The Illicit Trade of Human Organs Overview Decried as “neo-cannibalism” by leading experts in the field,101 the illicit trade in human organs reveals the dark complexities of humanity, medical ethics, and law in the global economy. The practice of human organ trafficking is fueled by increasing demand and supplied by donors coerced through force, the threat of force, or the promise of payment. Though it is primarily centered on kidneys, the human organ trade also includes the sale of livers, hearts, pancreases, lungs, corneas and human tissue. Unfortunately, voluntary organ donation remains insufficient and most countries fall dramatically short of meeting demand. A 2008 Economist article stated that, while 30,000 transplants are performed yearly in the United States, 100,000 people remain on waiting lists, “with 4,400 names being added each month.” 102 As a result of this shortage, and in spite of laws which exist in almost all countries prohibiting the sale of one’s organs, a thriving illicit organ trade has risen to supply demand.
Estimated Value of the Illicit Organ Trade
Estimated Value of the Illicit Organ Trade The kidney is the most commonly transplanted organ, with a global estimate of 68,500 transplants performed per year. This is followed by the liver (20,100), heart (5,200), lung (3,250), and pancreas (2,800).103 While there is a distinct shortage of data on the price and frequency of illegal organ transplants, experts have estimated that globally, 5 to 10 percent of kidney transplants are a result of trafficking.104 This means that illegal trafficking accounts for some 3,400 to 6,800 kidney transplants per year. The $50,000 broker’s fee plus medical and transportation expenses bring the price of each transplant to approximately $150,000, meaning the retail value of the global illicit kidney market would range from $514 million to $1 billion per year.105 With 20,100 transplants per year, the partial liver transplant is the second most common procedure. There are no estimates as to how many of these include illegally acquired partial livers, however, according to a 2009 Reuters report, “the World Health Organization estimates about 10 percent of all organ transplants worldwide involve unacceptable or illegal transplants.”106 Therefore, using 101 Scheper-Hughes, Nancy and Lawrence Cohen, “Extreme Research,” Berkeley Magazine (Summer 1999), accessed August 19, 2010, http://berkeley.edu/news/magazine/summer_99/feature_darkness_scheper.html. 102 “Organ transplants: The gap between supply and demand,” The Economist (October 9, 2008), accessed July 17, 2009, http://www. economist.com/node/12380981?story_id=12380981. 103 Dr. Luc Noel, MD. Coordinator of the Clinical Procedures team, World Health Organization (July 29, 2009). Email correspondence. 104 Caplan, Arthur, Beatriz Dominguez-Gil, Rafael Matesanz, and Carmen Prior, “Trafficking in organs tissues and cells and trafficking in human beings for the purpose of the removal of organs,” Council of Europe/United Nations Study, 2009, p. 58, accessed December 15, 2010, http://www.coe.int/t/dghl/monitoring/trafficking/docs/news/OrganTrafficking_study.pdf. 105 Interlandi, Jeneen, “Not Just Urban Legend,” Newsweek, January 10, 2009, accessed July 8, 2009,http://www.newsweek.com/ id/178873/output/print. 106 Kahn, Michael. “Study highlights need for more kidney donations,” Thomson Reuters, 18 February 2010, accessed August 18, 2010, http://www.reuters.com/article/idUSLI302791. 22 Global Financial Integrity a conservative range of 5 to 10 percent it can be estimated that a yearly range of 1,000 to 2,000 partial liver transplants involve illegally acquired livers. According to a 2007 article in the Pittsburgh Tribune-Review, a liver transplant could be purchased, “within 90 days at a South American hospital for about $100,000.”107 At this rate, the global illicit liver market would range from around $100 to $200 million. Combining these two markets, this report estimates the global retail value of the illicit organ trade at between $600 million and $1.2 billion per year. This estimate does not include estimates for heart, lung, or pancreas transplantation, for which data are insufficient.
