Here in the United States, nearly 4,000 people a year die waiting for a kidney. And while it’s illegal almost everywhere in the world to traffic in organs, there is a thriving global market. Now, a new study suggests that, not only is this gruesome crime is on the rise, but it’s also enabled and facilitated by legitimate institutions.
The stories are grim and often impossible to confirm: illicit clinics, corrupt doctors and global networks dealing in human flesh. International organ trafficking is a big business, with an estimated value of $50 million in 2008, according to the European Platform on Ethical Legal and Psychosocial Aspects of Organ Transplantation.
Although there is no internationally agreed definition, ‘organ trafficking’ is broadly defined as situations in which people are tricked into giving up organs. Some victims have been duped into believing they need an operation, during which an organ was removed without their knowledge. Others, out of financial desperation, agree to sell an organ but are not paid for as agreed.
The trade involves a network of human traffickers including mobile surgeons, brokers, patients, and sellers who meet for clandestine surgeries involving cut-throat deals that are enforced with violence, if needed. In recent years the sites of illicit transplant have expanded from Asia to the Middle East, Eastern Europe, South Africa, Central Asia, Latin America and the US.
What are your organs worth?
Many of the “kidney hunters” are former sellers, recruited by crime bosses into the tight web of transplant trafficking schemes. Sellers include poor nationals, new immigrants, global guest workers, or political and economic refugees recruited from abroad to serve the needs of wealthy transplant tourists.
How illicit organ trading becomes legitimate business
But the illicit organ trade doesn’t operate completely underground. Once organs are trafficked, mainstream health care services help to “launder” these transactions, giving them the appearance of legitimacy while hindering estimates as to how often these crimes happen — in fact, nobody knows how many organs are being traded across the world.
“If countries do nothing about this problem, the consequences for both donors and recipients can be terrible, as they may have to deal with dreadful health outcomes,” said Dr. Ana Manzano, a professor in the School of Sociology and Social Policy at the University of Leeds and lead author of the study.
The worldwide demand for donated organs and tissues has grown exponentially since the first successful corneal transplantation over a century ago in 1906. Over time, surgeons developed the ability to perform new transplant procedures, beginning with the first successful kidney operation in 1954, and quickly followed by liver, heart, pancreas, lung, intestines, hand, and in 2010, even face transplants.
As complex as these surgeries may be, acquiring organs for transplantation is the greater challenge. Nevertheless, in the United States an average of 79 people receive an organ transplant each day.
However, a deeper look at the numbers reveals telling inconsistencies. In 2013, for instance, a total of 121,272 Americans were waiting for an organ, while 28,954 people had received an organ and 14,257 others had donated one. Unless some of these donors had given up two or more organs, roughly half of the recipients — or 14,697 people — must have obtained their organs illegally.
This discrepancy in the figures speaks to Dr. Manzano’s point. According to her research, the true extent of organ trafficking is difficult to pinpoint due to organ laundering — when the illegal purchase of organs appears to be a legal transaction. Various aspects of the global organ trade help to launder the transaction:
- Trafficking is a crime that spans several countries and may involve hundreds of people in a single transaction — tracing organs is difficult.
- Countries do not agree on penalties for those who buy organs, and across the globe, there is little consistency in enforcement of organ trafficking laws.
- Status is another factor: Some surgeons perform illegal transplants because they know they will only be caught if their colleagues report them.
- Those who give away their organs are often reluctant to talk due to a fear of prosecution.
- Those who purchase organs are likely to have falsified the transaction, saying a relative donated the organ.
- Insurers play a role whenever they pay for the follow-up treatment of transplant patients.
“In effect, illicitly purchased organs are transformed into legitimate organs by the process of integration into mainstream financial institutions (reimbursement by insurers) and health services (follow-up treatment),” wrote Dr. Manzano. “Countries should follow the example of places like Spain where reporting the recipient of an organ purchased abroad is compulsory if follow-up care is requested.”
But beyond imposing regulations on transplants and post-transplant care, putting an end to the international organ trade also demands that we target the underlying factors driving the gruesome business. Poverty and corruption are fundamental themes behind sellers giving up their organs, as most donors see it as the only option to make money. The seller generally earns between $2,000 to $6,000 for a kidney, though post operation care is almost never taken into account. Unaware of all the risks involved, the donors often find themselves even worse off than before the operation, and with little or no money left to help them live. For most buyers, who have been waiting on transplant lists for months, desperate need and frustration push them to commit the illegal act.
“Unless these issues are addressed and countries work together to take firm action against the traffickers,” said Dr. Monzano, “more people who have their organs trafficked will die.”