and a legal framework for the issue, but have not provided the sanctions required for enforcement.
China
Since the late 1980s, China relied on executed prisoners to provide the bulk of its transplanted organs. This ready source of organs made it second only to the United States for number of transplantations performed. There is evidence that the government attempted to downplay the scope of organ harvesting through confidentiality agreements and laws, such as the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Prisoners. Critics further allege that organs were not distributed on the basis of need, but rather allocated through a corrupt system or simply sold to wealthy Chinese and foreign individuals. One source estimates that China executed at least 4,000 prisoners in 2006 to supply approximately 8,000 kidneys and 3,000 livers for foreign buyers. In the 2000s, the country came under increasing international and domestic pressure to end the practice of using organs from prisoners. Since then, it has implemented a number of reforms addressing these allegations. It has developed a registry of voluntary, non-incarcerated donors; it is believed that these living and deceased donors supply most of the organs transplanted in the country today. China also standardized its organ collection process, specifying which hospitals can perform operations and establishing the legal definition of brain death. In 2007, China banned foreign transplant patients and formally outlawed the sale of organs and collecting a person's organs without their consent. Many non-profit organizations and international jurists are skeptical that China has truly reformed its organ transplant industry. In particular, although the number of organs taken from prisoners has dropped dramatically, there is no prohibition on collecting organs from deceased inmates who sign agreements purporting to donate their organs. There continue to be reports of prison officials offering death row inmates the opportunity to "voluntarily" donate their organs upon death, with the implication that those who decline may get worse treatment from their jailers. In 2019, allegations of forced organ harvesting in China were examined by the China Tribunal, an independent people’s tribunal chaired by Geoffrey Nice KC, former prosecutor at the International Criminal Tribunal for the former Yugoslavia. After assessing all available evidence, including expert medical testimony, statistical analysis of transplant data, investigative research, and witness accounts from former detainees and medical professionals, the tribunal concluded that forced organ harvesting from prisoners of conscience had been committed in China for years and on a significant scale, constituting crimes against humanity. The tribunal determined that Falun Gong practitioners had been one — and probably the principal — source of organs for China’s transplant industry. With respect to Uyghurs, the tribunal found evidence of mass detention and systematic medical testing consistent with organ profiling, and concluded that Uyghurs were at risk of being used as an organ source and constituted a likely future source of organs, while noting that there was insufficient evidence at the time of the judgment to conclude that they had been subjected to forced organ harvesting on the same scale. The tribunal further concluded that forced organ harvesting was ongoing at the time of the judgment and that no evidence had been presented to demonstrate that it had ceased. The tribunal’s findings were reported by international media and medical journals. The BMJ described the judgment as concluding that forced organ harvesting had occurred in China on a significant scale and highlighted serious ethical concerns for the global medical community. Major news organisations, including BBC News and The Guardian, also reported on the tribunal’s conclusions and findings. In August 2024, The Diplomat reported its interview with Cheng Pei Ming, the first known survivor of China's forced organ harvesting. Cheng, a Falun Gong practitioner, recounted how he was subjected to repeated blood tests and a subsequent forced surgery while imprisoned in China and later discovered during medical exams in the U.S. that segments of his liver and a portion of his lung had been surgically removed.
India
Before 1994, India had no legislation banning the sale of organs. Low costs and high availability brought in business from around the globe, and transformed India into one of the largest kidney transplant centers in the world. However, several problems began to surface. Patients were often promised payments that were much higher than what they actually received. Other patients reported that their kidneys were removed without their consent after they underwent procedures for other reasons. In 1994, the country passed the Transplantation of Human Organs Act (THOA), banning commerce in organs and promoting posthumous donation of organs. The law's primary mechanism for preventing the sale of organs was to restrict who could donate a kidney to another person. In particular, the THOA bars strangers from donating to one another; a person can only donate to a relative, spouse, or someone bound by "affection". In practice, though, people evade the law's restrictions to continue the trade in organs. Often, claims of "affection" are unfounded and the organ donor has no connection to the recipient. In many cases, the donor may not be Indian or even speak the same language as the recipient. There have also been reports of the donor marrying the recipient to circumvent THOA's prohibition.
Philippines
Although the sale of organs was not legal in the Philippines, prior to 2008 the practice was tolerated and even endorsed by the government. The Philippine Information Agency, a branch of the government, even promoted "all-inclusive" kidney transplant packages that retailed for roughly $25,000. The donors themselves often received as little as $2,000 for their kidneys. The country was a popular destination for transplant tourism. One high-ranking government official estimated that 800 kidneys were sold annually in the country prior to 2008, and the WHO listed it as one of the top five sites for transplant tourists in 2005. In March 2008, the government passed new legislation enforcing the ban on organ sales. After the crackdown on the practice, the number of transplants has decreased from 1,046 in 2007 to 511 in 2010.
United States
On September 21, 2021, 92 Republican members of the U.S. Senate and House asked the heads of multiple federal agencies to investigate organ harvesting for research purposes. The letter stated, "We are alarmed by public records obtained from the National Institutes of Health (NIH) which show that the University of Pittsburgh (Pitt) may have violated federal law by altering abortion procedures to harvest organs from babies who were old enough to live outside the womb." However, PolitiFact reported several months earlier that "There is no indication that the fetal tissues used in the [University of Pittsburgh] experiments were 'purchased'," suggesting that the congress members' later description of this research as involving organ harvesting was inaccurate.
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