Analyzing the Flow of Illicit Organs
As with other forms of trafficking, the illegal kidney trade generally “flows from poor, underdeveloped countries to rich, developed ones.”108 Common countries of origin for donors include China, India, the Philippines, Turkey, Egypt, Moldova, Romania, Brazil, Bolivia, and Peru. Buyers are known to come from developed countries including the United States, Canada, Japan, Italy, and Australia, as well as the wealthy classes from developing countries such as Saudi Arabia, Israel, and Oman.109 Recently China, Pakistan, and the Philippines have taken steps to prohibit ‘transplant tourism,’ which the United Network for Organ Sharing defines 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.”110 These efforts have dramatically slowed the practice of open transplant tourism, but experts believe that the practice continues as “an underground criminal activity.”111
In many ways, the illicit organ trade is the perfect criminal enterprise. When viewed from the perspective of the desperate buyer, there is a strong case to be made in favor of organ trafficking. The gap between global demand and the supply of licit organs is so vast that illicit donors will be viewed by many as heroes. Unfortunately these heroes, citizens of the world’s most impoverished communities, are more often than not motivated by their own desperation. 107 Fabregas, Luis. “Transplant ‘tourism’ questioned at medical centers in Colombia,” Pittsburgh Tribune-Review (18 February 2007), accessed July 20, 2009, http://www.pittsburghlive.com/x/pittsburghtrib/s_493727.html. 108 Scheper-Hughes. “Organs Without Borders,” Foreign Policy (January 5, 2005) p. 26, accessed August 17, 2010, http://www.foreignpolicy. com/articles/2005/01/05/organs_without_borders. 109 Ibid. 110 Budiani-Saberi, D.A. and F.L. Delmonico. “Organ Trafficking and Transplant Tourism: A Commentary on the Global Realities,” American Journal of Transplantation (2008) p. 925-929, accessed August 19, 2010, http://cofs.org/COFS-Publications/Budiani_and_DelmonicoAJT_April_2008.pdf. 111 Dr. Luc Noel, MD. Coordinator of the Clinical Procedures team, World Health Organization (29 July 2009). Email correspondence. IFF Update 23 This context, where both buyers and sellers are driven by their most basic need for survival, is primed for criminal exploitation. A middleman usually offers a donor around $5,000 for a kidney or partial liver and often ends up paying less than that. In China, for example, a 19-year-old was offered a little more than $5,000 for part of his liver. After the surgery, when he approached the middleman for payment, he was beaten and paid a mere $3,660.112 The middleman then arranges the transplant, charging the buyer approximately $150,000. This fee will usually cover travel and other expenses, after which the middleman nets around $50,000.113
Illicit Organ Trafficking and the Developing World
Organ traffickers operate in the vast chasm that exists between the world’s wealthy and the world’s poor. In developing countries, economic stagnation and deficiencies in law enforcement combine with increasing globalization and improved communications technology to create the perfect space for this criminal enterprise. The lack of economic opportunity forces people to consider options they might otherwise find dangerous or reprehensible, while inadequate law enforcement enables the traffickers to operate with little fear of being arrested or fined. At the same time, thanks to technological advancements in travel, trade, and communications, traffickers now have access to the major markets in developed countries all over the world. In essence, this allows them to buy an organ at the lowest price from the poorest donor, and sell it to the highest bidder in the richest country. Though the global shortage has fueled a debate as to whether or not organ sales should be legalized, the practice is currently banned in every country except Iran. This pushes the practice underground which can have serious economic and health-related repercussions. Economically, there is the obvious loss of government revenue due to tax evasion. Everyone from the donor to the middleman to the person performing the transplant has a strong incentive to keep the transaction under cover. Not only would taxes reduce profits, but transparency would also open the door to prosecution. In this way, as with most transnational crime, even what appears to be financial inflow to a developing country has very little impact on the official economy, and does little to spur development. The illicit organ trade can also involve serious health risks for donors and recipients alike. According to Nancy Scheper-Hughes, a leading expert on organ trafficking, “recovery from surgery is much more difficult when you don’t have clean water or decent food.”114 This is quite often the case for donors in developing countries, even if the transplant is performed in a certified hospital. For 112 Likun, Zuo. “Human organ black market exploiting poverty and hope.” The China Post, May 10, 2010, accessed August 17, 2010, http:// http://www.chinapost.com.tw/print/255889.htm. 113 Interlandi, Jeneen, “Not Just Urban Legend,” 2009. 114Ibid. 24 Global Financial Integrity the recipients, complications can involve fungal infections, compromised grafts, or tuberculosis, although these risks are probably weighed against the possibility of not getting a transplant at all.115 In short, for the developing world, there are very few redemptive aspects to the illicit organ trade. Donors are paid next-to-nothing relative to the overall trade, while the huge profits of the middlemen disappear into the shadow economy, further promoting the self interest of criminals and others who would profit from poverty and state weakness. Also, the shortage of legitimate donor organs is not only a problem for developed nations. By making human organs available to the highest bidder, traffickers prevent the poor from having access to the organs that they too so desperately need. In these ways human organ trafficking profits from and perpetuates the inequities that exist in the global economic system.
115 Osterweil, Neil, “WTC: Black Market Kidney Surgery Offers No Guarantees,” MedPage Today, July 26, 2006, accessed November 1, 2010, http://www.medpagetoday.com/Nephrology/GeneralNephrology/3814.